Root Canal Treatment

The term ‘root canal’ describes the cavity in the centre of a tooth root. The nerves and blood vessels are present within the root canal. Root canal is a treatment used to save a tooth that is decayed and infected, during which the nerves and pulpal tissues are removed and the canals inside the tooth are cleaned. If left without treatment, the tooth will become painful and pus may form. The nerves are not indispensably essential to a tooth’s functionality in the oral cavity. Its role is sensory that’s to provide the sensation to temperature (hot or cold). The absence of nerves doesn’t affect the normal functioning of the tooth in chewing food.

When does the nerves and pulp need to be removed from a tooth?

 

After a decay or caries, bacteria begin to grow and multiply within the pulp chamber. The bacteria and decayed remains cause an infection or abscess. An abscess is a pus-filled area that forms at the apex/end of the tooth root. It may create further complications like:-

•    Swelling spreading to other areas of the face and neck.

•    Bone loss in the jaw around the infected tooth.

•    Drainage of pus through gums and cheek forming a sinus tract.

 

What damages tooth nerves?

 

A tooth's nerve and pulp become infected due to deep caries or decay, failed large fillings, a crack or chip in the tooth, improper bite or occlusion, trauma to the tooth structure etc. Pain is the first and foremost sign of a root canal treatment, but a non-vital painless tooth can also be indicated for RCT.

What is done during the RCT procedure?

 

The first step involves taking multiple X-ray to see the anatomy and shape of the root canals and diagnose the infection in the surrounding area. Then local anaesthesia is injected to numb the area near the tooth. A rubber dam (a sheet of rubber) is placed around the tooth to keep the area free from saliva and to maintain a clear field for procedure. An access cavity is then drilled into the tooth following which pulp, decayed nerve tissue and related debris with bacteria is eliminated from the tooth using root canal files and copious irrigation. Saline water, sodium hypochlorite and chlorhexidine are used intermittently to flush away the debris and reduce the bacterial load in the canals. After proper cleaning and shaping of canals, they are sealed permanently by bio-compatible filling material on the same day when a single sitting RCT is being done. If there is an infection, a medication needs to be put inside the tooth to clear it up and final sealing is done later (in multiple sitting RCTs). A temporary filling is placed in the tooth to keep out contaminants like saliva and food particles between schedules. To fill the interior of the root canals a sealer paste and a plasticized compound called gutta percha is placed in it and to fill the exterior access cavity a permanent filling material like composite is used. The final step involves putting a cap or crown on the root canal treated toot. The tooth becomes weak and brittle after root canal due to loss of major tooth structure mass, thus to protect it from breaking and to restore complete functionality, placement of a crown is mandatory after a root canal treatment. 

Is Root Canal Painful?

 

RCTs have a reputation of being painful, requiring multiple visits to a dental clinic. But it’s completely painless procedure done under local anaesthesia and can be done in a single visit.

 

What are the post-op complications after Root Canal Treatment?

The patient may feel mild discomfort after RCT due to tissue inflammation after completion of the procedure, especially in case of severe infection. This sensitivity or discomfort is controlled with over-the-counter pain-killers and antibiotics. There’s no hindering of normal day to day activities during a root canal treatment. It is advisable to avoid chewing hard food from the tooth undergoing RCT till the crown has been placed to prevent breaking of the fragile tooth structure.

Are Root Canal Treatments successful?

 

The procedure is highly successful with more than a 95% success rate. Teeth fixed with root canal treatment may last lifetime. The crown placed after RCT is natural looking and one cannot identify a root canal treated tooth from a natural tooth by looking at it.

Complications of a Root Canal Treatment:

•    More than the routinely anticipated number of root canals in a tooth.

•    An undetected crack or fracture in the root of a tooth.

•    A breakdown of the inner sealing material or restoration over time causing re-contamination by       

      bacteria.

•    Marginal leakage from the crown over time due to gingival recession.

•    Highly calcified or blocked canals due to excessive trauma or wearing off tooth structure adds

      difficulty in treating.

•    Broken files in canals may result to complete root canal failures.

What are the alternatives to a Root Canal Treatment?

 

The only alternative to RCT is having the tooth extracted followed by placement of a bridge or implant to replace the missing tooth. These alternatives are not only more expensive than RCT but require more treatment time to restore the functionality and aesthetics.

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