Root canal treatment

Root canal treatment is a curative dental treatment for an infected dental pulp, pulp chamber, or root canal that has become inflamed and infected due to the buildup of bacteria that destroys the tooth roots, dental pulp, dentin, blood vessels, or tooth nerves, resulting in toothache, tooth decay, and pus. The endodontist will treat root canal infection by drilling out decay to open and remove inflamed and infected tooth tissue, including the surrounding area, for cleaning, repairing tooth roots, applying medicine, and filling root canals to restore a healthy, beautiful tooth with strength and serving forceful chewing functions.

What is dental pulp?

The dental pulp is the soft tissue within the innermost space of the tooth and root's center. This space is also known as the pulp chamber and the root canal. The pulp chamber consists of tissue and blood vessels that nourish and transport waste away from the tooth. Tooth nerves are responsible for sensations, and lymphatic vessels aid in waste removal and immune support. When tooth decay reaches the tooth tissue cavity, bacteria or toxins enter the tissues, causing inflammation and infection that spreads down to the tooth root. The tip of the tooth root has an open apex, a root-end opening that connects to the jawbone. The disease can spread into the tissue surrounding the tooth root, causing alveolar bone resorption, and resulting in sore, painful chewing, swollen gums, pus, bad breath, a loose tooth, and other complications.

What causes a root canal infection?

Root canal infection, or inflammation of the tissue inside the tooth, is due to a bacterial infection caused by tooth decay, broken tooth, cracked tooth, severe periodontal disease, or deep dental fractures from impacted incidents, all of which can result in infection, inflammation, or the death of tissue inside the tooth. If left untreated for an extended period, it will cause more severe and widespread damage to the tooth and surrounding tissue, making treatment more complicated with a lower chance of cure, eventually leading to gum and adjacent tooth disease.

What causes pus formation at the root tip?

Long-term, neglected tooth tissue inflammation or an infection spreading to the tooth root and surrounding tissue causes tissue destruction, alveolar bone resorption, and the formation of a pus bag that spurts against the gum tissue, causing the gums to swell with pus and become painful. In severe cases, there may be symptoms such as swollen gums, a swollen face, fatigue, and fever. A black shadow at the tip of the tooth root can be seen on the X-rays, indicating pus or inflammation of the tooth tissue. The endodontist will first clear and treat the pus in the root canal until the gums heal and no symptoms remain, after which the root canal will be dealt with, filled, and followed by gum and upper tooth restoration.

Which tooth requires root canal treatment?

1. Deep decay down the tooth root or close to the pulp tissue inside the tooth.
2. Broken, cracked tooth.
3. Dead tooth or tooth with no blood flow to the pulp.
4. A tooth requiring gum line repair before crown treatment.
5. A tooth with severe gingivitis or periodontal gum disease that leads to tooth death.
6. Worn out teeth due to teeth grinding or harsh chewing, resulting in teeth erosion into the tissue cavities.
7. Traumatic tooth injury

What are the symptoms of root canal infection?

Root canal infections are triggered by inflamed tooth tissues and nerves causing the pain. The tissue mediators will inflame the pulp tissue in the tooth, resulting in pus formation and the death of tooth pulp tissue, which will aggravate and spread until it leads to the following symptoms:

• Tooth sensitivity, as a first sign, will gradually worsen and become more severe with drinking hot or cold beverages or chewing food.
• Toothache that starts as a persistent toothache for some time after being triggered by precipitating factors. Toothaches can come on suddenly, come and go, or occur at night until the pain becomes constant and radiates to the tooth root, jaw, face, and adjacent teeth.
• Swollen gums and faces from root canal inflammation and/or pus accumulation.
• Fatigue and fever because of jaw and facial swelling
• Discolored and darkened teeth, secondary to damaged blood vessels within the tooth.

What is the root canal treatment procedure?

The endodontist will perform root canal treatment after taking a history and thoroughly examining the teeth and tooth tissues; taking dental x-rays to diagnose the cause of root canal infection; and providing a prognosis or possible outcome of the treatment, which includes explaining and providing treatment options to the patient.

The endodontist will perform root canal treatment as follows:

1. The endodontist will use local anesthesia to alleviate any discomfort during the procedure. In specific cases, the endodontist may prescribe medications, such as nitrous oxide, oral sedatives, or intravenous sedation, to help the patient relax and relieve anxiety. 
2. The endodontist inserts a rubber dam to isolate the treated tooth from the surrounding oral tissue.
3. The endodontist removes cavities or cracks in the tooth, drills an opening for access to the tissue cavities inside the tooth and the root canal, and removes inflamed and infected tooth tissue.
4. The endodontist uses a measuring device to determine the length of the tooth root.
5. The endodontist cleans and shapes the root canal wall and cleanses it with an antiseptic solution.
6. The endodontist applies medication to the root canal and places a temporary filling.
7. When the patient is free of the root canal infection and can chew normally, the endodontist will fill the root canal before referring the patient for upper tooth restoration to complete the root canal treatment process.
8. In severe inflammation and infection cases, the endodontist will continue to treat the tooth with medication or additional cleaning until the root canal heals, which will then be filled.
9. If the inflammation has not spread to the tissue surrounding the tip of the tooth root, the endodontist may be able to complete the root canal treatment in just one session.

What is root canal treatment aftercare?

After completing the final step of root canal treatment, the endodontist will advise aftercare tips to prevent the treated area from being damaged to help the patient maintain good long-term dental health. Root canal treatment aftercare includes the following practices:

1. The endodontist will prescribe pain relievers for 2-3 days of ongoing pain after treatment to reduce pain, swelling, or excruciating pain around the treated tooth.
2. Avoid using the treated tooth for one day to prevent the temporary filling material from falling off and cracking.
3. Brush and floss your teeth as usual to keep your mouth and teeth clean.
4. If the filling material cracks, make an appointment with an endodontist as soon as possible to prevent bacteria from seeping into the root canal.
5. Attend each follow-up appointment with the endodontist to ensure treatment continuity and to monitor symptoms.
6. When finishing the root canal treatment, a continuity restoration treatment, such as a dental crown, should be considered as soon as possible and should not be left unattended for an extended period.

Where to have root canal treatment?

Comprehensive Digital Dental Center

Root canal treatment is a methodical and exacting treatment to treat infections occurring in the pulp chamber and root canal, which are difficult to reach and involve pain management. During the diagnostic process, other complications that necessitate the collaboration of multidisciplinary specialists may come to light. Therefore, considering root canal treatment at a comprehensive digital dental center at a reputable hospital equipped with international standards of cutting-edge technology and medical equipment is essential in ensuring a safe, effective, complex root canal treatment outcome. A comprehensive digital dental center will provide a thorough diagnosis using a variety of dental equipment, including:

• A dental microscope is a crucial piece of dental equipment that enhances visibility beyond normal vision to see details inside a root canal and assess the condition of dental cracks.
• CT scan, a 3D computerized tomography to help see the condition inside the entire root canal and surrounding tissue in 3D, reducing the obscuration of normal 2D radiographs, assisting in the sizing and location of the lesion, and assisting in the precision and clarity of the various conditions and complexities of the root canal system.

For those endodontists considering dental crown, choosing root canal treatment at a comprehensive digital dental lab will assist the endodontist in designing quality dental crowns with CAD/CAM digital scanning systems, which aid in the design and production of dental crowns that are most suitable and meet individual needs.

Endodontist with experience and expertise

Root canal treatment is a complex procedure. Endodontists, therefore, play an essential role in every treatment process, starting with diagnosis, prognosis of the disease, and treatment process to achieve the best possible treatment outcome. In case of other co-morbidities or complications, the endodontist will collaborate with a team of dental specialists, such as periodontists or implantologists, to help diagnose, formulate a treatment plan, and determine the most suitable treatment options for everyone.

High-quality dental filling materials or high-quality dental crowns

For maximum safety in root canal treatment, choose a digital dental center or a leading hospital with a selection of high-quality dental materials with safety standards certified by the FDA (Food and Drug Administration), including the highest level of equipment sterilization to reduce the chance of complications that may follow, such as re-infection of the pulp chamber or root canal, which may cause side effects such as toothache, tooth sensitivity, or gingivitis, etc.

What are the benefits of root canal treatment?

Root canal treatment is a safe and effective dental treatment with a high success rate of 98%. The benefits of root canal treatment are as follows:

• Relieves and eliminates symptoms associated with tooth infections.
• Prevent inflammation and infection from spreading to other tissues and teeth.
• Help regain forceful chewing function.
• Aids in the preservation of natural teeth.
• Prevent gaps between teeth if teeth extraction is needed, which may result in the following dental issues, such as falling teeth or gingivitis.
• Help preserve the Alveolar bone surrounding the tooth root and the fullness of the face.

Does root canal treatment hurt?

The dental pulp is densely crowded with nerves and blood vessels. When the endodontist performs root canal treatment, expected pain will likely occur. The pain severity correlates with the degree of inflammation. The endodontist may consider administering local anesthetics before the procedure to help alleviate pain and anxiety. However, once the elimination of the infectious agents is successful, the pain will subside.

How long does recovery from root canal treatment take? 

Typically, recovery time after root canal treatment is less than one week. However, there may be associated symptoms such as pain, swelling, fatigue, and fever during the first 2-3 days after treatment. The symptoms will then gradually subside with the use of a pain reliever. Those experiencing severe, persistent pain without relief should seek the immediate attention of a dentist to have the symptoms checked and appropriate treatment administered.

How to prevent root canal infection?

Dentists recommend a bi-annual dental checkup to detect tooth decay, cracked teeth, or other abnormalities within the oral cavity and tooth to receive prompt treatment or prevention before the teeth become inflamed and infected. Brushing and flossing teeth daily is a necessary routine for preventing dental decay, which can lead to inflammation of the tooth tissue. Always be aware of any toothache, sensitive teeth, bleeding gums, swollen gums, or other warning signs, and seek immediate treatment from a dental specialist. Early root canal treatment from the outset of symptoms will help relieve pain, make you feel better, and enable you to regain normal tooth function quickly.

FAQ

• How long does a root canal procedure take?
  Typically, root canal treatment for a single tooth requires 1-2 appointments (or 1-2 days) for treatment and follow-up. The dentist will take approximately 30 minutes to 1 hour for each treatment, depending on the severity of the inflammation and infection. For those with severely damaged tooth roots, the dentist may recommend additional appointments for dental crowns to prevent the tooth root from becoming inflamed or infected again.