Root canal treatment

A root canal treatment is done to repair and save a badly damaged or infected tooth instead of removing the tooth from the mouth. During a root canal treatment, the dentist removes the severely damaged or infected nerve tissue (called the dental pulp) from inside the tooth. A filling is placed using a material called gutta percha to take up the space where the dental pulp was located. Root canal treatment can be performed by a general dentist or by a root canal specialist, called an endodontist.

The dental pulp

The dental pulp is the soft tissue located in the centre of the tooth as well as in the canals of the tooth root/s. Both nerves and blood vessels are located in the dental pulp.

A tooth can continue to function without the dental pulp after it is removed and replaced with a filling by a root canal treatment.

What damages the dental pulp?

The three main methods of damage to the dental pulp include:

• Tooth decay that travels into the dental pulp causing it to become infected or severely inflamed.
• Severe injury or damage to a tooth. This type of damage can come from playing sports, a car accident or even a fall.
• A crack in the tooth that extends into the dental pulp.

Possible signs and symptoms

There are a few signs and symptoms that mean you might need a root canal treatment.

• Severe pain that does not go away after taking pain medication.
• Severe pain when biting together or while chewing.
• A pimple on the gums next to a tooth.
• Tooth discomfort that continues even after the hot or cold item has been removed from the mouth.
• Deep tooth decay that may or may not be associated with pain or discomfort.
• A swollen area of the face.

The root canal treatment process

A root canal treatment may be performed from start to finish in one appointment. However, it often requires multiple appointments. During a root canal treatment the following procedure occurs:

1. Local anaesthetic is given to ensure the treatment is pain-free.
2. A rubber dam is placed to isolate one or more teeth from the rest of the mouth.
3. The dental pulp located in the centre of the tooth and extends down the tooth root/s is located and accessed.
4. The dental pulp tissue is removed using small metal files and disinfectant.
5. The disinfected space is filled with a material called gutta-percha.
6. This root canal filling is sealed as a barrier from stopping bacteria from re-entering the space.
7. The crown of the tooth is then fixed with a filling or a crown.

Dental x-rays are a key part of root canal treatment and will usually be taken before, during and after treatment. These x-rays help the dentist see inside the root canals of the tooth, which cannot be seen with the naked eye.

An x-ray of a completed root canal treatment. Getty images.

What is a rubber dam?

A rubber dam is a square sheet of latex that is used to isolate one or more teeth from the rest of the mouth during dental treatment. Non-latex rubber dams are also used. It is a very important part of the root canal treatment that may impact treatment success.

During root canal treatment, a rubber dam is applied to one or more teeth. This is done for a few reasons. The rubber dam prevents saliva from entering the treatment area. Saliva contains bacteria which can contaminate the area that is being cleaned and disinfected. As well, small instruments and disinfectant liquids are used to remove the dental pulp tissue. The rubber dam provides a safe space for these to be used away from the rest of the mouth and throat.

Read more about Rubber dam for dental treatment.

Does root canal treatment hurt?

Local anaesthetic is used during a root canal treatment to ensure that no discomfort occurs while the dentist is performing the treatment.  
People may experience discomfort after their root canal treatment appointment, however many people do not. Your treating dentist will provide advice regarding pain relief.

How will my tooth be fixed after the root canal treatment?

Teeth treated with a root canal treatment may be fixed with either a filling or a crown. Your dentist will assess the tooth to recommend what is best for the tooth. This is based on factors such as where the tooth is located in the mouth, pressure placed on the tooth, the amount of natural tooth structure present.

Molar teeth are used to chew our food which puts them under a lot of pressure. After a root canal treatment is completed, it is often recommended that molar teeth are fixed with a crown to protect them from the heavy chewing forces. Research has shown that covering of the cusps (raised points on the biting surfaces of the premolar and molar teeth) will increase the longevity of the tooth. It prevents cusps from bending and flexing, which can lead to the tooth fracturing. If the tooth fractures, it may need to be removed from the mouth.

Studies report that a root canal treated tooth has a greater chance of surviving for a longer amount of time if the tooth is fixed with a crown. One study showed that the number of years that a root canal treated molar tooth lasted, decreased significantly if a crown was not used to fix the tooth. After 1 years, 96% of molar root canal treated teeth survived, after 2 years only 88 % survived and by 5 years, it was down to 36% of teeth. Another study reported that root canal treated teeth that are not treated with a crown were 6 times more likely to be removed than teeth that received a crown after the root canal treatment was completed.

Alternatives treatment options

The only alternative to a root canal treatment is to remove (extract) the tooth from the mouth. If the tooth is removed, you will need to pay for further treatment to have the missing tooth replaced in the mouth. Replacing the tooth is optional and your dentist will explain the possible consequences that may occur if the tooth is not replaced.

Summary

A root canal treatment is done to repair and save a badly damaged or infected tooth instead of removing the tooth from the mouth. During a root canal treatment, the dentist removes the severely damaged or infected nerve tissue. A filling is placed to take up the space where the dental pulp was located. If you are experiencing any of the above symptoms or would like to find out more, ask your dentist. Alternatively, you can find an ADA registered dentist using our find a dentist service.