All of us will undergo Root Canal Treatment sooner or later during our life, so it is better to know basic information and tips about this type of dental treatment.
In fact, root canal treatment is a dental procedure in the endodontic field of dentistry, which is performed to treat the infection of the tooth pulp.
In order to better understand root canal treatment, It is important to basically know the structure of the tooth first.
Tooth structure
The tooth consists of two parts, the crown and the root. The crown is the white part of the tooth that you can see above the gums and you know it as a tooth. and the root is the part of the tooth beneath the crown that is embedded in the gums and jawbone to keep the crown stable.
All teeth are composed of four dental tissues:
Three of the layers are enamel, dentin and cementum are hard tissues and the fourth part where is pulp or the center of the tooth, contains nerves, blood vessels and connective tissue is the soft tissue.
From the outside to the inside:
Enamel
The white layer which is a hard calcified tissue and completely covers the crown of tooth to protect the inside parts of the tooth that are more vulnerable to bacteria, acidic foods, and temperature extremes. Enamel is the hardest substance in the human body.
Dentin
Dentin is the layer beneath enamel and cementum, which is yellow in color. When dentin loses its protective covering (enamel), dentin will be exposed to the mouth, especially in those who grind their teeth and clench their teeth together, dentin may be visible on the biting surface of their teeth. Dentin is softer and much weaker than enamel.
Pulp chamber
It is the space in the center of the tooth, where is occupied by the pulp containing nerves and blood vessels and connective tissues that nourish the tooth. The pulp is the only part of the tooth that contains living cells. When the pulp of the tooth gets infected, this diseased tissue (pulp) must thoroughly be removed and cleaned and the pulp chamber and root canals are filled and sealed with special materials. We call this root canal treatment.
When root canal treatment is needed ?
Root canal treatment is performed in cases where the pulp has been irreversibly damaged by infection or inflammation and there is no other choice but to remove and clean it and fill it with special fillers. The cause of pulp damage is usually one of the following:
- Breaking a tooth during an accident such as an crashes, falling, or playing.
- Deep tooth decay that has been left untreated and bacteria has entered the pulp which leads to pulp necrosis. (pulp necrosis is when the pulp tissue inside of your tooth dies)
- Leaking old or improper fillings that have caused decay to develop underneath.
If you experience any symptoms such as toothache or swollen gums or anything else that is unusual, see your dentist to check the condition of your teeth. Also, visit your dentist regularly to check the old tooth fillings so that if they start to separate or crack away from the tooth, they should be replaced as soon as possible to avoid root canal treatment.
The symptoms of dental pulp infection are as follows:
- Pain when eating or drinking, especially when the temperature is very cold or hot.
- Pain when biting down or chewing.
- loose teeth
Is root canal treatment still necessary even If Your Toothache Goes Away!?
Note that as the infection progresses, these symptoms may disappear because the pulp is necrotic and the dead nerves no longer send messages. You may think your tooth is healed, but the infection has actually spread. Finally, the following symptoms may appear:
- Return of pain when chewing
- Swelling of the gums around the affected tooth
- Purulent discharge from the teeth (dental abscess or pus)
- facial swelling
- Darkening of tooth color
Note that if you have a toothache, you must check it. An infected tooth will not heal on its own. If you leave the tooth untreated, its condition worsens and the adjacent teeth and bone are also at risk. If the infection becomes widespread and severe , the chance of success of root canal treatment decreases.
Root canal treatment steps
In order to treat a dental pulp infection, bacteria and infected tissue must be removed. If you don’t treat the tooth in time, you will have to extract the tooth. Since dental implant that replace teeth may cost you more money, and nothing is like your natural tooth, it is better to save your natural teeth as much as possible.
- To start the procedure of root canal treatment, the tooth is first numbed by local anesthesia.
- Your dentist then use a drill to open your tooth through the crown in order to access the pulp chamber.
- With the help of special dental tools such as drill and file, the entire infected pulp is removed and the pulp chamber is emptied and cleaned .
- The walls of the pulp chamber and the root canals, especially the tip of them, must be entirely shaved and cleaned.
- After the pulp chamber and root canals are all cleaned up, it is time to fill them. With special filling materials, your dentist carefully fills and seals the entire pulp chamber and root canals so that there is no way for bacteria to penetrate.
- At last, in most cases the tooth should be built up. Dental crowns are tooth-shaped “caps” that can be placed over the tooth and covers it. In this way, there is no need to worry about sharp pressure on the actual crown of the tooth and the risk of breakage is reduced.
Why would a root canal need to be repeated?
It is possible that the tooth does not heal as expected and infection returns and the root canal treatment fails. In these circumstances, you may need a procedure called endodontic re-treatment despite the initial root canal treatment.
The usual factors which can be attributed to endodontic failure are one of the following:
- The extremely narrow and curved root canals make it difficult to access leading in not properly being cleaned and treated
in the initial treatment. - Complexity of the Root Canal Morphology and Anatomy, such as an accessory (also known as extra or additional) root canal, has not been identified in the initial inspection and treatment.
- Postponing the Restoration of the root canal treated tooth with either crown or composite buildup which results in re-penetrating the bacteria.
- The restoration of the root canal treated tooth is not sealed enough to prevent crown and root canals from leaking bacteria leading in, infection keeps coming back.
It is still possible for the tooth that has a perfect root canal treatment failed to heal or develops new problems. The reasons are as mentioned below:
- New caries apears
- Breaking, cracking, or loosening of the tooth crown or filling (which was supposed to prevent the penetration of acidic foods and bacteria, but failed to do so.)
- Tooth breakage
- In this figure, the canal of the root of the tooth is shown. In the picture below, you can see that the root of the tooth has a secondary canal that may not be found during root canal treatment and may not be treated. As a result, the treatment fails.
What is the accessory root canal?
The accessory canal is a part of the complex anatomy of the tooth root canal that may be dismissed by the dentist during root canal treatment. The root system of the tooth, which contains fine vessels, nerves and connective tissues, is very complex and precise.
This root system, like the roots of plants, may have small branches that separate from the main channel. These different root branches are usually located in the areas where the roots of multi-rooted teeth join together or are located around the distal third of the root, however, they may exist anywhere else along the main root canal.
Sometimes it is very difficult to spot the accessory or extra root canal and to clean and fill it. In cases which some infected tissue remains untreated inside the tooth, it can be the source of re-infection.
Therefore, diagnosis and treatment of the root canal is very important in the success rate of the root canal treatment.
Frequently asked questions about root canal treatment
Some of the frequently asked questions are as follows:
Does root canal tretment hurt?
Despite the fact that root canal treatment may seem frightening, the experience is similar to a deep filling. You will not feel any pain during root canal treatment because the tooth is numbed under local anesthesia. You would also take painkillers if needed. This pain is controlled with common pain killers such as acetaminophen or ibuprofen.
Antibiotic use before endodontic treatment (Preoperative antibiotic prophylaxis) was shown to be ineffective, but use after endodontic treatment was effective in reducing the flare-up rate in asymptomatic non-vital teeth.
According to a review of 72 other studies conducted on patients undergoing root canal treatment, it was found that the pain before the treatment was high in these people, but within a day after the treatment, it decreased to an average level and within a week After the treatment, it significantly subsided and became minimal.
Can you have root canal treatment while pregnant ?
If you are pregnant, it is recommended not to do any non-urgent treatments (such as cosmetic dental treatments) but necessary dental treatments can be done safely during pregnancy. Root canal treatment is a treatment that should not be left untreated at any stage of pregnancy. However, due to the need for X-rays, it is recommended to do this in the second trimester of pregnancy.
Is it possible to postpone tretment of dental problems during quarantine (due to corona disease)?
For urgent dental treatments, you must see a dentist as soon as possible. Among the things that need to be referred are:
- Swelling of the gums, cheek, or face that has spread to the neck, eyes, or floor of the mouth.
- Severe pain that makes you lose sleep or concentration.
- A mouth ulcer that has not healed after two weeks.
- Bleeding more than 20 minutes after tooth extraction that does not stop even with firm pressure of the jaw on the dressing.
- A broken tooth that caused pain or possible injury to the cheek or tongue.
- Tooth falling
- Bleeding due to facial injury
What is the difference between root canal treatment of front teeth and wisdom teeth or large molars?
For root canal treatment, the dentist needs to drill through a crown so that can access the pulp chamber. For the front teeth, this drilling is often performed on the back surface of the tooth, but for the posterior teeth, drilling is mostly performed on their upper surface, that is, the surface of the tooth where we bite on it.
After the treatment finishes, the access cavity created on front teeth is closed with tooth filling material. Temporary materials are usually used until the crown is prepared and placed on the tooth. However, sometimes crowns are not necessary for the front teeth because there is not much pressure on these teeth. But for back teeth that are under insurmountable constant pressure, a crown is often needed to prevent the tooth from breaking and chipping.
In order to cover the front tooth that its root canals have been treated, the aesthetic criteria must be met, because its color difference with other teeth can affect the beauty of the smile. Even when the veneer is chosen exactly the same color as the adjacent teeth, due to the gradual discoloration of the teeth that have undergone root canal treatment and the resistance of the veneer to color change, Root canal teeth will not blend naturally with the rest of your teeth. They tend to look darker and duller than natural, untreated teeth. In this case, this problem can be solved with whitening the teeth.
Another significant difference between root canal treatment of the front and back teeth is the number of their roots. Front teeth have fewer roots (usually have a single root containing 1 root canal). Usually, small molars or premolars and back teeth have two or three roots, each containing one or two root canals. The more roots a tooth has, the longer the treatment will take to complete. The treatment may not be completed in one session and several sessions may be required to complete the treatment procedure.
How long does a root canal treated tooth last?
For root canal treatments due to the dental decay and pulp infection, the pulp of the tooth is removed and its pulp chamber and root canals are filled with materials. As the structure of this tooth is damaged, it becomes weaker than other healthy teeth, therefore, no matter how much it is treated, it still has a shorter life span than other teeth. A tooth can last between 10 to 15 years after undergoing a root canal treatment. That said, it is worth mentioning that you can strengthen your tooth that had a root canal by using dental caps or other methods.
What is the success rate of root canal therapy?
Root canal therapy has a high success rate, typically around 85-95%. However, success can vary depending on various factors such as the tooth’s condition, the expertise of the dentist performing the procedure, the patient’s overall oral health, and how well the tooth is cared for after the treatment. In cases where the tooth is severely damaged or has complex root structures, the success rate might differ. It’s essential to follow post-treatment care instructions provided by the dentist to increase the likelihood of a successful outcome.
Root Canal Challenges: Retreatment and Surgery
The field of endodontics, which deals with the intricate inner workings of our teeth, often encounters challenges due to complicated canal anatomy. Each tooth has a network of tiny canals that house the dental pulp, nerves, and blood vessels. These structures can take on numerous forms and configurations, making the work of endodontists all the more challenging. When a root canal treatment isn’t successful, or a tooth’s anatomy is too intricate to navigate during the initial procedure, endodontic retreatment and surgery may become necessary.
Endodontic retreatment is a complex procedure aimed at correcting the issues that persisted or emerged after an initial root canal treatment. Sometimes, despite the best efforts of the dentist, certain areas of the root canal system remain infected or the treated tooth fails to heal as expected. In such cases, endodontic retreatment is the answer. It involves reopening the tooth, removing any prior filling materials, cleaning, and disinfecting the canals, and then refilling them to promote healing. This process can be particularly challenging when complicated canal anatomy is involved.
In cases where the retreatment also proves ineffective or the anatomy of the canals is just too intricate, endodontic surgery may be the next step. This involves a surgical procedure to expose the root canal tips and address the issues directly. Endodontic surgery can be a last resort to save a tooth that might otherwise need extraction. During this procedure, the endodontist makes a small incision in the gum, gains access to the root tips, and either removes infected tissue, repairs damaged root tips, or seals any cracks or openings in the tooth. It’s a delicate and precise operation that requires expertise, especially when dealing with complicated canal anatomy.
The recovery period following endodontic surgery can take several months or even years, depending on the severity of the problem and the patient’s overall health. During this time, the body’s natural healing processes come into play. The tissues around the tooth gradually heal, and new bone forms in the surgical area. The success of the procedure ultimately hinges on whether the tooth can heal as expected. For some patients, it might be a matter of months before they experience relief from pain and discomfort, while for others, the process can extend into years.
