Root Canal Therapy or Endodontics

What is it?

Root canal treatment, also known as endodontic treatment, refers to the treatment of the inner part of the tooth known as the nerve or pulp. Blood vessels, connective tissue, and lymph vessels along with nerves, occupy space together within the pulp chamber and nerve canals. [see diagram ] This pulp tissue is important for the tooth to grow but is not necessary for an adult tooth to survive. If the pulp becomes infected, then the tissue within the tooth, as well as the bone and tissue around the tooth are destroyed. The tooth becomes abscessed. This necessitates the removal of the infected pulp tissue to allow the surrounding bone to return to normal health.

Why does it need to be done?

Once the nerve tissue is infected, and the tissue begins to degenerate, there is no effective way for the body’s immune system to enter the tooth and kill the bacteria. Root canal treatment provides a way to remove the bacteria and damaged tissue from within the tooth. This promotes an environment where the immune system can clean up any residual bacteria and irritants that surround the tooth. Complete healing should occur.

How do you know when root canal treatment needs to be done?

An infected tooth may or may not be painful but will usually experience extreme sensitivity to touch, hot stimuli or cold stimuli. Sometimes an abscess is noted years later on an x-ray without any pain. A pimple on the gums may indicate an infected tooth. A fractured tooth exposing the nerve, a previous history of trauma, or a deep cavity usually leads to treatment.

How is it done?

The tooth is anesthetized with a local anesthetic and is isolated using a rubber dam. A small opening is made through the biting surface to access the pulp chamber and root canals. A series of instruments are used to remove the infected tissue and the cleaned root canal system is sterilized using a disinfectant. The root canals are sealed with a rubber compound to prevent bacteria from reinfecting the tooth again. A filling is placed and a crown is sometimes made to protect the fragile remaining tooth structure. Antibiotics and pain killers may be prescribed if needed.

How long does it last?

As long as the tooth is properly protected, usually with a crown, it should last a lifetime. More tooth decay, further accidental damage, gum disease, or bacteria which cannot be totally removed can cause root canal treatment to fail, in which case the tooth may need to be retreated.

What is the alternative?

The only other way of definitively eliminating the infection is to extract the tooth. This route may lead to other undesirable consequences such as damage to adjacent teeth, reduced chewing ability and cosmetic changes.