Demystifying root canal treatment

Many people have a deep-seated fear of root canal (endodontic) treatment. They will say “not as bad as a root canal” – as if it is one of the worst human experiences. Such fears are unfounded. In professional hands, root canal treatment is the best way to keep your natural teeth and preserve good dental health. By having better information about this treatment, you will understand why it is often called ‘the tooth saver’, says endodontics specialist Dr. Tony Druttman www.londonendo.co.uk

Life doesn’t always play us a fair hand. Most of us try to keep our teeth in reasonable condition because we know that long-term neglect can be painful, both in the mouth and pocket. Yet there are occasions when unnoticed changes take place to our teeth. We only become aware of this when we have dental pain or our dentist discovers an underlying problem during a routine inspection. The following advice about root canal treatment will help to put your mind at ease.


A dental microscope allows precise
inspection of the tooth root

Should anecdotal evidence influence you?
Very often patients describe their root canal experiences with terms like “it was very painful” and “I had to go back six times”. That’s unfortunate, but not the way things need to be. When carried out correctly, the endodontics procedure is no worse than having a normal filling, although it may take a little longer. People often agree to root canal treatment with reluctance, when there seems to be little other choice. In fact it is the best solution in cases of substantial dental damage or decay. Advice by a dentist will give you a clearer picture than advice by other patients.

Why do teeth need root treatment?
The nerve and blood vessels in the tooth (known as ‘dental pulp’) are there to help the tooth grow to maturity. They protect against bacteria within the body. Bacteria play a defensive role in the general mouth area, but can become destructive when they attack the body via the dental pulp or through gum disease.

In fact, recent research has found a correlation between gum disease and coronary heart disease. Bacteria cause decay in teeth. When the decay is deep, it can allow bacteria to invade the dental pulp – the living tissue inside your teeth. Your dentist removes the decay in the tooth to protect the pulp and to restore the function and appearance of the tooth. However repeated bacterial attacks can weaken the pulp to such an extent that the nerve can no longer recover, and so the pulp dies.

How do you know if something is wrong?
The point is – you don’t always know. Different nerve systems within the pulp will cause the tooth to respond in different ways. The nerve may die quietly and never cause any symptoms. It may be a chance x-ray that alerts the dentist to a problem. Alternatively the dying nerve may cause a great deal of pain and be very difficult to locate. When the nerve becomes irreversibly damaged, then either the pulp or the tooth has to be removed.

Will a root-treated tooth feel different?
The treated tooth is referred to as being dead because it has lost its internal nerve and blood vessels. However there is still a nerve and blood supply to the outside surface of the tooth, so the successfully root-treated tooth should feel normal.

Is there an alternative to endodontic treatment?
If you choose not to have root treatment, your affected tooth will be extracted. Should you fill the space? That depends on functional and aesthetic grounds. People today are aware of their mouth and smile, so someone displaying unaesthetic black gaps between their teeth may feel self-conscious about speaking or smiling. Back teeth may not be immediately noticed in a smile, but they are very important in terms of chewing function. Every tooth stabilizes the teeth adjacent to it and those immediately above or below. If it is removed and not replaced, other teeth may well shift from their natural positions. This will stimulate problems with gum disease, food packing (leading to further decay) and bite problems.

If a tooth needs extracting, what next?
Teeth can be replaced with bridges, implants or removable dentures and the possibilities should be discussed with your own dentist. Implants have revolutionized restorative dentistry and can be an excellent substitute for the natural tooth. The dental root has often been described as nature’s implant, so wherever possible existing teeth should be kept in place. However there are situations when it is neither feasible nor cost-effective to keep the tooth. The options have to be considered carefully either by your general dental practitioner, or by an endodontics specialist.

How successful is endodontic treatment?
Nobody can guarantee success. However when the endodontic treatment and the restorative treatment that follows it are both carried out to a high standard, long-term success is very likely. Failure would be caused by the leakage of bacteria into the root canal system or by mechanical failure i.e. fracture of the remaining tooth.

Should endodontic treatment fail, it may be possible to re-treat the tooth. If further treatment is impossible, the tooth may require extraction. Endodontic re-treatment may be carried by your own dentist or by an endodontist, depending on the particular problems and reasons for the failure.

General dentist or root canal specialist?
General dentist are trained to carry out root canal treatment and many of them do this to a very high standard. Whether root canal treatment is carried out by your regular dentist or an endodontics specialist will depend on many factors. Is your dentist skilled, experienced and confident in performing these kinds of procedures? Is it a straightforward treatment or are there complications? The molar teeth have a more complicated root canal system than the front teeth (incisors and canines), are harder to access and may require more specialized equipment.

While endodontics specialists are usually more expensive, their training and experience enable them to deal more easily with complications. In many cases, this involves re-treating teeth where the original root treatment has failed.

Dr Anthony Druttman, Endodontics Specialist, www.londonendo.co.uk