Root canal treatment

A root canal treatment or RCT is a conventional therapy to save a non-vital or inflamed tooth. It is a conservative form of treatment which means that minimal tooth structure is replaced and treated to prevent extraction of the tooth. In this therapy, the inflamed and infected or completely non-vital soft tissue of the tooth, known as the dental pulp, is removed and replaced with inert dental cement.

Diagnosing the need for an RCT is easy and painless, using X-Rays and electronic pulp testers. The treatment involves removal of the pulp and replacing it with an inert dental filling then finally covering up the tooth with an artificial crown.

If you keep avoiding the dentist and keep putting off root canal treatment for later, there might be a lot of complications. Hence, in this piece you will get to know, what exactly is an RCT, when do we need it, why and how much does it hurt.

Also, you come to know ways in which you can protect the pulp so that to avoid this treatment in the future.

What is root canal treatment?

The term root canal treatment indicates that the root canal requires treatment. Root canal treatment is a dental procedure to save an infected tooth. The infection and inflammation occur in the roots of the teeth.

An endodontist, a dentist who specializes in the treatment of pulp and tooth preservation, performs RCT wherein he/she removes the pulp of the infected tooth, cleans the area, disinfects, and fills the space with an inert dental cement like Gutta Percha.

The pulp is the soft tissue which constitutes the life of the tooth as it consists of nerves and blood vessel necessary for sensitivity and nourishment of the tooth. Hence, when dental cement replaces the pulp, the tooth becomes non-vital but doesn’t fall off its socket.

It doesn’t fall off because it fuses with the underlying bone as soon as it loses vitality, as part of a repair process known as Ankylosis.

If the treatment is done on an inflamed and vital pulp, then RCT can be painful. But the dentist manages this pain with the help of medication and anesthesia. Root canal treatment is a mandatory therapy if you wish to salvage your ailing tooth from extraction or removal. (1)

When do you need an RCT?

A root canal treatment is performed to save a tooth that has badly decayed or infected. During a root canal procedure, often the pulp is removed which constitutes of blood vessels and nerves after which the inside of the tooth is cleaned and sealed using dental cement.

Without RCT, the infected tooth will lead to further complications like the infection of the tissue which surrounds the roots (periapical region).

What is pulp Inflammation or pulpitis?

Pulpitis is irreversible damage to the tooth this can only be treated by root canal treatment or tooth extraction. Pulp inflammation occurs due to infection from tooth decay or trauma like a blow to the tooth and fracture.

Pulpitis is the primary indication for the need of RCT. It is of two types as acute and chronic pulpitis depending upon the severity and duration of the inflammation.

Acute pulpitis

Acute pulpitis is a severe and fast onset form of pulpitis and generally presents with –

  • Pain at night or on laying down
  • Sharp stinging pain
  • Fever
  • Swelling around the tooth
  • Swelling in the gland below the lower jaw

Chronic pulpitis

Chronic pulpitis is a long-standing and untreated case of acute pulpitis. It has fewer symptoms than acute pulpitis but is more damaging to the pulp. Chronic pulpitis has no severe symptoms just a dull intermittent pain which occurs once in months.

Chronic pulpitis progresses to periapical abscess and granuloma which are more serious complications of untreated pulp infections.

Diagnosing the need for root canal treatment

Diagnosing the need for RCT is a rather straightforward process. An endodontist can quickly determine the vitality and health of pulp with the help of a few intraoral X-Rays and pulp tester.

If the pulp is already dead, the tooth will be non-receptive to heat and cold tests. This is a clear indication of a need for RCT. Other than this, if your tooth is fractured, you will need root canal treatment to save it. (2)

Treatment procedure of RCT

A root canal treatment involves multiple visits to your endodontist. The various steps involved in the entire treatment are –

Pulp testing and diagnosis

The first step to this process is to identify the type, cause, and degree of pulp injury for proper treatment planning. Pulp testers and diagnostic X-Rays come handy in this step.

Numbing the tooth with local anesthesia

As we know, RCT can be painful if the pulp is vital. The dentist administers lignocaine, a local anesthetic, to ease the pain. This keeps the tooth and surrounding area numb even for hours after the procedure.

Preparation of the tooth

This step involves preparing the tooth for the procedure. The tooth structure is cut and reduced with the help of specialized drills and cutters to clear out any debris.

Also, the dentist ensures measures to guarantee proper retention of the cement when filled in. The root canal is then made more extensive with the help of fine needles called files.

Isolation of the prepared tooth

There should be no contamination of the tooth with saliva or any fluids. The prepared tooth and canals should be completely dry to receive the cement. Drying is done using simple aids like cotton rolls and paper points.

Later the tooth is isolated from other teeth in the jaw using a rubber dam sheet (a sheet of rubber covering the natural teeth and clamps holding the tooth under treatment).

Filling of the canals and application of cement

In this step, the widened canals are filled with an inert cement called Gutta Percha till the tip of the root. After that, the crown part of the prepared tooth is sealed off with Glass Ionomer cement, a particular type of high bonding material.

Placement of artificial crown or composite resin

The ultimate step of this entire procedure is sealing off of the tooth to prevent it from further damage. After root canal treatment, the tooth becomes non-vital, fragile and susceptible to fracture.

To avoid this, an artificial crown is placed over the natural crown to ward off the extra biting force exerted by the opponent tooth on the treated tooth.

Complications of RCT – Mid treatment flare-ups during an RCT

Despite the best efforts of your dentist to treat and seal off an infection, new complications and relapse of the previous infection might occur even after a root canal treatment.

There can be complications in between the ongoing procedure as well, like severe pain or bleeding from canals. These are called mid-treatment flare-ups.

The most likely reasons for such uncalled complication may be one of the following –

  • A left out untreated root canal when there are multiple canals.
  • An undetected fracture in the tooth.
  • Contamination of the prepared tooth with saliva or saline water.
  • The inadequacy of filling material.
  • Overfilled canals.
  • Underlying undetected infection.
  • Poor response of the tooth to the treatment might be due to improper patient compliance.
  • Trauma to the treated tooth.

Retreatment may or may not cure the lesion. In severely damaged teeth, endodontic surgery like apicectomy can be a treatment option where the apex or tip of the root is exposed by removing the overlying gum and bone tissue.

In this case, the tooth is treated retrograde (backward) which increases the chances of success for the procedure. (3)

Managing post-treatment pain

During root canal treatment procedure, mid-treatment pain is controlled by the dentist with the health of local anesthetics. Though these anesthetics keep the treated are numb for hours after completion of treatment, pain might return once the effect of anesthesia wears off.

In that case, there are various methods in which the root canal pain can be managed and they are –

  • Take prescription painkiller medication given by the dentist.
  • Saline lukewarm water mouth rinse after at least 6 hours of filling.
  • Ice packs placed externally on the treated area at an interval of 4 hours.
  • Eating semi-solid and easy to chew food.
  • Avoid beverages that are extremely hot or cold.

However, if the pain is unbearable and persists over a day or so, consult your dentist as it can be due to one of the post-ops as mentioned above complications of root canal treatment.

Prevention – how to protect the pulp?

To protect your pulp, you need to protect the hard-outer tissues of the tooth which are enamel and dentin. The most straightforward and most inexpensive method to do so is to maintain good oral hygiene; brush twice daily, floss between the teeth and use an antibacterial mouthwash.

Any trauma or fracture can also lead to pulp injury. Wear mouth guards if you are an athlete or participating in any sport that might cause a blow to your teeth.

Visit your dentist every two months for routine checkups so that a minor decay doesn’t progress into pulpitis and require root canal treatment.

Over to you on root canal treatment

Any dental treatment pertaining to the sensitive pulp is deemed to be painful. Root canal treatment is a lot less painful than extracting the same tooth.

Also, RCT a lot less expensive than implant of an artificial tooth in place of the lost natural tooth. Thus, RCT is a conservative therapy which is the best way out for an irreparably damaged tooth.

Ignoring initial tooth pain will only lead to future complications and loss of a tooth. Hence, act promptly and see a dentist if you suffer from symptoms of pulpitis and get treatment as soon as possible.