Root Canal Treatment

What is Root Canal Therapy (RCT)?

Root canal therapy is the treatment of the pulp of the tooth. It is necessary when the pulp, containing the nerves and blood supply of the tooth, is infected. The goals of RCT are to remove the bacteria and infected pulp from the pulp chamber and the root canals and fill these empty canals with the solid filling material to prevent future problems. This procedure of root canal treatment can be done by a general dentist, but the one who specializes in this field is an Endodontist. Dr. Gupta is a renowned and competitive Endodontist with excellent clinical skills. What are indications for Root canal therapy?

Spontaneous pain or throbbing pain while biting.
Sensitivity to hot and cold foods.
Severe decay or an injury that creates an abscess (infection) in the bone.
Physical trauma to the tooth
Advanced gum problem

That are the symptoms that indicate the need for root canal therapy?

- Moderate to severe lingering toothache when having hot or cold foods.
- Severe tooth ache which wakes you up in sleep
- Pain on chewing or biting.
- Swelling on your gum which when pressed may release blood or pus

Pain that starts in one tooth and spreads to other regions of the jaw or head e.g. an infected lower molar (back tooth) may cause you to feel pain in the ear!
Tooth which is non vital due to chronic infection may not produce pain

How is a root canal treatment done?

After taking proper X ray of the tooth, dentist will gently make an opening into the tooth. Local anesthesia will usually be required to prevent pain during the procedure.
All the decayed tooth is removed and the access is gained to the root canals.
Then the root canal files are used to entirely clean the root. These root canal files increase in thickness when they enter the root and help in removal of the pulp of the tooth. They help in removing the dead pulp debris and bacteria.
After this is done, there are 2 ways of which one is chosen by the dentist - Either do everything else in a single seating or sealing the cavity with a soothing medicine with a temporary filling material for few days until the next seating is called for the completion of the procedure.
The use of soothing medicine is that it prevents the spread of further infection, if there was any prior to the cavity preparation, or also prevention of occurrence of any new infection in that region.
The final stage includes the filling of the canal with some plastic material called Gutta Percha which are bio-compatible, and after the canal is filled, a suitable and aesthetic regular cement filling is done over it, which can be accompanied with crown placement sometimes.

How long will the procedure take?

Root canal treatment usually takes 2 or 3 visits. The length of each visit and the duration between visits will depend on the nature of work to be performed and the extent of infection. In some cases where there is no infection and root canal treatment is performed from a restorative point of view, the procedure can be completed in Single visit.

Why does my dentist advice RCT when I do not have pain in my tooth?

Damage to the pulpal tissue may occur without any pain and hence go undetected for months or even years. There may have been prior pain, but because it was brief it could have been forgotten. Your dentist may advise a root canal based on the following observations:

A routine dental check-up reveals the presence of a tooth which is discolored in comparison to the others. This is indicative of an unhealthy and damaged pulp.
A routine x-ray reveals either an abscess around the root of a tooth, damages to the root structure itself and / or changes in the pulpal tissue space. These signs indicate a long standing and chronic infection in the tooth.

Although currently pain free, if left untreated a damaged tooth could eventually flare up. If a root canal is advised, it is in your best interest to have the tooth treated before further damage occurs.

Why does a root canal need to be re-treated and how will it be done?

A small percentage of root canals may get re-infected due to the following reasons:

Root canals are complex and often there is more than one canal in each root. Some canals are extremely difficult to see and may be missed even with sophisticated instruments.
Root canals are complex and often there is more than one canal in each root. Some canals are extremely difficult to see and may be missed even with sophisticated instruments.
New decay and a loose or broken filling can expose the root canal filling to bacteria and saliva, causing the tooth to be re-infected.
Lastly, treatment may fail because the root canal was not thoroughly cleaned or sealed in the first instance.
For re-treatment of a root canal the tooth is re-opened, the old filling is removed; the canals are re-cleaned and re-filled. Some cases could require surgical intervention.

What is Endodontic Surgery?

In some cases the infection persists or recurs around the tooth even after routine root canal therapy has been completed. In such cases it becomes necessary to surgically access the infection through the gum and bone tissues and clean it out from around the root of the tooth. This is called "Surgical Root Canal Therapy" (SRCT). There are different types of endodontic surgeries. The most common is the Apicoectomy where an opening is made in the gum region of the problem tooth and the infected tissue removed along with a part of the root. The end of the remaining root is then sealed with a small filling, stitches are made in the gum tissue and healing generally proceeds uneventfully.

Other types of endodontic surgeries include:

Curettage (removing of only inflamed tissue)
Root Amputation (selected removal of roots)
Hemisection (dividing the tooth in half)
Intentional Replantation (removing and reinserting the tooth)

What happens after the treatment?

It is important to evaluate the healing process after root canal treatment. This is normally done 6-9 months after completing your treatment. You are requested to return for the follow-up appointment, during which your tooth is examined and an x-ray taken to evaluate the healing.