ROOT CANAL TREATMENT

ENDODONTICS AT TOWNGATE DENTAL

Although it is a common dental procedure, root canal treatment (RCT, also known as endodontic treatment) can in some cases be complex and challenging to complete successfully. Every tooth is different, and some teeth have multiple roots which can be curved or hard to access. Because of this, general dentists will often refer more complex cases to a dentist who has the necessary experience, training and equipment to achieve the best outcomes from RCT.

Tooth after RCT

At Towngate Dental Practice, Dr William Holme has a special interest in endodontics and has worked over several years to develop his knowledge and skills in this area to provide the highest standard of RCT to his patients. To reinforce this, he has completed a master’s degree in endodontics at the University of Central Lancashire.

We have also invested in advanced equipment to ensure our patients get the best possible outcomes from RCT. In particular, we have a surgical microscope which gives 25x magnification. This is invaluable in helping to find and clean the canals, which can be just 0.05 mm wide, with some teeth having one canal while others have four or five.

Dr Holme is happy to receive referrals from other dentists for more challenging RCT cases. Because no two root canal treatments are the same, you will usually require an initial consultation with Dr Holme at Towngate to assess the tooth and undertake any further tests required (such as additional x-rays or a 3D scan). He will then be able to advise you further about the specific treatment required to save your tooth. 

Dr Holme with microscope

FREQUENTLY ASKED QUESTIONS ABOUT RCT

Root canal treatment (RCT) is a common dental procedure where a dentist carefully removes inflamed or infected pulp (including nerve fibres) from inside the roots of the tooth. Special instruments are used to shape the canals so that bacteria can be cleaned out. After the canals have been disinfected, they are then filled with a rubber-type material called gutta percha, which stops any more bacteria from growing in the canal. Finally, the tooth is re- sealed with composite material.

A tooth is made up of three layers. There is an outer shell of enamel which is very hard, with a layer of dentine (which is slightly softer) underneath. Together these protect the inner layer, the dental pulp. The pulp is a collection of nerve fibres and blood vessels in the middle of the tooth, extending into canals in the roots; it is essentially the heart of the tooth.

When bacteria reach the pulp as a result of decay, trauma, a deep filling or other damage to a tooth, it can cause inflammation (which is what causes toothache) or infection of the pulp (which can cause an abscess).

When the pulp becomes inflamed or infected, there are usually just two treatment options to choose from. You could have the tooth extracted, and then consider the options to replace the tooth (for example, with a dental implant), or in many cases you could save the tooth by having root canal treatment.

It is possible to have an infected root canal but no pain. However, at any stage that tooth could start causing pain or a serious swelling. A root canal procedure should prevent that from happening.

If it is not possible to save the tooth with RCT, or you decide not to go ahead with the treatment, the alternative is an extraction. You can then either accept the space left behind (which is likely to lead to neighbouring teeth drifting into the gap), or you can have a prosthesis to fill the gap. This could be a partial denture, a bridge or an implant. In many cases, an implant is the best solution. We will discuss with you if we feel an extraction and an implant may give you a more successful or predictable outcome.

There is a common misconception that RCT hurts. It can usually be done safely and painlessly under local anaesthetic. It is common to have slight tenderness for a couple of days after treatment, but this can be managed with over-the-counter painkillers if required.

Following RCT, the root canals are sealed with a composite filling. To protect the tooth for the long term, we usually advise placing a crown or ceramic onlay. This provides the best seal to prevent bacteria getting back into the tooth, and also strengthens the tooth to reduce the chance of it breaking.

Most teeth require a crown after RCT, especially premolars and molars. RCT does make a tooth weaker and the crown acts as a support band around the tooth to prevent it breaking. These can be made with no metal in them to blend in and look like a natural tooth.

The average life of a tooth after RCT is usually estimated as 10-12 years, although with a well-sealed restoration and good oral care they can last a lifetime! Proper dental care includes regular brushing and inter-dental cleaning, a low sugar diet and regular dental check-ups.

As with many medical treatments, RCT is not guaranteed to work in all cases. That said, success rates are very high (between 80-90%). Factors that affect the chance of success are how long the infection has been present and how large it has grown, the strength of the remaining tooth structure, and whether a crown is placed on the tooth after RCT.

If we think RCT does not have a good chance of success, we will let you know beforehand and discuss other options.

In most cases, if initial RCT fails and the infection returns, the tooth can be treated again. This is known as root canal re-treatment. This can be done even if the original RCT was carried out many years ago.

There are inevitably risks with any treatment and RCT is no exception. Sometimes root canals have narrowed with age or due to previous fillings, which can make them difficult to find and clean. If too much tooth is removed while finding the canal, an instrument can perforate the side of the tooth. This can be repaired but may affect the long-term success of the treatment. As RCT is intricate and the instruments very thin, they can occasionally break inside the tooth during treatment and remain stuck in the canal. It is sometimes possible to remove the broken instrument but the process can further damage the tooth.

However, when RCT is carried out by an experienced dentist using advanced equipment (such as our surgical microscope) the risks are minimised. We will discuss these risks with you on a case-by-case basis.

Research overwhelmingly shows that RCT is safe and effective in eliminating toothache. There is no scientific evidence linking RCT to disease elsewhere in the body.

In rare cases, infection may be very persistent around the tip of the root, or it may not be possible to open up the root canal (for example, if there is a large post in the tooth). In these instances, you may need to have a small surgical procedure (known as apicectomy). The tip of the root is cleaned through an incision in the gum and bone above or below the tooth.

More information for patients about RCT is available from the British Endodontic Society.