Root Canal Purpose, When to do it, Procedure, Alternatives, Video

What is a root canal?

Root canal therapy, commonly referred to simply as a root canal, is a dental procedure for repairing and salvaging a badly decayed or an infected tooth. The root canal procedure involves removal of infected and decaying debris within the pulp of the tooth, thorough cleaning, and sealing of the tooth cavity with synthetic materials. This procedure helps to relieve the unbearable pain associated with tooth decay, to prevent further spread of the decay, and also to halt the spread of infection to the surrounding normal tissue. The procedure is usually performed by a dental surgeon or an endodontist. An endodontist is a dental surgeon who is specialized in management of diseases of dental pulp and nerve.

Purpose of a root canal

The central cavity which is normally present in the tooth is called root canal. The soft area within this canal is the pulp and the nerve supplying the tooth lies in the canal within the pulp. After the tooth completely emerges, the nerves are not essential for maintaining normal function and health of the tooth. The prominent function of these nerves is only in sensing hot and cold.

Damage to the nerve or the pulp can lead to its break down along with increased risk bacterial infection. The infection of the pulp and collection of decayed debris is associated with severe pain and can lead to pus formation. A root canal procedure is performed in such situations and removal of the pulp along with the nerves in the procedure does not hamper normal functioning of the tooth. If left untreated, the infection can spread beyond the root canal and form large abscess collection causing swelling of face and neck.

Risk factors for tooth decay are :

• cracking or chipping of teeth
• recurrent dental interventions in the form of fillings
• injury to the face
• poor oral hygiene

When to do a root canal

Decayed and infected teeth are the primary indications for root canal treatment. Symptoms of tooth decay which favor root canal treatment includes :

• severe tooth pain
• inflamed and painful gums
• sensitivity to hot and cold
• discoloration of teeth

Root canal is also indicated in situations where infections of the pulp cannot be prevented effectively, like in a cracked tooth.

Preparing for a root canal

An X-ray of the affected teeth is initially taken to identify the direction of the roots, to see the extent of the tooth infection and to look for signs of spread of the infection to the bone and surrounding tissues. Local anesthesia may be used by some dental surgeons in order to make the procedure painless. A suitable local anesthetic based on the surgeon’s preference and patient’s sensitivity may be injected to make the affected part numb. Some of the surgeons may perform the procedure without any anesthesia as the nerve of the affected tooth may already be dead and therefore incapable of pain.

Root canal procedure

• An access hole which is drilled through the tooth to reach the pulp chamber.
• Infected pulp, the decay debris and the nerve of the tooth are drilled out and removed.
• The tooth is thoroughly cleaned using a file to free it from all debris and water or sodium hypochlorite is used to flush it out.
• The tooth is then sealed. Sometimes the sealing may be delayed in the presence of infection for few days. Such a cavity may be filled with antibiotics to clear the infection.
• Temporary filling with calcium hydroxide paste may be done in situations where the procedure is not completed in one session. The procedure may be completed at a later date after removing the temporary filling. The temporary filling prevents contamination of the cavity with food particles and saliva. Patients are advised to avoid chewing of food with the affected side to prevent contamination and breaking of the fragile tooth until full restoration is attained.
• Once the tooth is completely cleaned out, the filling may be done with a rubbery paste like compound material called gutta-percha along with a sealer and cement.
• Stabilizing the teeth by covering it with suitable crown increases its viability by several folds.
• Anti-inflammatory analgesic drugs like ibuprofen are usually used after the surgery to reduce sensitivity, pain and inflammation.

Post procedure care consists of maintaining good oral hygiene with regular brushing, flossing and antibacterial mouthwash. Regular visits to the dentist for follow up consultations is advisable. The effectiveness of a root canal in achieving the desired goals  is very high and its success rate is around 95%. The restored teeth may last lifelong.

Root canal video

Root canal complications

• Root canal treatment can be a painful procedure. Immediately following root canal treatment, the teeth may be painful for a few days due to inflammation of surrounding normal tissue. This discomfort can be easily reduced by using simple pain killers like ibuprofen or naproxen.
• Re-infection and increased risk of tooth decay may be seen in following conditions.
  – If any of the root canal was left out without cleaning.
  – Any inadequacy in the root canal restoration procedure.
  – Breakdown of sealing material with time
  Re-infection may then require another root canal. Endodontic surgery like an apicoectomy, which involves resection of the root-end, is commonly done to treat re-infection for better results. Apicoectomy is done through an opening in the gum tissue and it usually provides complete cure.
• Need for several dental visits and quiet higher cost of the procedure.

Root canal alternative

Alternative options include extraction of the affected tooth with or without replacement with a bridge or artificial denture and to leave the affected tooth as such which has a risk of worsening of pain and spread of infection.