Endodontics

Root canal treatment

Dentists agree that it is always better to keep your natural dentition because, in case of extraction, the other teeth’s alignment is affected, leading to jaw problems and gum diseases. A successful root canal treatment can allow you to keep your teeth, without the need to get dental implant surgery, or a bridge installed.

What is a root canal treatment?

Teeth are made of three hard layers:

• the enamel;
• the dentine;
• the cement.

The space protected by these layers is called the root canal. It is filled with dental pulp, a soft tissue made up of terminal blood vessels and nerves that contribute to the tooth’s development. Once a tooth is fully grown, it can survive without its pulp, but if it is infected, it must be taken out. The procedure is called a root canal treatment, or an endodontics therapy.

When do I need to undergo root canal treatment?

Dental pulp can be damaged by an enamel fissure, a deep cavity or an accident. In all of the instances, bacteria can infiltrate the tooth and infect the pulp, which causes pain and inflammation. Sometimes, pulp can get infected or die without any pain. Your dentist can notice changes:

• in the colour of your teeth;
• in the appearance of your gums;
• in your jawbone or in the tooth’s root, with the signs apparent on an X-ray image.

Sometimes, when a tooth is badly damaged, your dentist can conclude after an exam and assessing x-ray images that the dental pulp will not survive.

In all cases, a root canal treatment can reduce, and sometimes prevent, symptoms from occurring and thus saving the tooth.

The root canal treatment and your dentist

During a regular dental check-up, your dentist will make sure that none of your teeth are infected or damaged, even if they all seem healthy to you. If he notices that you need a root canal treatment, your dentist can either do it himself, or recommend you to an endodontist. He can also refer you to a specialized dentist if your child’s primary tooth (milk tooth) has been damaged.

Do not wait until it is painful. Talk to your dentist as soon as you notice an issue, such as tooth decay, a defective filling, or if you injure a tooth. The faster you take care of it, the better chances you have of alleviating pain and saving your tooth.

The procedure

• A member of the dental team places a dam around the tooth to protect it from the bacteria contained in the saliva throughout the treatment.
• Your dentist may proceed with local anesthesia if he judges that there is a risk of pain.
• Your dentist makes an opening in the tooth to access the root canal and the damaged pulp.
• The pulp tissue is removed and the root canal is enlarged and cleaned with precision tools.
• The root canal is then filled with a rubber-like material called gutta-percha.
• Finally, a temporary or permanent filling is applied to the opening in the tooth.

What you should consider

A root canal treatment can be completed in one visit, or over the course of several appointments, depending on the complexity of the root canal’s anatomy and the extent of the damage to the pulp. In some cases, the infection has spread from the tooth to the bone, creating an abscess. The infection must be drained before the root canal is filled.

Sensitivity can be felt one or two weeks after the treatment. You should not feel any intense pain or inflammation. If it is your case, contact your dentist immediately.

In order for your tooth to look as much as possible like a natural tooth, the treatment necessitates the placement of fillings or a crown. The restorative method will depend on the stability of what remains of the tooth. A posterior tooth will probably need a crown because a lot of pressure is applied on these teeth during mastication. If a lot of pulp was removed, a post may be necessary to hold the crown in place. A discoloured tooth can either be whitened or covered with a crown or a veneer.

Second treatment and root canal surgery

While root canal therapy is generally successfully completed in one treatment, a second is sometimes necessary. In this case, the filling is removed and the root canal is once again cleaned, prepared and filled.

Dentists or endodontists may decide to go with surgery if a conventional root canal treatment cannot be undertaken or was unsuccessful.

Surgery is necessary to:

• Examine the tip of the root canal to make sure that there is no fissure (or fracture);
• Remove the sections of the root canal that could not be cleaned during the initial treatment;
• Get rid of an infection that has not healed after the conventional treatment.

Who will conduct the surgery or second treatment? During their studies, every dentist learns how to do undertake a root canal treatment. However, in some complex surgical situations, your dentist could refer you to an endodontist. Most of the time, a tooth undergoing endodontic therapy can be saved, but it sometimes fails and the only solution remaining is extraction.