This is the cleaning out of the hollow inside of the tooth and is called an Endodontic treatment by dentists.  Essentially it is the removal of all of the internal tooth contents which are blood vessels lymphatics and nerve tissue (nerve).  It involves both the mechanical clean out and chemical preparation of the canal system inside the tooth.  All teeth have different shapes and roots, therefore they all have different root canal systems.

Why do I need a root canal treatment?

The commonest cause for a root canal treatment is pain.  In some teeth, the nerves can become inflamed (swollen) or necrotic (dead).  In such situations there are only two ways to stop the pain which is either to remove the whole tooth or by remove the nerve that is causing the pain.

The tooth nerve can become infected from the following:

• Trauma

• Tooth decay

• Very worn teeth

• Gum disease

• Cracks in teeth

• Broken down old fillings

• Repeated dental treatments to a tooth

It should be noted that the mere act of performing treatment on a tooth (fillings, crowns or orthodontic treatments etc) can lead to inflammation of the nerve which may require a root canal treatment.

One of the most unfortunate causes of a root canal treatment is trauma.  A knock to a tooth may cause the nerve to die over time.  The tooth becomes grey and it can be a painless process.

Xrays of bone loss caused by abscess.

Are root canal treatments painful?

By far the commonest question asked of dentists is this one!  And we will testify that a root canal treatment is NOT painful!  

The use of local anaesthetic to make the tooth numb will prevent pain while the procedure is done.  In very rare circumstances, it can take a lot to get the tooth to go numb.  When this happens, we place special paste inside the tooth to allow the nerve to settle so that at a later appointment the treatment can be completed painlessly.  Some people do experience post operative discomfort which can easily be relieved by normal over the counter pain medication.  Root canal treatments can be a fairly lengthy process to go through, and you need to be aware that you would be committing to at least two visits to finish the treatment.  Generally it will take up to five visits to finish the root canal treatment and place a crown on the tooth for protection.  If a crown is not placed immediately, it is highly recommended to be done within the first year of a root canal treatment to prevent breakages as the tooth begins to dry out post treatment.

What can be done to prevent root canal treatment?

In some cases there is nothing that anyone can do.  Some nerves will become inflamed due to previous treatment or trauma to the tooth and will start to hurt by itself.  However, as tooth decay is the major cause of an abscess requiring treatment from an RCT, simply by having regular examinations with X-Rays (every 2 years) is the best way of avoiding the treatment.

What happens after my tooth has had a root canal treatment?

The prognosis for teeth that have had root canal treatment is very good.  Over 90% success rates have been noted in the literature.  Once the RCT is complete, the tooth is restored with a filling and in most cases a crown is placed on the tooth that has been treated.  This is particularly true of back teeth.  A crown will prevent the tooth from cracking when patients take a bite of something hard.  If this happens the tooth may have to be extracted, hence it is better to protect the tooth and your investment.

What complications can occur when I have a RCT?

Complications are low, but like any medical treatment there may be unexpected complications.  These complications can lead to additional costs for remedial treatments.  It may lead to the tooth being lost.  Unfortunately as we deal with biological entities we cannot give a guarantee, so it is best to avoid requiring the root canal treatment in the first instance.

These are some of the possible complications, it is not meant to include all complications but give a brief overview:

• The most common problem that can happen when performing a root canal treatment is breakage of the instruments used to clean out the tooth.  These instruments are called dental files.  If a file breaks in a canal that is infected, and the file can neither be removed or bypassed, there is an increased possibility the tooth could have an abscess that does not resolve and may require extraction.

• Undiscovered canals can lead to infection and failure of the root canal treatment.

• Cracks in the tooth will lead to bacteria being able to enter into the canal system causing an infection.  These cracks may not be visible and only the persistence of an infection may be what leads to the diagnosis.  Some patients may crack the tooth part the way through the treatment.

• Perforation of the tooth roots where the canals are very curved or very receded may happen.  This is where the file used to clean the canal does not negotiate the bend in the canal and can make a hole in the side of the tooth.  It is sometimes possible to fix these but in some cases it may only be possible to extract the tooth.

• Poorly fitting restorations (fillings crowns) can allow bacteria to reenter the root canals causing an infection.  It is therefore very important that the final restoration be a high quality one.

In other cases, the tooth may have ongoing tenderness that is inexplicable.  The tooth may need to be retreated at additional cost, or extracted.