What is a root canal?
Root canal treatment is also known as endodontic procedure, is a dental procedure designed to save a severely decayed or infected tooth. When the tooth is infected or decayed, it can spread into the center of the tooth (dental pulp); all of the sensitive areas of the tooth are in the dental pulp. When this area becomes infected, it can be excruciating, requiring immediate treatment.
When Is a Root Canal Treatment Required?
Essentially when the infection that affects the tooth causes decay that surpasses the enamel and dentin, it will also eventually expose the pulp tissue and infect it. Root canal treatment can also be performed after a traumatic event or in the presence of periodontal disease.
Some of the common causes are:
- Tooth decay
- Tooth fracture
- Repeated dental procedures on the tooth
- A trauma to a tooth may cause pulp injury, even if it has no visible chips or fractures.
Signs and symptoms that indicate a root canal is needed
When a root canal treatment is needed, you will experience some signs or symptoms, some of these include:
- Acute and prolonged dental pain
- Tenderness when chewing or biting
- Pain when touched
- Face, neck or head may present swelling.
- Dental discoloration
- The presence of pus causing lousy taste and halitosis
- Swollen lymph nodes
Advantage OF Root Canal Treatment
- Root canal treatment helps maintain a natural tooth in the oral cavity.
- Eliminates dental infections and consequences such as halitosis
- Avoid mobility and displacement of adjacent teeth.
- It helps restore functionality and aesthetics with the final restoration.
- Prevents the need for more expensive dental treatments
Root Canal Procedure
First step: Diagnosis and treatment plan
To determine that a tooth needs a root canal treatment; it is essential to make an accurate diagnosis. A series of tests are needed to help establish the state of the nerve.
- X-rays: A radiographic study is necessary to see the state of the tooth in its entirety. Without an X-ray, the operator will not be able to see the inside of the tooth and, therefore, will not know the extent of the decay or fracture and if it touches the nerve and if it has affected the root.
- Vitality test: If the nerve involvement is not entirely clear on the X-ray, then a vitality test of the tooth is assessed.
The abnormal reaction to thermal changes will determine if the tooth condition requires a root canal treatment or if more conservative techniques can be performed to maintain the vitality of the affected nerve.
Second step: Root canal treatment procedure
- After determining the need for a root canal treatment, the endodontist will apply anesthesia in the tooth and surrounding tissue. Anesthesia will be used in all cases, regardless of whether the nerve is vital or not. Thanks to this, the procedure will be painless, and the patient will feel comfortable.
- Isolation: The dentist will proceed to perform absolute isolation of the affected tooth. The isolation consists of the placement of a latex rubber dam, which will be pressed by a metal clamp around the tooth. If absolute isolation is not used, it would lead to failure of treatment and tooth loss since contact with the oral cavity during treatment will prevent the absolute disinfection of the infected tooth.
Patients allergic to latex should notify the endodontic specialist who is treating them so that the dentist can take the necessary measures.
- Initial cleaning: The dentist will remove the carious tissue (if present) with special instruments, and he or she will access the dental nerve. Once the nerve is accessed, the root canals are located, to begin with, the root canal treatment.
- Working length determination: In this step, using a digital device called an apical locator, the endodontist determines the size of the tooth. In the past, this procedure was very complicated, since the endodontist only had radiographic visualization of the root apex. In some cases, it was necessary to do many radiographs to find the appropriate measure. Nowadays, this electronic device allows the dentist to achieve his/her objective without the need to carry out any radiograph. Cases where the apical locator is not indicated are very few, it will be necessary to use the old radiographic method to determine the working length.
- Root canal preparation: This preparation will be carried out using mechanized instruments, which will accomplish a much more efficient cleaning and shaping of root canals. The tools used are called files, and as their name indicates, they are instruments that allow the progressive filing of the root canal.
The objective of filing the root canals is to eliminate all of the nervous and bacterial tissue contained within the root canals. In the past, endodontists used to do this procedure in several sessions, and today, the preparation is done in a single visit, with a few exceptions.
At the same time that the canals are filed, it is necessary to rinse them with an antimicrobial solution. Irrigation will allow dragging all the remains obtained through the filing movement, towards the outside of the tooth. It will also disinfect the walls of the root canal. Correct irrigation and absolute isolation, are the critical factors for the root canal treatment’s success since its main objective is the complete disinfection of the area.
- Tooth sealing: The last step of the endodontic procedure or root canal treatment is its three-dimensional filling. The tooth will be filled with a thermoplastic material called gutta-percha, accompanied by sealant cement. This material is fully biocompatible and can be viewed in radiographs if future reviews of the treated tooth are necessary.
Your dentist may prescribe oral antibiotics to treat or prevent any infectious process after the procedure.
If the patient visits the endodontist with an infectious process that is clinically or radiographically visible (apical abscesses or pus exudate) the treatment will be carried out in a minimum of two phases, putting medication inside the canal between both visits.
After completing the root canal treatment, the tooth should be restored as soon as possible. In general, and due to the significant loss of tooth structure, with has made the root canal treatment necessary, a type of restoration that offers protection of the tooth is recommended; it may be a porcelain inlay, onlay, or prosthetic crown. The amount of lost tooth structure will determine which type of final restoration will be used.
If an inlay is possible instead of a crown, it must be the treatment of choice. This will make the treatment much more conservative, and the tooth will have a better chance to last over time. The final restoration will completely seal the endodontic treatment and protect the tooth from fracture.
- Take pain medication as recommended by your dentist.
- If your endodontist prescribes antibiotics, it is necessary to take them for the indicated length of time, even if symptoms are gone.
- If discomfort and pain are persistent, you should call your dentist immediately.
- Rinse three times a day with a special mouthwash prescribed by your endodontist.
- Visit your dental specialist for the final restoration placement.
- Proper dental hygiene
- Avoid hard, crunchy, or chewy foods.
- Wear an occlusal splint or night guard if you grind your teeth or have bruxism.
- Avoid sugary foods
- Since tooth decay can often develop into an infected root canal, it is advisable to visit the dentist every six months for routine dental check-ups and professional teeth cleaning.
Frequently Asked Questions
What are the most common signs and symptoms that may indicate the need for a root canal treatment?
Each case is different, but the most common symptoms are severe pain or hypersensitivity to cold or heat. Sometimes the patient has no symptoms, and the dentist detects the condition on a regular check-up.
What happens when the dental pulp is injured?
The nerves, capillaries, specialized cells and connective tissue are in the pulp. The dental pulp extends from the crown portion to the end of the root, which is in the jawbone.
When the nerve suffers some trauma or injury, and it is not able to regenerate, nerve cell death occurs. The most common causes of dental nerve death are tooth fracture or the presence of extensive tooth decay. Both lesions allow the entry of bacteria into the pulp chamber. Germs and bacteria will cause an infection inside the pulp chamber. If the condition is left without treatment, there will be a collection of pus at the end of the root called a dental abscess. Abscesses can damage the adjacent bone.
Is it necessary for my tooth to receive other dental treatment or special care after the endodontic treatment?
In most cases, a tooth with an indication for root canal treatment already has an advanced decay process and significant loss of structure, which increases the chances of fracture.
The final and correct restoration of the tooth must be placed as soon as the root canal treatment is completed. If the restoration is not placed immediately, bacteria could re-infect the treated area, and another root canal treatment is going to be necessary in the future.
Is there another alternative dental treatment instead of root canal treatment?
Your dentist’s priority will always be to save the natural tooth since it is always a better option than having a prosthesis, but this will not always be possible, so the only alternative would be tooth extraction and replacement with a dental implant or fixed prosthesis.
Tooth loss can have consequences on function, aesthetics, movement of the adjacent teeth and low self-esteem, so it is advisable to replace the lost tooth as soon as possible, as indicated by your dentist.
Do’s and Dont’s After a Root Canal Treatment
- Take your medication as prescribed
- Eat soft foods
- Maintain a good oral hygiene
- Maintain regular dental check-ups for your dentist to monitor the healing of your treated tooth.
- Do not eat or chew on the endodontically treated tooth until the dentist places the final restoration.
- Avoid chewing hard or crunchy foods
- Do not brush your teeth aggressively
Myths About Treatment
Myth #1: Root canal treatment is an excruciating treatment that does not guarantee predictable results.
Truth: Thanks to the materials and advanced technology that exists nowadays, the treatment is practically painless and minimally invasive.
Endodontics can and should be performed under manageable conditions and with the most superb possible comfort for the patient. Analgesics and anti-inflammatories efficiently help control pain before and after the procedure.
Endodontics is one of the dental disciplines that have evolved the most with digital workflow in the dental office. The most complex cases are becoming simpler, obtaining a very high success rate (98%), allowing the patients to keep their natural teeth longer in the oral cavity.
Myth #2: The best option is tooth extraction and dental implant placement.
Truth: The best option is always to keep the natural teeth, if possible. Not even the best implant in the world will be able to replace the function and appearance of your natural teeth identically. All specialist’s priority is to restore and maintain the natural dentition. That does not mean that a root canal is always possible. In cases of vertical fractures, insufficient support, etc. tooth extraction would be the best alternative.
Myth #3: Tooth color will be darker after root canal treatment
Truth: If the specialist in endodontics follows and respects the principles, steps and fundaments of a root canal procedure, there should be no alteration in the tooth color after the root canal treatment.
Improper procedures performed by the professional may cause darkening.
Myth #4: Root canal treatment is costly
Truth: Root canal treatment is not costly if you consider that a root canal treatment allows you to keep a natural tooth in your mouth. The prosthesis used to replace a missing tooth, fixed prostheses, or dental implants have a much higher cost than a root canal treatment and its final restoration.