Root canal (Endodontics)
Tooth pain does not necessarily have to be because of a root canal. You can experience pain even if the nerve of the tooth is dead (to learn more, see pulp damage). Quite often, the symptoms are obvious, and a “root canal treatment” (root filling) where we remove inflammation/infection is the best treatment. Simply put, we gently remove the soft tissue inside the tooth (the pulp), clean it and seal it. Today, this can be done without any pain. However, we always try to save the pulp in order to not perform a root filling.
There are four different scenarios depending how extent of the damage:
- Pulp inflammation with a chance for recovery
- Pulp inflammation with no chance for recovery
- Pulp partially or fully infected with bacteria
- Already root filled teeth with problems
Pulp inflammation with a chance for recovery
If possible we always begin by removing the trauma (eg caries) to the pulp in order to save the pulp.
Above is a schematic example of a healthy tooth (left) and one with a caries lesion (right) filled with bacteria that irritates the pulp. The tooth is very sensitive, especially to cold. This inflammation will create pressure inside the pulp chamber, making the nerve even more sensitive. A quick way to alleviate the pain is to remove the pulp and do a root filling. But this would be very destructive to the tooth and require even more root canal treatments. In many cases, when most of the caries is removed and, more importantly, the cavity is sealed from the mouth with a tight temporary filling, the pulp relaxes and the inflammation disappears. After a while (usually two months) we check the tooth to see if we have managed to save the pulp tissue. This also saves you the cost of a root filling. In some cases, however, the inflammation spreads causing pain, making it necessary for a root canal treatment.
Pulp inflammation with no chance for recovery
When the symptoms are more severe and/or when we can diagnose an irreversibly damaged pulp, the two options are to remove the tooth or try to save it with a root canal treatment. The root canal treatment is similar to the treatment for an infected tooth, but generally has a little bit better prognosis and can sometimes be done a bit faster.
Depending on the case, we always inform you about the prognosis and the alternatives.
Pulp partially or fully infected with bacteria
When bacteria gets into the pulp (eg: above via a caries lesion) the infection spreads down the root canals and even comes in close contact to the bone. Common symptoms at this stage are tenderness to touch and chewing, discolouration of the tooth, and swelling, drainage and tenderness in the lymph nodes, as well as nearby bone and gum tissues. Sometimes, however, there are no symptoms. When treating this, we remove the diseased and dead pulp tissue from the tooth with specially designed instruments used to clean out the root canals and pulp chamber (at Snö we always use new instruments).
This stage is not painful; the area is numb and the tissue being removed is either dead or dying. Once the pulp, along with the nerves contained in it, is removed, the tooth itself can no longer feel pain. If there is an infection outside the root, it can cause some pain, but usually disappears. In difficult cases, we leave a special paste inside the tooth to fight the bacteria. In other cases we do the filling of the tooth in the same session.
Root canal fillings are selected to exactly fit into the freshly prepared canals. Usually, a rubber-like material called gutta-percha is used to fill the canal space. It is a thermoplastic material (“thermo” – heat; “plastic” – to shape), which is heated and then compressed into and against the walls of the root canals to seal them. Together with an adhesive cement called a sealer, the gutta-percha fills the prepared canal space. Sealing the canals is critically important to prevent them from becoming reinfected with bacteria. When the infection is gone, the bone will heal (right) into the cavity it created during the infection.
Your tooth will then need a permanent restoration — a filling or a crown — to replace lost tooth structure, and provide a complete seal to the top of the tooth. This step is particularly important.
Already root filled teeth with problems
The prognosis of a root canal treatment depends on how thoroughly the dentist does the treatment. If it is done very quickly, or without good infection control, it might feel right, but could develop problems later. It might get reinfected due to leakage. This is why we put so much effort in performing the treatment as thoroughly as possible.
Sometimes, even after being thorough, the tooth could become reinfected due to hidden canals or small fractures. It may be possible to redo the cleaning/filling procedure. The last option for a problematic tooth is to remove it. Then the infection always disappears.
At Snö we give you pain-free techniques. You will always get information regarding all available scientifically proven techniques, alternatives, risks and prognosis. You can always ask your Snö team any questions you have regarding your procedures.