Root Canal Treatment

Know more about Root Canal Treatment

Root canal treatment is done to treat the infection or inflammation of the pulp or the Root canal space. It is best summarized as the disinfection and cleaning of the root canal space and filling up the canals to prevent re-infection. The procedure itself can be done in one visit or over several sittings. The choice of the number of sittings depends on the status of the infection. Several x-rays are required before, during, and after the procedure to ensure that the root canal treatment is performed in accordance to standards.

The root canal treatment is started off with adequate anesthesia. For a painful tooth, usually the achievement of anesthesia can be more challenging. Experienced endodontists or root canal specialists will explain what it is needed for proper anesthesia.

Then there would be placement of a rubber cloth so that the tooth can be isolated from the tongue, cheeks, lips and the saliva.

This would follow up with an access opening into the root canal space of the tooth by using rotary burs. After there is an access to the root canals, there would be cleaning and shaping of the canals using small files. Copious irrigation with a disinfecting solution would be done concurrently. After the canals were adequately cleaned and shaped, the canals are filled up with a filling material that is usually gutta percha (a rubbery material) and biocompatible cement.

The tooth will then need a final restoration. It serves as a final seal over the tooth to prevent root canals from infection/reinfection. For posterior teeth, a full coverage restoration such as a crown will be required to prevent the tooth from fracturing.

Insertion of the files to confirm that the canals were cleaned and shaped along the whole length of the canals

Radiograph of root canals with root canal fillings

Signs and symptoms that indicate the need for root canal treatment

There would be preceding signs before root canal infection or toothache. These can be large decay, fracture or severe gum disease.

Another indicator would be the presence of pain. As mentioned earlier, toothache is a result of pulpitis (inflammation of the pulp). In the mild form of pulpitis the tooth may present as very sensitive tooth to cold temperature (eg. cold drinks). There is substantial chance that this may heal and the pain will subside with appropriate and timely treatment.

In more severe form of pulpitis, the tooth can be painful to thermal changes and the pain can linger up to several minutes. There can be spontaneous or sudden pain in the evening which can cause disruption of sleep.

Once there is infection of the root canal space, sometimes obvious signs will emerge. These can be swelling and sometimes there will be pus discharge from the surrounding gums.

Not all cases presented with signs and symptoms that can be observed by patients themselves. A dentist/dental surgeon or an endodontitst (root canal specialist) will be the best person to make the best judgement.

Complications that can arise from root canal treatment

Most of the complications are limited to the well-being of the tooth or its supporting structures. Some of the common complications are listed below.

  1. Sometimes after completion of root canal treatment, despite root canal treatment being appropriately performed and with no signs of infection or inflammation, the patient may feel that the tooth may not be as it used to be eg. Feels sensitive on biting or touched.
  2. There are aberrations of the tooth anatomy that result in higher chance of procedural complications. To name a few:
    • Calcification of the root canal can render the root canal space undetectable or too small for ease of cleaning. Without the root canal space being properly cleaned, persistent infection of root canal space may occur.
    • Curved canals can cause higher chance of instrument fracture which may render further cleaning of the canals impossible
    • Premature tooth or tooth with limited tooth structure may fracture during treatment.

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

Curved and long canals shown in the radiograph can cause procedural errors

Calcification causing narrow canals can increase the chance of procedure errors

Complications to a patient’s general health due to root canal treatment are rare. If these complications do arise, it is usually due to the patient’s pre-existing medical condition. If he/she is allergic to certain medications or materials, or has any health condition that requires special care, the dentist or endodontist should be informed before the start of the treatment.

Courtesy from Society of Endodontists, Singapore website for the radiographs