Root Canal Treatment

Root canal treatment is the disinfection and cleaning of the root canal space and filling up of the canals to prevent re-infection.

The Cause of Toothache

A toothache is a common term for pulpitis, the inflammation of the tooth pulp, the fragile living tissue in the tooth that contains blood vessels, nerves and connective tissue. The pulp is protected from bacterial infection by the encasing tooth structure. In the presence of decay, fracture, cracks or gum disease, the pulp tissue will be inflamed resulting in pulpitis/toothache.

If pulpitis is allowed to progress, the bacterial infection will cause the pulp to degenerate and there will be an infected space within the tooth, giving rise to inflammation of the bone tissue around the tooth root.


Signs and Symptoms of Tooth Problems

The most common indicator is pain from the tooth, which is typically described as a sharp lingering pain in reaction to hot or cold, a spontaneous pain in the evening or pain when biting. More obvious signs are swelling and pus discharge from the surrounding gums. In some cases there are no symptoms and the problem can be detected only through a thorough examination.

Root Canal Treatment 

Root canal treatment can be carried out to relieve symptoms related to the infection or inflammation of the pulp. The procedure itself can be done in one or several visits. It is routinely done with the placement of a rubber cloth so that the tooth can be isolated. Several exposures for radiographs are required before, during and after the procedures to ensure that it is performed to the correct standards.

The treatment involves:
 • Drilling the tooth to gain access to the pulp
 • Cleaning and shaping the canals using small files
 • Inserting the files to confirm that the canals are thoroughly cleaned and shaped 
 • Filling the canals, usually with gutta-percha (a rubber base material) and biocompatible cement

Other situations requiring root canal treatment include dental trauma, which usually refers to fractures of the tooth structure and/or loosening of the tooth within its socket.

Related: Dental Trauma

Pain Relief for Root Canal Therapy
There are several anaesthetic procedures that can numb the tooth before root canal treatment can proceed. In some cases, the infection has caused the site to be more resistant to the anaesthetic and the clinician may need to adopt more measures to provide adequate anaesthesia.

Transient pain can occur following root canal treatment and can be adequately controlled by oral medicine. In some rare instances, there can be swelling from the tooth following root canal treatment. The clinician will need to re-examine the tooth and decide on the necessary follow-up therapy.



Taking Care of Root Canal-Treated Teeth

A tooth that is root canal-treated has a greater tendency to fracture, so patients are advised to not chew on hard foods before the tooth can be crowned or restored. Otherwise, the tooth should be maintained with brushing and flossing in the same way as the other teeth to prevent tooth decay or gum disease. 

Complications of Root Canal Treatment 

Sometimes, even when the treatment has been carried out correctly, the patient may find that the tooth is sensitive to touch. This may be the result of complications in the procedure due to unusual structure of the teeth, such as:
 • Calcification of the root canal space 
 • Very curved canals 
 • A premature tooth or tooth with a limited tooth structure that may fracture during treatment

When such complications occur, the success rate may be affected and other follow-up treatment may be required.



When Further Treatment is Necessary

Root canal treatments usually have good success rates but depend on the pre-existing condition of the tooth.

When the treatment fails, there is usually persistent inflammation of the bone and sometimes swelling and pus discharge.

Some of the reasons why root canal treatment fails are:
 • Persistent or recurrent root canal infection, which can occur even when a good root canal treatment has been performed. The assessment of re-treatment will be based on the quality of the root canal filling, the status of the disease and the nature of the signs and symptoms
 • A defective restoration that may compromise the seal of the root canal fillings from bacteria in the mouth


Redoing root canal treatment can be complex as it can be complicated by the presence of materials that are difficult to remove. 

Endodontic Treatment/Apical Treatment/Apicectomy 

This is a surgical procedure that is required when there are signs that the root canal treatment has failed. When such surgery is recommended, it may be because redoing the root canal treatment has a limited therapeutic value. Common instances where surgery is recommended include:
 • Persistent disease despite the root canal treatment 
 • Teeth with extensive restorations 
 • Exploratory purposes for teeth suspected of cracks; a crack is an incomplete fracture of a tooth 

This can be performed under local anaesthesia and will require cutting the gums to expose the inflamed or infected tissue. The affected tissue is then removed and the root is treated before the gums are stitched back.




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