Many of us are dreaded by root canal procedure because of myths and misconceptions which are linked with root canal treatment. Various questions which may arise in patient’s mind before root canal procedure are answered in this write-up. Before getting root canal treatment done, it is necessary that patient knows about the procedure. Root canal treatment is one of the procedures which will endeavor saving the tooth. Root canal treatment is done when infection reaches the pulp portion of the tooth. In case of untreated tooth decay or in case of accidental exposure of dental pulp or trauma to the dental pulp, root canal treatment is done. In case of root canal treatment, infectious portion of the tooth is removed and cleaning, shaping and filling of root canals is done.
1. What is root canal treatment?
2. Who performs root canal treatment?
3. When is root canal treatment required?
4. How will I know that root canal treatment is required?
5. What will happen in root canal treatment?
6. What is gutta percha?
7. How long will numbness be there after root canal?
8. Are number of root canals different in different teeth?
9. How many sittings are required for root canal treatment?
10. How long will root canal procedure take?
11. Are there any alternatives for root canal treatment?
12. Why can’t antibiotics be used to treat infection in the tooth?
13. Are pain meds and antibiotics a good substitute for root canal treatment?
14. Does pain occur during root canal treatment?
15. Will I feel pain after root canal treatment?
16. Do I have to visit my dentist again after getting root canal treatment?
17. What follow up care is required after root canal procedure?
18. Can I go to work after root canal treatment?
19. Can pregnant women undergo root canal treatment?
20. How successful are root canals?
21. Which is a better option- Tooth extraction or root canal treatment?
22. What is the cost of root canal treatment?
23. What will happen if root canal treatment is not done?
24. What is dental abscess?
25. Will discoloration of tooth occur after root canal treatment?
26. Why does root canal failure take place?
27. How will I know that root canal failure has taken place?
28. What can be done in case of failure of root canal treatment?
When the nerve present in the tooth becomes infected or damaged, then root canal treatment is done to remove the infection and save the tooth. It mostly occurs because of entry of bacteria in pulp (Nerve) portion of the tooth. In case of root canal treatment, cleaning and shaping of canals is done followed by filling of canals.
A general dentist or an endodontist can perform root canal procedure. If tooth is very painful before root canal procedure, then RCT should be preferably performed by an endodontist who is specialist in root canal treatment. In case of difficult root canals or in root canal re-treatment cases, an endodontist should be approached. Fees charged by an endodontist is more than fees charged by a general dentist.
Root canal treatment is done in case of untreated tooth decay in which infection has reached dental pulp. If accidental exposure of pulp occurs or during excavation off deep dental caries, root canal treatment is required. Before giving fixed partial dentures, root canal treatment may be done.
Untreated tooth decay Trauma to the pulp
Pain, sensitivity to hot and cold food stuffs, tooth discoloration, swelling and tenderness of gums and recurring or persistent bump on gums are the symptoms which suggest that root canal treatment is required. There may not be any pain or other symptom before root canal treatment. By clinical and radiographic examination, dentist may make out that whether root canal treatment is required or not.
Pulp damaged due to trauma suggesting requirement of root canal treatment
After detailed history, clinical examination and radiographic examination, diagnosis is made and tooth is selected for root canal treatment. During root canal treatment procedure, tooth is made numb by giving local anesthesia and then rubber dam is applied for isolation of the tooth. With a drill, dentist will remove the decayed portion of the tooth and will approach pulp chamber and canal. This is called as access cavity. After access is obtained, endodontic file is used for cleaning and shaping of canals and after cleaning and shaping of canals, canals are filled with gutta percha. Pulp chamber is filled with permanent filling materials such as dental amalgam or composites.
Decayed tooth Opening access to decayed tooth
Cleaning and Shaping of Canals Filling Root Canal with gutta percha
Gutta percha is coagulated, purified exudates from mazer wood tree and is ADA approved material used to fill the root canals.
Numbness will last for several hours after root canal treatment. Avoid chewing until the effect of local anesthesia wears off as it can lead to risk of biting lip, cheeks or tongue. After root canal treatment, patient can drink or use straw to have liquids.
Different teeth have different number of root canals present. Front teeth usually have one root and single root canal in the root. Premolars or bicuspids have one or two roots present and have one or more root canals present. Upper molars usually have three roots and they have three or four root canals present. Lower molars usually have two roots and three or four root canals. Root canal treatment will be more complicated if number of canals are more. That is why cost of molar root canal treatment is more than root canal treatment cost for bicuspids or front teeth.
Root canal treatment can be done in single sitting or 2 sittings. Number of sittings for root canal treatment may be more. Number of dental appointments required to perform the procedure depends on degree and amount of infection which is present and complexity of root canal.
Root canal treatment can be done in single appointment or multiple appointments. RCT procedure is generally done in 2 appointments and duration of each appointment is around 45 minutes to 90 minutes.
Root canal treatment is done when infection reaches the pulp portion of the tooth. When infection reaches the dental pulp, then 3 alternatives are available. Patient can either get:
1. Root canal treatment
2. Endodontic surgery (Apicoectomy with retrograde filling)
3. Tooth extraction
Root canal treatment or Apicoectomy will save the toot. Tooth extraction should be the last resort and should be done when there is no other option.
Apicoectomy Tooth Extraction
Why can’t antibiotics be used to treat infection in the tooth?
When infection reaches the pulp portion of tooth, then to remove the infection, only 2 treatment modalities are available. Patient can either get root canal treatment done or can get the tooth pulled out. When the pulp portion of tooth is infected and becomes dead, then reservoir of bacteria will occur in dental pulp and body’s immune system and antibiotics will not be able to fight tooth infection. To remove bacteria present in surrounding tissues and bone, antibiotics can be given.
Are pain meds and antibiotics a good substitute for root canal treatment?
Antibiotics will not treat the infection. If antibiotics and pain meds are taken, then patient may get pain relief for that time but infection can flare up again and will cause discomfort and pain. If root canal treatment is not done and only antibiotics and pain meds are taken by the patient, then infection will become chronic and may cause dental abscess later on. If patient wants to save the tooth, then he should get root canal treatment done.
Does pain occur during root canal treatment?
No pain occurs during root canal procedure. Novocain shot is given before root canal treatment so that there is no pain. If tooth is infected or in case of abscess in the tooth, multiple shots of anesthesia will be required to numb the tooth. In case of vital tooth with infected nerve that is hot tooth, tooth may cause some pain. In case of hot tooth that is in case of severe infection present in the tooth before root canal treatment, procedure should be preferably done by an endodontist.
Patient may feel pain for 1-2 weeks after root canal treatment. Pain can be because of irritation of ligaments which are surrounding the tooth structure or can be because of tissue inflammation adjacent to root canal treated tooth. For pain relief after root canal treatment, pain meds can be given. If infection was severe before root canal treatment, then antibiotics are also prescribed. If pain persists for long time, then it can be because of failure to root canal treatment.
After cleaning, shaping and filling of canals, you have to visit your dentist to get dental crown. After root canal treatment, tooth becomes brittle and to provide strength to root canal treated tooth, dental crown is required. Dental crown will hide the discoloration which may occur after root canal treatment and will reinforce the weakened tooth structure.
Crown Placed on Root Canal Treated Tooth
Patient should avoid eating from side of root canal treated tooth and should take the pain meds and antibiotics as directed. Complete course of antibiotics should be completed. Patient should take a soft diet after root canal treatment and should avoid too hot or cold food stuffs. Patient should avoid smoking, drinking and strenuous exercise and to reduce swelling after root canal treatment, ice pack application can be done. Patient should follow all the instructions of his dentist.
Most of the patients can return to work after root canal treatment. They should avoid any strenuous work after the procedure and should plan a light schedule.
Pregnant women can undergo root canal treatment. Anesthetics which are used are safe during pregnancy and x-ray radiation is too minute to cause any damage. An X-ray radiation is concentrated on mouth region and not on stomach and lead apron is given to avoid any harmful damage. Dentist should be aware of fact that lady is pregnant.
How successful are root canals?
If root canal treatment is done properly, then they are successful in 90% of cases. Tooth becomes brittle and weak after root canal treatment. Dental crown should be placed after root canal treatment to provide strength to the tooth and to avoid tooth fracture.
Root canal procedure is anytime a better option than tooth extraction. Root canal treatment saves the natural, biologic tooth and is safer and less invasive procedure than getting the tooth pulled out. In long run, root canal treatment followed by dental crown is more cost effective procedure than tooth extraction and getting the tooth replaced with dental implants or dental bridges.
Cost of root canal treatment varies on the basis of type of tooth which requires root canal treatment and whether a general dentist or a specialist performs the procedure. Cost of root canal treatment also varies from place to place. Front tooth root canal treatment will cost around $360-$700 and bicuspid root canal treatment cost will be around $600-$900. Cost of molar root canal treatment is around $800-$1300.
If root canal treatment is not done, then infection can spread from tooth to supporting structures and bone and can lead to pus formation. Pus formation can occur because of rapidly multiplying bacteria and severe throbbing pain will occur on biting down. Patient may also suffer fever, nausea, difficulty in swallowing and breathing in case of spread of infection.
Localized collection of pus in alveolar bone at the root apex of tooth is called as dental abscess. In case of abscess, infection extends from root apex to periradicular tissue through apical foramen.
After root canal treatment, tooth may become discolored because the tooth becomes non-vital after root canal treatment. Discoloration can occur because of entry of hemosiderin pigment which is formed from hemoglobin into the dentinal tubules. To hide discoloration after root canal treatment, dental crown can be given. Chances of discoloration are less with introduction of new material and technology.
Root canal failure can occur because of unexpected number of root canals which if missed causes root canal failure. Resistant bacteria in root canal, breakage of file during root canal procedure, defective or incomplete restorations, and cracked root can lead to failure of root canal.
Inadequate filled canals and broken instrument in left lower incisor
Mild to severe pain or edema in the gums adjacent to root canal treated tooth suggest failure of root canal treatment. These signs and symptoms may be persistent from time of root canal treatment or can occur month or years after root canal treatment.
In case of root canal failure, re-root canal treatment, endodontic surgery (Apicoectomy with retrograde filling) or tooth extraction can be done. In case of root canal re-treatment, old gutta percha is removed and recleaning, shaping and re-filling of canals is done.
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