Root canal treatment





Definition

Root canal treatment, also known as endodontic treatment, is a dental procedure in which the diseased or damaged pulp (central core) of a tooth is removed and the inside areas (the pulp chamber and root canals) are filled and sealed.


Purpose

An inflamed or infected pulp is called pulpitis. It is the most common cause of a toothache. To relieve the pain and prevent further complications, the tooth may be extracted (surgically removed) or saved by root canal treatment.

Demographics

Root canal treatment has become a common dental procedure. According to the American Association of Endodontists, more than 14 million root canal treatments are performed every year, with a 95% success rate.


Description

Inside the tooth, the pulp of a tooth is comprised of soft tissue that contains the blood supply, by which the tooth receives its nutrients; and the nerve, by which the tooth senses hot and cold. This tissue is vulnerable to damage from deep dental decay, accidental injury, tooth fracture, or trauma from repeated dental procedures such as multiple fillings or restorations over time. If a tooth becomes diseased or injured, bacteria may build up inside the pulp, spreading infection from the natural crown of the tooth to the root tips in the jawbone. Pus accumulating at the ends of the roots can form a painful abscess that can damage the bone supporting the teeth. Such an infection may produce pain that is severe, constant, or throbbing. It can also result in prolonged sensitivity to heat or cold, swelling, and tenderness in the surrounding gums, facial swelling, or discoloration of the tooth. In some cases, however, the pulp may die so gradually that there is little noticeable pain.

Root canal treatment is performed under local anesthesia. A thin sheet of rubber, called a rubber dam, is placed in the mouth and around the base of the tooth to isolate the tooth and help to keep the operative field dry. The dentist removes any tooth decay and makes an opening through the natural crown of the tooth into the pulp chamber. Creating this access also relieves the pressure inside the tooth and can dramatically ease pain.

The dentist determines the length of the root canals, usually with a series of x rays. Small wire-like files are then used to clean the entire canal space of diseased pulp tissue and bacteria. The debris is flushed out with large amounts of water (irrigation). The canals are also slightly enlarged and shaped to receive an inert (non-reactive) filling material called gutta percha. However, the tooth is not filled and permanently sealed until it is completely free of active infection. The dentist may place a temporary seal, or leave the tooth open to drain, and prescribe an antibiotic to counter any spread of infection from the tooth. This is why root canal treatment may require several visits to the dentist.

Once the canals are completely clean, they are filled with gutta percha and a sealer cement to prevent bacteria from entering the tooth in the future. A metal post may be placed in the pulp chamber for added structural support

During a root canal, the diseased pulp of a tooth (A), is removed (B). The remaining empty tooth is filled and sealed with a filling or crown. (Illustration by GGS Inc.)
During a root canal, the diseased pulp of a tooth (A), is removed (B). The remaining empty tooth is filled and sealed with a filling or crown. (
Illustration by GGS Inc.
)
port and better retention of the crown restoration. The tooth is protected by a temporary filling or crown until a permanent restoration may be made. This restoration is usually a gold or porcelain crown, although it may be a gold inlay, or an amalgam or composite filling (paste fillings that harden).

Diagnosis/Preparation

Signs that a root canal treatment is necessary include severe pain while chewing, prolonged sensitivity to heat or cold, or a darkening of the tooth. Swelling and tenderness of the gums or pimples appearing on the gums are also common symptoms. However, it is also possible that no symptoms will be noticed. The dentist will take an x ray of the tooth to determine if there is any sign of infection in the surrounding bone.


Aftercare

Once a root canal treatment is performed, the recipient must have a crown placed over the tooth to protect it. The cost of the treatment and the crown may be expensive. However, replacing an extracted tooth with a fixed bridge, a removable partial denture, or an implant to maintain the space and restore the chewing function is typically even more expensive.

During the time when antibiotics are being used, care should be taken to avoid using the tooth to chew food. The tooth has been structurally weakened and may break, or there is a possibility of the interior of the tooth becoming reinfected.

If the tooth feels sensitive following the procedure, a standard over-the-counter pain medication such as ibuprofen or naproxen may be taken. This sensitivity will fade after a few days. In most cases the patient can resume regular activity the following day.


Risks

There is a possibility that a root canal treatment will not be successful the first time. If infection and inflammation recur and an x ray indicates a repeat treatment is feasible, the old filling material is removed and the canals are thoroughly cleaned out. The dentist will try to identify and correct problems with the first root canal treatment before filling and sealing the tooth a second time.

In cases where an x ray indicates that another root canal treatment cannot correct the problem, endodontic surgery may be performed. In a procedure called an apicoectomy, or root resectioning, the root end of the tooth is accessed in the bone, and a small amount is shaved away. The area is cleaned of diseased tissue and a filling is placed to reseal the canal.


Normal results

With successful root canal treatment, the tooth will no longer cause pain. However, because it does not contain an internal nerve, it no longer has sensitivity to hot, cold, or sweets. Because these are signs of dental decay, the root canal recipient must receive regular dental check-ups with periodic x rays to avoid further disease in the tooth. The restored tooth may last a lifetime. However, with routine wear, the filling or crown may eventually need to be replaced.


Morbidity and mortality rates

In some cases, despite proper root canal treatment and endodontic surgery, the tooth dies and must be extracted. This is relatively uncommon.


Alternatives

The only alternative to performing a root canal procedure is to extract the diseased tooth. After restoration or extraction, the two main goals are to allow normal chewing and to maintain proper alignment band spacing between teeth. A fixed bridge, a removable partial denture or an implant will accomplish both goals. However, these are usually more expensive than a root canal treatment.


Resources

BOOKS

Peterson, L. J., E. Ellis, J. R. Hupp, and M. R. Tucker. Contemporary Oral and Maxillofacial Surgery, 4th edition. Amsterdam: Elsevier, 2002.

Tronstad, L. Clinical Endodontics: A Textbook 2nd edition. New York: Thieme Medical Publishers, 2003.

Walton, R. E. and M. Torabinejad. Principles and Practice of Endodontics, 3rd edition. Philadelphia: Saunders, 2001.

Wray, D. Textbook of General and Oral Surgery. Amsterdam: Elsevier, 2003.


PERIODICALS

Bader, H. I. "Treatment Planning for Implants versus Root Canal Therapy: A Contemporary Dilemma." Implant Dentistry 11, no. 3 (2002): 217–223.

Buchanan, L. S. "Negotiating Root Canals to their Termini." Dentistry Today 19, no. 11(2000): 60–71.

Douglass, A. B., and J. M. Douglass. "Common Dental Emergencies." American Family Physician 67, no.3 (2003): 511–516.

Himel, V. T., and M. E. Levitan. "Use of Nickel Titanium Instruments for Cleaning and Shaping Root Canal Systems." Texas Dental Journal 120, no. 3 (2003) L 262–268.


ORGANIZATIONS

Academy of General Dentistry, 211 East Chicago Avenue, Chicago, IL 60611. (312) 440-4300. http://www.agd.org .

American Academy of Pediatric Dentistry, 211 East Chicago Avenue, #700, Chicago, IL 60611-2663. (312) 337-2169. Fax: (312) 337-6329. http://www.aapd.org .

American Association of Endodontists, 211 E. Chicago Ave., Suite 1100, Chicago, IL 60611-2691. (800) 872-3636 or (312) 266-7255. Fax: (866) 451-9020 or (312) 266-9867. info@aae.org. http://www.aae.org .

American Dental Association, 211 E. Chicago Avenue, Chicago, IL 60611. (312) 440-2500. Fax: (312) 440-7494. http://www.ada.org .

OTHER

Animated-Teeth.com . [cited May 2, 2003]. <http://www.animated-teeth.com/root_canal/t1_root_canal.htm ; .

Health Promotion Board of Singapore. [cited May 2, 2003]. http://www.hpb.gov.sg/hpb/haz/haz03029.asp .

New Zealand Dental Association. [cited May 2, 2003]. http://www.nzda.org.nz/public/rootcanals.htm .


L. Fleming Fallon, Jr., MD, DrPH

WHO PERFORMS THE PROCEDURE AND WHERE IS IT PERFORMED?



A root canal treatment may be performed by a general dentist or by an endodontist. An endodontist is a dentist who specializes in endodontic (literally "inside of the tooth") procedures. The procedure is usually performed in a professional dental office. In rare situations, it may be performed in a hospital outpatient facility.

QUESTIONS TO ASK THE DOCTOR



  • What will be the resulting functional capacity of the tooth?
  • Is the oral surgeon board certified in endodontic surgery?
  • How many root canal procedures has the oral surgeon performed?
  • What is the oral surgeon's complication rate?

User Contributions:

dr.jalal jafar
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Jun 17, 2006 @ 10:22 pm
thanks you very mutch im master student and i need some information from this site
Dr.shuheir
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Oct 10, 2008 @ 11:23 pm
Q-What since cause of post pain of root canal treatment?
hannah
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May 31, 2009 @ 2:14 pm
Root canal treatment is done when there is no chance of tooth to be saved, and the patient doesn’t want it to be extracted although decayed. It is done to kill the vitality of the tooth and then filling it with mechanical components, and placing a cap over it.
The procedure involves the removal of the nervous elements of the tooth which have been infected or decayed already due to microbial action or any physical pressures.
Root canal Treatment
Dr. Ilda
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Dec 15, 2009 @ 3:15 pm
What are the substances, pastes or materials that are mostly recomanded to be used in every step of the procedure of endodontic treatment? It would be great if i recieve an answer. thanks!
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Apr 22, 2010 @ 4:04 am
The article is very informative. Iam to undergo root canal treatment in the next 2 days and the article has allayed my doubts / fears about the treatment. Thanks
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Jul 20, 2010 @ 1:13 pm
I'm 16 and i have a problem with swallowing pills. My dentist gave me some amoxicillin monday and it came in a bottle 28 and i have 23 left. i swallowed one whole but it took me a long time two swallow that one, i crushed one up a swallowed it, and i threw 3 of them away because the capsule cover was to wet to swallow. If your dentist already prescribed the pill form to you and you already it from the pharmacist ,can u ask him for a exchange in a liquid or chewable tablet form??
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Oct 29, 2010 @ 8:20 pm
GREAT SUMMARY
NORMAL TREATMENT EXPLAINED
ENCYCLOPEDIA OF SURGERY
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Dec 10, 2010 @ 8:20 pm
I am under root canal treatment. Doctor advised for 5 sessions in 5 days interval between sessions. I completed second session. Doctor asked me to chew food as normal. I am still getting little pain while chewing. After reading the article I understand the reason for still having pain and more clarity about further steps. Thanks for a informative article.
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Jan 10, 2011 @ 10:10 am
What other fillings besides the gutta percha would you recommend? My research indicates that various minerals, including mercury, are used in this filling. Are the alternatives, MTA and calcium oxide good as good or better than the gutta percha?
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Jan 14, 2011 @ 10:22 pm
what will be the cost of porcelin crown in canada after root canal treatment is done
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Mar 27, 2011 @ 4:16 pm
Good info for this article on root canals - need to shorten it of the introduction article and use pieces in part two and three
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May 9, 2011 @ 5:05 am
q1.why the need of root cenal treatment and what are the material use in root cenal treatment
q2 how the patent care for this treatment
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Aug 31, 2011 @ 4:16 pm
I WANT TO KNOW CAUSES OF PAIN DURING ENDODONTIC TREATMENT OF LOWER 6 ALTHOUGH I GAVE NERVE BLOCK ANAESTHESIA
leen
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Dec 25, 2011 @ 4:16 pm
please-what are the materrials(substances-pastes)that are recomanded to be used in every step of the procedure of endodontic treatment?thanks
DR.NASIR NEWAS
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Aug 15, 2012 @ 2:02 am
at first many many thanks.i m dr nasir newas from bangladesh i m an intern doctor.i like ur post bt i nd more video tht i can improve my skills.thank you
dr sujata
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Oct 5, 2012 @ 8:20 pm
how can we manage when file perforated in the furcation of mandibular 1st molar
Sushil
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Apr 26, 2013 @ 9:09 am
during my RCT procedure of my lower molar, doctor had to cut my gum because as per the dentist it was protruding in the way of the Root Canal.However after that my tooth is not stopped bleeding.Doctor is not sure what to do know.
Please advise as to what can be done now?
Dr.Nimatullah(Abid)
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Jul 10, 2013 @ 6:06 am
Thank you very much..I am a student in stomatology in Afghanistan SpinGhar University..Q..what shuld we do to infected tooth befor extracion?

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