The centre of each tooth consists of a chamber, called the pulp chamber. This chamber holds the blood vessels and nerves (known as pulp tissue) which keep the tooth alive and give it sensation to things like heat, cold and pressure. Pulp tissue extends from the pulp chamber down the roots and into the bone via root canals where it connects to larger nerves and blood vessels. Pulp tissue can die for a variety of reasons including bacterial attack (due to a large cavity), an irritating filling, trauma, gum disease and excessive wear and tear. As the pulp dies, dead tissue products build-up in the bone forming an abscess which can result in pain, temperature sensitivity, swelling and can keep you awake at night. The best way to resolve these issues is root canal (endodontic) treatment.
Root canal (endodontic) treatment is the process of removing the infected/dying pulp from the tooth and filling the root canals with a sealant material. The number of root canals varies from 1 to 4 and all open into the pulp chamber. During appointments, a thin latex sheet (rubber dam) is used to isolate the tooth from bacteria in the mouth. An opening is created in the tooth to access the pulp chamber and root canals. The canals are cleaned and shaped using very fine instruments (called files) manipulated by hand and drill. The files can range from 17mm-31mm in length and 0.08 to 0.80 mm (80 microns to 800 microns) in diameter.
Full treatment occurs over a number of visits (usually between 2 and 3) to ensure the removal of all debris from the root canals and allow for bone healing. Special antibiotic dressings are placed in the root canals between visits to destroy bacteria and promote bone healing. Temporary fillings are placed in the teeth to seal the internal aspects of the tooth from saliva.
When it has been determined that the canals are free of infection, they are filled with a special rubber-like material and sealant. It may take several months before healing is completed and for the tooth to become totally pain free.
Root canal treatments are successful in over 95% of completed cases. The outcome depends on a wide range of factors, but includes the skill of the dentist; the co-operation of the patient; the anatomy of the patient and access to the tooth; the health, well-being and healing capacity of the patient; the type and quantity of bacteria present in the mouth and in the root-canal system; the shape of the root canals; position and angulation of the tooth; previous restorations of the tooth and pathology associated with the tooth. You will be informed as soon as possible if difficulties are encountered.
Like all treatment there is a slim chance of an unwanted event occurring. These include:
- Fractured instruments: due to the nature of the canals and instruments, it is possible for instruments to break in the canals. If possible these instruments are retrieved and root canal treatment proceeds as normal. If the instrument is stuck permanently, then this will reduce the chances of success. Your dentist will discuss this with you further.
- Pain/discomfort: It is common to experience some slight discomfort during and following root canal treatment. This should be easily controlled with anti-inflammatory or pain relief medication. Severe pain is very rare.
- Loss of tooth: some teeth do not respond to root canal treatment and need to be extracted.
- Infection: it is possible for bacteria to persist in the bone following root canal treatment for a number of reasons. These include exceptionally virulent/strong bacteria and insufficient healing capacity of the patient. This may result in the need for extraction
- Discolouration: it is common for root canal treated teeth to darken overtime due to the materials used during treatment. This is often a cosmetic issue which can be individually dealt with.
- Altered feeling: it is common to experience varied sensations from a tooth during and following root canal treatment. This generally returns to normal.
An endodontist is a root canal treatment specialist. You may need referral to an endodontist if your treatment is too difficult for us to handle or if unexpected events occur during or after treatment. The fees for the endodontist are separate to ours.
Following obturation (filling) of the root-canal system it is common to experience mild discomfort for up to 10 days however in rare cases this can persist much longer. This can be controlled with anti-inflammatory medication. Any increase in pain after the first few days is uncommon and must be reported as antibiotics may be required.
What’s included in the cost?
The cost of root canal treatment includes the following:
- All radiographs
- the initial diagnostic radiographs
- working and measurement radiographs
- radiographs of the completed root canal treatment
- All necessary anaesthesia (local) to “numb” the tooth
- Access into the tooth
- Removal of the nerve tissue
- Cleaning and shaping of the canals
- Irrigation of the canals with medicated solutions
- Placement of medicated dressings where needed
- Filling the canals with root canal filling materials
- A temporary filling in the access opening between appointments or at completion of the root canal
- Any emergency visits necessary during treatment of the root canal for the tooth being treated
Restoration of the tooth
Before commencing with root canal treatment it is important to give some thought to the final restoration that will be placed on the tooth. Teeth are weakened following root canal treatment and although a conventional restoration (filling) can restore the tooth in the short to medium term, a long term solution will require a stronger restoration such as a crown or inlay/onlay. Crowns are hard porcelain coverings which cover the tooth similar to the way a helmet covers a person’s head.
Crowns are extremely strong and are the longest lasting restoration a person can have. Please note that the cost of the final filling in the tooth, regardless of whether it is a crown, onlay or normal filling has a separate cost associated with it.
There is only one real alternative to root canal therapy and that involves extraction of the tooth, but will obviously create a gap. There are three issues associated with a gap:
- Tipping of the adjacent teeth: the teeth either side of the gap will tilt into the space to reduce it but not close it. This results in a food trap which can lead to cavities forming in the surrounding teeth if they are not flossed regularly. It also causes the bite plane to change which can cause overloading of the jaw joint.
- Over-eruption of the opposing teeth: the teeth that opposed the missing tooth will begin to move further out of the gum. This alters the bite plane which leads to overloading of the jaw joint.
- Aesthetic problems.
There are three main options for replacing a missing tooth:
- Dental implant: this consists of a titanium screw which supports a porcelain crown. This is the best option to replace a missing tooth.
- Porcelain bridge: this option involves using the two adjacent teeth as supporting pillars and placing porcelain tooth in the gap.
- Removable denture: this involves using an acrylic or metal-based plate to replace one or more missing teeth.
If you have any questions about Root canal treatment or would like more information please don’t hesitate to ask. Phone (07) 5576 4900