The core of your teeth is made of a bundle of nerves and blood vessels, called dental pulp. They enter through tiny canals in the roots of the teeth. The number of roots and canals is different, depending on the type of the tooth, and sometimes there could be individual differences too.
A damage to the tooth could cause an inflammation to develop in the dental pulp. In many cases that is also combined with a bacterial infection. The most common causes for pulpal inflammation are:
deep tooth decay (dental cavities);
trauma (including the trauma from an extensive tooth restoration);
compromised structural integrity (a crack or a fracture of the tooth).
Because the pulp sits in an enclosed space with hard walls, the swelling accompanying the inflammation causes buildup of pressure, which manifests as pain. This is the so-called pulpitis. In some cases, if the pulp is not completely enclosed by the hard tooth tissue (due to a large defect), the pain can be minimal or none, and the pulpitis can go unnoticed. As the inflammation progresses, the blood vessels in the pulp cannot maintain their normal function and start to die off, together with a nerve degeneration, leading to loss of vitality of the tooth. In the majority of cases this is combined with bacterial infection, which initially is contained in the pulp space, but can easily start spreading out through the canals in the tooth’s roots. At this stage the pain could completely disappear, but the disease actually progresses further, to its next stages. That can be a slow process and go unnoticed for a period of time. It can manifest as a different degree of discomfort when pressure is applied over the tooth – during normal function, or when you clench the teeth together. The tooth also can become slightly darker. In case of more serious infection it can manifest as localised swelling around the tooth, a small blister appearing on the gum, or a pronounced swelling of the face due to a collection of pus – an abscess. If the process is not treated accordingly it can progress further in the jaw bone, leading to changes in the bone structure and ultimately a cyst formation, which is a reaction of your body trying to isolate the source of infection. The further the disease progresses, the lower the chances of successful treatment of the tooth are. In very advanced cases the removal of the tooth could be the only way to eliminate the source of infection.
Root canal treatment is a final solution to preserve a tooth which otherwise would need removal due to the disease affecting its pulp and surrounding bone.
We will ask you about your symptoms, carefully collecting all the information, even some that might seem irrelevant to you. We will also ask you about your general health, current medication you might be using and about previous dental treatment you might have had. Then we will carefully examine your mouth. Radiographs (X-rays) will be taken in most cases to aid the diagnostic process.
You can discuss in details the procedure, possible outcomes and alternatives to the root canal treatment with us in full confidence. That will help truly understand what is involved and what are the limitations of the proposed therapy. It is very important that you consent to the treatment with full understanding about what is involved in the process.
How is a Root Canal Treatment done ?
The aim of root canal treatment is to remove the source of pain and/or infection. It is usually performed under local anaesthesia. It can take one or more visits and depends on factors like root canals structure, presence of infection, etc.
After the local anaesthetic (if applied) has taken effect, we create access through the tooth structure, allowing us to remove the diseased tissue. An isolation barrier, usually a rubber sheet (called rubber dam or dental dam), is placed to separate the tooth from the rest of your mouth. That is done to protect your mouth from the instruments and active solutions used in the treatment process. It also ensures prevention of secondary contamination from the natural fluids in the mouth. The canals will be mechanically shaped to allow good access. Due to the complexity of the canal system in the roots, mechanical access is difficult and not always possible in all parts. In our clinic laser light is used to aid the active solutions in the removal of all debris from the canals system of your tooth. Another type of laser light, with strong antibacterial capabilities, is employed after that, to ensure optimal disinfection.
If at any stage, we think it is necessary, we could temporarily close the tooth access leaving some medication in it. The treatment will be continued in a subsequent visit, which is usually within several days.
The final stage of the root canal treatment is sealing the root canal system and restoring the tooth.
The access to the pulp and the loss of vitality usually leaves the tooth structurally weaker, so indirect restorations are used to protect it. We will discuss the restorative options in details with you, so we can choose the best way forward in keeping the tooth functioning.
What can I expect after treatment ?
The treatment will not significantly affect your normal routine on the day. The main disturbance will come from the numbing effect of local anaesthetic, which lasts for several hours. Post treatment tenderness and various degree of discomfort in the first couple of days are possible, and pain relief could be required. If you need pain relief, you can use over-the-counter painkillers like paracetamol or ibuprofen. If you take such medications, please always consult the information leaflet and consult your pharmacist if you have any concerns.
How quickly will it heal ?
If there is an infection involving the jaw bone, the healing process is slow. Typically after 9-12 months a radiographic investigation is necessary. The healing is assessed by comparing with the original situation. Further checks could be needed in the following years. In rare cases the healing could be unsatisfactory. We will consider alternative approaches in those cases and will discuss them with you, so we can resolve the situation in the most favorable way.
Please note that regular and examinations and maintenance are important for the long term success of any dental treatment.