For many people, the phrase root canal is not something that evokes the same sort of emotion as puppy dogs or beach sunsets. Much of this unpleasant reaction can be born out of hearing other people’s tales, or perhaps a misunderstanding of what it is, and why a root canal is needed.
Most dentists would agree that nothing we do to replace missing teeth is as good as the original. So, what if you have a tooth that is heavily damaged, sore or infected and you are faced with a choice. Do I have my tooth removed or do I have a root canal and try to keep it?
Firstly, let’s explain a little bit about the anatomy of the tooth
The part of the tooth you see in your own mouth is what dentists refer to as the crown. This is what pokes through into the gum. The outer layer is white enamel. For those who like trivia, it is also the hardest substance in the human body. However, it is not indestructible.
This outer protective ENAMEL shield is susceptible to decay and to cracking. And once this layer and the under the layer of DENTINE are breached, there is a pathway for the bacteria that live in our mouths to progress to the NERVE or PULP of the tooth and cause infection.
The nerve sits in the centre of the tooth and extends down into the roots. The term “root canal treatment” refers to the removal of nerve tissue from within the roots of the tooth and the disinfection of the canals to remove bacteria.
Bacteria are almost always the cause of pain and infection of the nerve of the tooth. Infections of the nerve result in swelling inside the tooth. The pressure, plus chemicals produced by bacteria and the body can cause extraordinary pain known as pulpitis or “tooth ache”.
Toothache can be very debilitating. Some of the early signs are an increase in sensitivity to temperature changes. Hot or cold drinks or food can trigger a nasty response that can hang around for several minutes. This is different from simple tooth sensitivity which is usually less intense and fades as soon as the stimulus is removed. A severe toothache can often wake you in the middle of the night. In many cases, it can be relieved by over the counter pain killers such as paracetamol (Panadol) or ibuprofen (nurofen). However, these are not a cure for the underlying infection. Teeth can also become painful to biting pressure, or very sore to touch.
Additionally, taking antibiotic tablets are not effective in treating toothache and removing the underlying cause as they simply cannot reach the source of the infection appropriately.
Another less obvious sign of an infected tooth may be the slow development of a cyst or an abscess. In many situations the infection of the nerve causes it to die slowly, often without acute pain. The root canal system becomes overrun with bacteria, pus and the by-products of the dying nerve. These then start to spread outside the tip of the tooth into the surrounding jaw bone. Sometimes this is very painful, sometimes it is not, however, a certain type of dental x-ray is able to detect the presence of this infection. The severity and progress or development of the infection are highly variable, however, the removal of infection is important.
A tooth accurately diagnosed by your dentist to have an infected nerve or an abscess requires treatment to remove that infection.
If your dentist feels that the tooth is repairable or stable enough to last a reasonably long time, they may suggest a root canal treatment.
As mentioned, a root canal treatment removes the painful nerve tissue from WITHIN the tooth and its root and disinfects it. The aim of this is to preserve the natural tooth so it can be rebuilt and restored.
So how is it done?
It all starts with great pain management. The majority of these procedures are done completely pain – free. Current local anaesthetic products and techniques are highly effective, and it is very rare to have a situation where the process will be uncomfortable.
The process involves removing any decayed or damaged tooth structure and accessing the nerve tissue from above.
As mentioned, the aim is to remove the infected tissue within the root system of the tooth. This is done with a combination of highly specialised instruments and irrigating solutions. It is essential to have x-rays during the treatment to aid in locating all of the nerve tissue.
In most circumstances, the process is completed over 2 or 3 visits. This allows placement of an antibiotic paste into the tooth that better assists with disinfection and long term success.
Success rates for root canals are very good. General dentists typically achieve 85-95% long term success which means a period of over 10 years with no pain or returning infection. This is assisted in many cases by adding a crown to the tooth which improves the seal and longevity of the tooth. There are also Endodontists, which are dentists who undergo extensive study and training to devote their entire practice to performing root canal treatment.