If you are a dentist at a party quite often you will get quizzed about the different types of dental procedures. So in this article, we seek to clarify – What is a root canal in dentistry?
Root canal treatment is aimed at removing infected and painful tissue within the tooth to avoid having the entire tooth removed. A root canal does not remove the roots of the tooth, as one of the goals is to preserve sound tooth structure best as possible. By performing a root canal treatment it is also critical that the tooth is able to be restored or rebuilt in order to help keep it for as long as possible. Antibiotic tablets are not effective at removing infections within teeth, so are not a useful alternative to root canal treatment.
Before we get into too much detail, it is important to have an understanding of the anatomy of your teeth. The outer shell of the tooth or enamel, can be breached by decay, wear or accidental damage. If the breach extends through the dentine layer and reaches the pulp (nerves and blood vessels) then it is highly likely the tissue will become infected which can result in pain or abscess.
Bacteria from our mouths enter the root canal and spread through the inside of the tooth and eventually can reach the jaw bone by travelling through a hole in the root tip. The root canal treatment process is directed at removing all of the tissue within the tooth and removing the bacteria. If bacteria and nerve tissue can be successfully removed, the pain and infection will resolve.
So how is it done?
The first step of a root canal treatment is to have the tooth assessed to see if it has a good chance of long term durability. Some teeth are too badly damaged to be able to be made strong enough. Your dentist also needs to explain the costs, number of appointments and likely success rates, and what other steps are required to rebuild your tooth once the root canal part of the process is complete. What is important to understand, is that removing, or extracting the entire tooth is also an option in lieu of proceeding with root canal.
For the vast majority of procedures, the dentist is able to perform the treatment painlessly. Modern local anesthetic products and techniques are reliable and effective. In some scenarios, additional anesthetic, alternative injection sites or waiting longer for them to take effect are typically sufficient to remove any pain or discomfort. Rare scenarios of extreme swelling of infection can present challenges when it comes to achieving profound pain relief, however, dentists can typically work around these issues.
Once the local anaesthetic is working, the dentist will place a plastic drape called a rubber dam over the tooth to be worked on. This provides a barrier to stop saliva contaminating the inside of the tooth and also stops any of the unpleasant tasting disinfecting solutions contacting the tongue or other areas.
Removing tooth decay and accessing the nerve tissue required special instruments and techniques to locate, clean and ultimately disinfect the inside of the tooth. A combination of cleaning solutions is also necessary during root canal treatment to help achieve a successful outcome. The shape and makeup of the inside of a tooth can vary. Some teeth have multiple roots and even more branches of nerve tissue while some have just one. Dentists use a combination of their knowledge, X rays and other scans to find and treat the canals.
In most cases, root canal treatment is completed over 2-3 visits. Once the nerve tissue is cleaned out, an antibiotic paste is left inside the tooth for several weeks to better improve the chances of disinfection. The procedure is completed when the inside of the tooth is sealed and a permanent filling is placed over the tooth.
In some cases, it is recommended that the tooth is strengthened with a crown after a root canal treatment has been completed. This not only protects a weakened tooth from breaking but is a well-proven way of improving the seal and prolonging its life.
Do root canals always work?
In over 90% of cases, root canal treatment results in success, meaning that the tooth remains free from pain and infection for over 10 years and in many cases much longer. Of course this does mean that some root canals do not work, which frustratingly means that the tooth needs to be extracted. Your dentist can assess and provide a good estimate of how likely you are to have successful treatment. In some cases, it is possible to refer the patient to a dental specialist known as an endodontist for more challenging cases. Endodontists undergo extensive university masters training and devote their careers to this particular procedure.
It is important to make an informed decision about what dental procedures you undertake, and their likely outcomes. Most dentists will agree that a solid tooth with a good long term prognosis will be preferable over an implant, bridge or denture as a first option.