Root Canal Treatment (RCT)
Root canal treatment (endodontics) is the dental procedure used to treat infection in the soft tissue at the centre and roots of a tooth.
Infection in this area is caused by bacteria that live in the mouth.
Common causes for infection can be tooth decay, broken fillings and even damage to teeth as a result of trauma.
When root canal treatment is needed.
Root canal treatment is required when the pulp has been damaged by a bacterial infection.
The pulp will begin to perish if it’s infected by bacteria, allowing the bacteria to then multiply and spread into the surrounding tissue and bone.
The symptoms of a pulp infection include:
- pain when eating or drinking hot or cold food and drink
- pain when biting or chewing
- a loose tooth
Further symptoms which can eventually occur if treatment is not carried out promptly:
- swelling of the gum near the affected tooth
- pus oozing from the affected tooth
- facial swelling
- the tooth becoming a darker colour
As the infection progresses, these symptoms often disappear as the nerve dies and the tooth no longer has the same ‘feelings’.
It is important to understand that it may appear that the tooth has healed but in reality, but the infection may have spread through the root canal system and damaged the nerve irreparably.
Leaving the infection to become established may also mean that when treatment is completed there is less chance of it being successful, and it may spread through the bone to the adjacent teeth.
Antibiotics can be used to reduce the symptoms temporarily however they will not eradicate the infection completely.
Treating the infection.
To treat the infection in the root canal, the bacteria need to be removed. This can be done by either:
- removing the bacteria from the root canal system (root canal treatment)
- removing the tooth (extraction)
However, removing the tooth isn’t usually recommended as it’s better to keep as many of your natural teeth as possible as detailed in our handout entitled, ‘The Implications of Losing a Tooth’.
How it is performed.
Root canal treatment is carried out by your dentist over two or more appointments. If the work is particularly complex, your dentist may refer you to a specialist in root canal treatment, known as an endodontist.
Preparing for treatment .
Before having root canal treatment, your dentist may take an X-rays of the affected tooth. This allows them to build up a clear picture of the root canal and assess the extent of any damage.
Root canal treatment is usually carried out under local anaesthetic, a painkilling medication that numbs a specific area of the body.
Your dentist will place a rubber sheet around the tooth to ensure it is dry during treatment. The dam also prevents you swallowing or breathing in any chemicals the dentist uses.
Your dentist will open your tooth through the biting surface to access the soft tissue at the centre of the tooth (pulp). They’ll then remove any infected pulp that remains.
Cleaning and filling the root canal
After the pulp has been removed, your dentist will clean and enlarge the root canal so it can be easily filled. The root canal is usually very narrow, which makes it difficult to fill.
Your dentist will use a series of small files to enlarge the canals and make them a regular shape so they can be filled.
This part of the treatment may take several hours to complete, and may need to be carried out over a number of visits.
If the treatment needs to be carried out over several sessions, your dentist may put a small amount of medication in the cleaned canal in between visits to kill any remaining bacteria. The tooth will then be sealed using a temporary filling.
Sealing and fixing the tooth
At your next visit, the temporary filling and medication within the tooth is removed and the root canal filling will be inserted. This, along with a filling, seals the tooth and prevents reinfection.
Root-filled teeth are more likely to become brittle and break than healthy unrestored teeth, so it is recommended that a crown is placed on the tooth to protect it.
In some cases a root-filled tooth may darken, particularly if it has died as a result of injury like a knock to the tooth. There are several ways your dentist can treat discolouration, such as whitening the tooth using chemicals.
A crown is a cap that completely covers a real tooth. It is usually necessary to use a crown after root canal treatment to prevent the tooth fracturing. Teeth which have been treated with root canal therapy can often be more susceptible to breakage due to now being ‘hollowed out’. This is why it is important to protect the investment you have made by placing a crown over the tooth to provide stability.
The size of your tooth will be reduced and the crown will be used to replace what’s removed. A mould of your tooth will be taken to ensure the crown is the right shape and size, and fits your tooth accurately.
When fitting the crown, cement will be used to glue the crown to the trimmed-down tooth.
Recovering from root canal treatment
It’s important to look after your teeth when recovering from root canal treatment. You should avoid biting on hard foods until all of your treatment is complete.
After your final treatment, your restored tooth shouldn’t be painful, although it may feel sensitive for a while after.
Over-the-counter painkillers, such as paracetamol or ibuprofen, can be used to relieve any discomfort. Return to your dentist if you continue to experience pain or swelling after using painkillers.
In most cases it’s possible to prevent the need for further root canal treatment by: