THE ROOT CANAL/ ENDODONTIC TREATMENT

The dreaded root canal. It’s really not as bad as its reputation.

A nerve on a tooth dies or becomes infected for a number of reasons. The most common reason is caries. A tooth consists of a nerve chamber and 1 to 4 nerves which run down into the root/s of the tooth. The number of nerves depends on the tooth. Root canal treatment is generally over 2 visits.

The first visit: We remove as much of the nerve and bacteria from the nerve canals as possible. We place an antibiotic into the area with a temporary filling containing a sedative. Sometimes the tooth is still very sensitive to pressure after the anaesthetic has worn off. This discomfort may last 1 to 2 days.

The second visit:  We will see you 1 to 2 weeks after the start of the root canal treatment. This visit is usually about an hour long. At this visit we measure the length of the nerve canals and the nerve canals are cleaned and sterilised thoroughly. The canals are now filled and sealed. A permanent filling is now placed. The tooth may be tender to bite on but this subsides quickly within a day or two.

If after 2 days there is still discomfort on the tooth, please contact the rooms.

Any negatives? Pain. Sometimes. We will anaesthetise you again should this happen or instruments may fracture. We minimize this possibility by using new instruments.

What are the possibilities that your root treated tooth may later give you problems?  Not often but sometimes. We will obviously do everything possible to minimize this possibility but it is obviously not possible to give absolute guarantees. Bacteria from the infected tooth nestles in the bone surrounding the root. Healing of this area is dependent on your body’s ability to get rid of this bacteria. Remember we are dealing with the body, which is dependent on your resistance levels.

Part of the success of a root treated tooth is the ability to seal the filled root canal from the surrounding environment. In other words the filling that is placed must not leak. If it does, bacteria will re-enter the root of the tooth and re-infect the tooth. More often than not teeth that need to be endodontically treated have very large fillings associated with them. These fillings often extend below the gum line and the success of this seal is dependent on your ability to take care of the tooth.

Because of the large fillings these teeth are also vulnerable to fracture.

It is therefore best to do a post and core crown on these teeth. This involves the placement of a post into the root of the tooth to give it strength. Over this we place a crown for optimal seal.

Teeth which are root treated often lose their colour over time and will become darker than the surrounded teeth. There are two ways of dealing with this. If the filling on the tooth is small, the tooth can be bleached. If the filling is large a post and core crown may be indicated.

What happens if a root treated tooth gives problems

Why do endodontically treated teeth give problems? Below are the main reasons:

• a nerve is missed during the original endo
• there are still bacteria nestled in the canals
• there are still bacteria nestled in the bone supporting the tooth
• the root canal was done inadequately due to stones in the canals or difficult anatomy of the root system
• the filling on the tooth is leaking
• The tooth becomes re-infected and possibly starts paining. Perhaps is sensitive to pressure.

What is the treatment protocol?

• 1. I will first place you on an antibiotic to see if we can clear up any infection in or around the root.
• 2. If this doesn’t settle the tooth, the next option is to redo the root canal.
• 3. If the tooth is still symptomatic, an apicectomy is indicated.
• 4. If there are still problems, the tooth will have to be removed.