Inside teeth, all the way to the tip of the root, is a soft tissue called pulp which contains nerve and blood vessels. If a tooth is decayed or has had repeated dental treatment or fractures, bacteria can enter the root canal and cause the pulp to become infected or inflamed; an infected nerve may cause pain and can lead to abscesses.
The aim of endodontics is to prevent or eliminate disease within the tooth and surrounding bone by cleaning and disinfecting the root canals using files and antibacterial irrigation, known as root canal treatment.
Sometimes an antiseptic dressing is left inside the tooth for several days, and the root canals are then filled with a rubbery material called gutta-percha to prevent re-entry of bacteria into the canals.
Root canal treatment is carried out under local anaesthetic and is painless, although patients may suffer some sensitivity afterwards, which normally settles down in 12 to 24 hours and can be relieved with painkillers. Depending on the complexity of the case, treatment may be carried out in one to two sessions, with each session lasting between one and two hours.
Some factors affecting endodontic treatment can only be identified when the tooth is opened up, for instance a tooth may have a hairline crack but until the tooth is opened it is not possible to know the extent of the crack or whether root canal treatment is feasible or not.
After root canal treatment has been carried out, the tooth is weakened and more susceptible to fracture and the endodontist will therefore refer the patient to a prosthodontist at Harley Street Dental and Implant Clinic to restore the tooth immediately. Placement of a crown is recommended on back teeth as it covers the whole tooth, preventing it from splitting.
As with any medical procedure, root canal treatment may occasionally fail and studies have shown a success rate of approximately 90 per cent, with a four per cent chance of developing a mild abscess after treatment. Failure may be due to a number of reasons, most commonly presence of bacteria in the root canals because the bacteria were inaccessible. Other reasons the treatment can fail are the presence of accessory root canal anatomy such as extra canals, further fractures in the tooth, leaking of the filling or crown due to decay, bacteria on the outer aspect of the roots, and the presence of cysts.
Once the cause of failure has been established, further treatments and prognoses will be considered and discussed with the patient. Re-root canal treatment has success rates of 48 to 98 per cent depending on the pre-existing conditions, which the endodontist will take time to discuss with the patient.
During re-root canal treatment, the existing root filling is removed and the root canals disinfected, then examined with the aid of an operating microscope to detect cracks or anatomical aberrations. Occasionally if a tooth is found to have cracks extending into the root canals the only option is extraction of the tooth.
If infection persists deep in the root canal a surgical approach may be necessary to lift the gum over the tooth and gain access to the inflamed or infected tissues around the tip of the root and clean the infection out.
Sometimes the tip of the root may be removed as well, and the gum is then stitched back in place and the inflamed tissues sent to a pathology laboratory for examination. Sutures are removed after three to four days and there may be a swelling, pain and bruising for a few days.
If you are experiencing deep dental pain, arrange an appointment with an endodontist at Harley Street Dental and Implant Clinic.