Root Canal Treatment - Ivy Cross Dental Surgery

ROOT CANAL TREATMENTS

What is root canal treatment?

Root canal treatment is more correctly termed – ‘Endodontic treatment’.

The nerve and vascular tissue (or pulp) inside a tooth and tooth roots can ‘die’ (devitalize) for a number of reasons including…

Decay (a breakdown of the tooth surface and tissues by acids produced by bacteria)
Trauma or fracture of the tooth
Wear or tooth surface loss (from grinding, erosion, abrasion etc)
Significant gum disease
Heavily filled or crowned tooth (which can devitalise as a process of attempting to save it)

Root canal treatment is conducted when one of the above problems leads to…

Intolerable sensitivity when eating, drinking or when air is drawn over the tooth
Pain on biting where a fracture or crack threatens the structural integrity of the tooth
Significant discomfort, which occurs as the pulp becomes inflamed, heralding the probable progression to death of the pulp
Pulp necrosis (death of the pulp tissues) leading to the formation of an abscess

The aim of root canal treatment is to relieve discomfort, prevent the risk of, or remove a source of infection. Doing this allows the tooth to be retained as the alternative is extraction of the tooth.

The relief of discomfort that this procedure provides (and advances in treatment techniques and equipment) now mean that patients feel very comfortable choosing this as a positive method of attempting to keep a tooth that is otherwise compromised.

What is the procedure for having root canal treatment?

Treatment usually involves 2 visits to the dentist (usually a week or two apart), following diagnosis.

Visit 1 (around 1 hour in length)

Your dentist will make you comfortable by anaesthetising the tooth to be prepared
Your bite (occlusion) will be checked whilst the anaesthetic takes effect
A protective shield (rubber dam) will be placed around the tooth to prevent it being contaminated with saliva and bacteria from the mouth during preparation
The tooth will be cleaned by removal of the decay and/or an old existing filling first, leaving a clean cavity
The necrotic and infected tissue inside the tooth will be drained through access prepared through the top of the tooth
The inside of the tooth will be flushed out with an antibacterial solution
The openings to the tubes (or canals) which travel within the tooth roots will be identified
A computer (apex locator) will be used to accurately determine the length of the root canals and it may be necessary to also take a radiograph (x-ray image)
Instruments and an antibacterial solution will be used to carefully clean and shape the inside of root canals
The canals and tooth will then be temporarily filled with a sterile calcium-based material
The rubber dam will be removed

Visit 2 (around 1 hour in length)

Your dentist will make you comfortable by anaesthetising the tooth to be prepared
A rubber dam will be placed around the tooth, as per ‘Visit 1’
The temporary dressings will be removed and the inside of the tooth will be flushed out with an antibacterial solution
The root canals will be gently explored with an instrument to ensure it is free of debris and then dried carefully with blotting paper points
The root canal filling material will be ‘tried in’ the tooth to ensure it fits correctly and a radiograph (x-ray image) will be taken to establish that this is the case
The filling material will then be bonded in place with a sealant material and compressed with warm instruments to ensure that it flows into all the ‘nooks and crannies’
A permanent filling will then be placed in the access hole on the biting surface of the tooth
The rubber dam will be removed

The factor which led to root canal treatment (e.g. decay, abscess etc) and the treatment itself, both structurally compromise the tooth. For this reason, it is strongly recommended that the tooth is also crowned. This will reduce the risk of the tooth catastrophically fracturing. Generally, if a tooth is not crowned it is likely that it will fracture at a later date, necessitating extraction.

Many dentists feel apprehensive about discussing crowning a tooth following root canal treatment as they are concerned that the patient will feel that this is an unnecessary additional expense. The converse is true – if steps are not made to protect the tooth, then the time and money invested in treating it will be wasted. Furthermore, greater expense may be incurred in restoring the gap left by the fractured tooth having been extracted.

There are some circumstances where a crown is not necessary, but if your dentist does not suggest a crown after root canal treatment, then ask ‘why not’!

What is the material used for root canal treatment?

Gutta percha is a natural rubber-like material that is derived from the sap of the Palaquium species of tree. Historically gutta percha has been used in many things including electrical insulation, ornaments, golf balls and even chewing gum.

Gutta percha is biologically inert, easy to manipulate and resistant to degradation. These features render it the perfect material for sealing the canals within the root, as part of endodontic treatment.

I have a latex allergy can I still have root canal treatment?

To date it has been the experience of the profession (and of the author of this website) that there is no cross-reactivity between commercial gutta percha and natural rubber latex.

If you do suffer with a natural rubber latex allergy, however, you MUST discuss this with your clinician as it may be necessary to undergo a few tests before this material is used in you.

Internationally there have been a few reports and some unsubstantiated internet ‘chatter’ concerning reactions, but these reports do not indicate whether other potential sources of latex were properly excluded during treatment i.e. rubber dam, latex gloves, rubber bungs in syringes, rubber ring instrument markers, rubber widget strips, rubber polishing instruments or other materials with known cross-reactivity.

Reference – Journal of the American Dental Association, Vol 133, No 10, 1357-1367, 2002.

How long does a root canal treated tooth last?

Most dentists guarantee treatment for at least 1 year, but the minimum expectation is for a lifespan of 5 years. In favourable conditions a well root-filled tooth protected with a crown can last many decades, if not a lifetime. The theory and practice of endodontically treating teeth is supported by substantial evidence and research.

Advantages

Eliminates a potential dangerous source of infection in the head
Relieves pain
Tooth can be saved rather than extracted
Treatment is successful in around 95% of cases
Can be less expensive than replacing a lost tooth

Disadvantages

Not all teeth are amenable to root canal treatment
Following treatment 1 in 20 cases may still require specialist input or extraction
More expensive than extraction alone
Tooth is weakened by treatment and may require a crown to reinforce it
There may be tenderness after each treatment
The area may ‘niggle’ occasionally even if treatment is successful

How much should I expect to pay for root canal treatment?

Root canal treatment is a very intricate, technique sensitive and labour-intensive procedure. All of the Nickel-Titanium instruments that are used for your procedure can only be used once and only for you before they MUST be discarded (i.e. single use). In total the treatment occupies around 2.5 hours of surgery time. For these reasons it tends to be a relative expensive procedure.

In the private arena the combined cost of excellent treatment and high-quality materials required to produce a well endodontically-treated tooth should range from £350 to £650. The charges for treatment with an endodontic specialist may be more than this, but specialists tend to provide treatment for patients with particularly complex dental needs (your dentist will inform you if a specialist opinion is required).

Remember to clarify costs and obtain an estimate. Once you have carefully discussed your needs and been advised of the options available to you, all good dentists should issue you with a written quote for treatments, usually printed at the reception desk.

Some dental practices will offer 0% finance packages or accept payment through insurance plans.

As with everything in life, it is possible to seek out individuals who are willing to use cost-cutting techniques to offer ‘budget’ options (for those in whom short-term expenditure is the predominant factor influencing choice).

You should always feel comfortable with your dentist and trust them implicitly, so choose your clinician carefully. Speak to family and friends to find out who they would recommend. You can check a dentist’s or doctor’s credentials using the respective governing council websites (General Dental Council and/or General Medical Council registration search).

ROOT CANAL TREATMENTS

Advantages

Disadvantages

FIND US