Endodontics

Why do I need root canal treatment?
Every tooth has a hollow canal along its root/roots that contains blood vessels and nerves to the centre of the tooth. Root canal treatment (also called endodontics) is needed when the blood or nerve supply to the tooth (known as the pulp) is infected through decay or injury. Though you may not feel any pain the early stages of infection, sometimes the process of the nerve dying off can be very painful: this is called irreversible pulpitis (inflamed pulp). In some cases, your tooth could darken in colour, which may mean that the nerve of the tooth has died (or is dying).
When the tooth has died, the infection can spread through the root canal system. Your body will mount a defence against the infection but cannot kill all the germs as they are protected within the canal. This may lead to an abscess when the pus from the infection builds up in the gum around the root of the tooth. It can cause a swollen face or, if the infection can drain, a “gum boil”. These can be very tender and the tooth very tender to bite on but in many cases the infection is slow spreading and pain free.
When this has happened the only solution is to remove the tooth or perform root canal treatment.

What is a root canal treatment?
Root canal treatment is the process of removing the infection and sealing the canal to prevent more germs growing. It is performed in several stages.
The first stage is to access the canal system, and sometimes this means drilling through old fillings and crowns. It is good practice to remove fillings before starting treatment, if there is decay in the tooth or if the old fillings are in a poor condition. This is important to prevent germs re-entering the tooth during and after treatment, which may jeopardise success. Once this has been done, a sheet of rubber (rubber dam) is placed over the tooth. This keeps the tooth clean and protects patients from swallowing the small instruments dentists use during treatment.
After the root canal has been accessed, the canals are cleaned and shaped using small precise instruments and washing the canal out regularly with dilute bleach. When the canals have been cleaned, they are filled with a rubber-like filling that seals the canal from germs. This is the root canal filling. This process is complex and time-consuming and sometimes more than one visit is required.

Are there any risks?
Sometimes root canals disappear with age and injury and can be very difficult to find. If too much tooth is removed whilst searching for the canal, instruments can “perforate” the side of the tooth. These holes can be repaired but we have to accept the tooth is not as healthy as it was and the treatment may not be a success in the long run.
As root canal treatment is intricate and the instruments small, they may break during treatment and remain stuck in the canal. It is possible to remove the “separated” instruments but the process can further damage the tooth.

Does it hurt?
The treatment has a bad reputation as being painful but this is not true. With local anaesthetic it should be entirely pain-free.

How successful are root canal treatments?
The evidence suggests that rot canal treatment is successful in about 80-83% of cases. If your tooth is pain-free this is a great sign but dentists can only truly assess success by taking x-rays many months after treatment to see if there is healing of the infection at the tip of the root.
Sometimes root canal treatment is not successful but can be re-done. Re-root canal treating teeth does take longer as all the old root filling has to be removed first. It has similar success rates to routine root canal treatment.
Will I need more treatment on the tooth after root canal treatment?
Potentially, yes. It is very important that the root canal is well-sealed and the tooth protected from further injury. The most simple way of achieving this is by placing a big filling in the tooth. Unfortunately, these teeth have often had many fillings over the years and are very weak, as such it is recommended that crowns (or protective “fillings” such as onlays) are placed to protect them.

What is root canal surgery?
A root end surgery (or apicectomy) procedure is undertaken if it is not possible to clean the tooth from with the normal method of access. This is usually the case when the tooth has a post or if there have been multiple attempts at root canal treatment. This procedure necessitates making a cut in the gum and accessing the root infection directly at the tip of the root. The infection is cleaned out and the root tip removed. The canal is sealed with a special filling material and the gum stitched back into place. With modern techniques (using a microscope and very small micro-surgery instruments) this surgery is very successful and not as unpleasant as it may sound!!

Initial consultation fee will be £145, including initial “x-rays”/radiographs leading to a written report. Treatment fees vary greatly depending on the case, but generally between £750-950.

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