Root canal treatment is undertaken to treat or prevent an infection occurring inside the tooth. Treatment may be required after for the following reasons:

• Extensive decay in a tooth or a deep filling close to the pulp.
• Fractures or cracks within the tooth or leaky filling or crown
• Extensive gum disease and its treatment
• Trauma to the tooth and its complications
• Severe sensitivity
• After previous orthodontic treatment
• Occasionally, a healthy tooth may need root canal treatment to enable a crown to be retained (referred to as ‘elective root canal treatment’)

In principle aim of root canal treatment is to remove the infected pulp and the bacteria within the root canal system. By doing so, the number of bacteria in the tooth is reduced and this help your body to heal any infection around your tooth and in the bone holding the tooth.

Root canal treatment is not a treatment with a 100% success. Like all treatment’s things can fail. This could be for several reasons including:

• Not all the roots were located
• The root canals were not well cleaned to their full length
• Decay leaking into the root canal system due to a defective filling or crown
• Fracture within the tooth
• Complicated anatomy
• Periodontal disease
• Complications in your previous root canal treatment

This treatment can be more complex due to the previous attempt at root canal therapy.

Step One: Getting your tooth numb and placing a rubber dam.

Numbing your tooth with local anaesthetic will ensure your treatment is pain free. A rubber dam is then placed over your tooth, think of this as an anorak that sits over your tooth. This is particularly important in root canal treatment as it gives us a sterile environment to work in, preventing bacterial leakage into the tooth from your saliva and protects your airway from the fine instrument’s used in your treatment.

Step Two: Remove any old fillings

This allows us to remove any decay and examine how much remaining tooth structure you may have; it may allow us to rebuild the tooth before root canal therapy. If you have a crown, the crown will be removed before placement of the rubber dam, this allows us to see how much tooth structure you have left. If you don’t have a great deal of tooth left, then unfortunately root canal would not be justified as a definitive filling and new crown cannot be made.

Step Three: Cleaning the root canal

This stage is like a deep filling. We access the root canal system, locate the number of roots and begin to disinfect the root canals with antibacterial solutions.

Step Four: Filling the root canals

If all the roots have been located and disinfected, then we fill the root canals with a specific filling. This stage may require a new radiograph to check that all the canals have been cleaned and that we are filling the canals to the right areas.

Step Five: New filling/ Construction of a temporary crown.

In this stage we have finished the root treatment and we are placing a filling on the tooth this prevents any bacteria re-entering the root canal system from the oral cavity. If we removed the crown prior to the treatment at this stage a new temporary crow will be made for you chairside.

This is a question that is always on every patient’s mind. The simple answer is No, root canal treatment is painless. Be re-assured that treatment will not proceed until you are comfortable. Once the local anaesthetic has kicked in the root treatment should be a pleasant and comfortable experience.

Root canal treatment may need to be carried out over one or two visits. Between appointment an antibacterial medicament is placed inside your root canal and an intermediate restoration.

Cases more likely to require two or more visits include:

• Re-treatments
• If a large area of infection is visible on a radiograph or discharge of infection from within the tooth.
• Cases where the canals are hard to locate, or have large curves
• Trauma

• Searching for canals that are very small may result in a hole or ‘Perforation’ within the tooth. If small enough this can be repaired, and the tooth would be savable.
• Some canals are narrow, finding and opening the canals can cause our fine instruments to separate. If this occurs, we will attempt to remove the separated file or bypass it. Unfortunately, sometimes we cant achieve both and the tooth would be reviewed.
• Root canal treatment can weaken the tooth and increases the likelihood of it fracturing. A crown or filling would be required after your root canal treatment to prevent that happening.
• Incomplete healing which may require a period of monitoring, in some cases the lesion may not heal.
• Unfortunately, not all teeth can be saved and it maybe that after investigating your tooth it may be deemed unsavable and require extraction.
• Swelling, bruising and pain may occur in very rare occasions as a result of chemicals used to disinfect the root canal.
• After the appointment, you may have mild discomfort which can be managed with paracetamol and ibuprofen, this can last from 5-7 days and in some cases longer. In a very small number of cases, a post-operative flare up can occur that may require further treatment.

When root treating any tooth, the dentist must ensure that the tooth can be sealed from the oral cavity. Following a consultation, the dentist may inform you that the tooth cannot be saved if, for example, the tooth is badly broken down or has advanced gum (periodontal) disease.

There are  a number of options available other than root canal treatment:

• Do Nothing: This is always an option but you must be aware that the tooth is likely to cause further episodes of pain, swelling or infection.
• Extraction: This is a predictable option which removes and eliminates the source of pain and/or infection. The resultant gap may affect your cosmetic or functional outlook. The space can often be restored with a denture, bridge or implant; the most suitable option is made by assessing each case individually with your dentist.
• Surgical Endodontics: The infected root is surgically removed. The success of this procedure depends on a number of factors, if this is an option your endodontist has recommended, then they will discuss this with you in greater depth.