The aim of root canal treatment is to keep a tooth that is badly damaged or decayed. Some symptoms of a tooth that would benefit from root canal treatment are
waking you up from your sleep
pain to chew on
pain to hot and cold that lingers
tooth ache that requires pain killers
pain that pain killers don't help with
swelling in the gum
draining pus from the gum
Above: video of root canal procedure on a live patient!
Why does my tooth hurt?!
Believe it or not, teeth are actually alive!! There is a nerve inside each of our teeth. The nerve is also known as the 'pulp'. The nerve is located right in the middle of the tooth and is soft. The nerve is there because it helps our teeth form and grow when we are young (approx. less than 12 years old). Once our teeth have fully formed, our teeth can survive just fine without the nerve.
When our teeth get decay, or a hole in them, the nerve inside gets mad and inflamed. Often, the nerve doesn't start hurting until the hole is quite big. This is why it's so handy to have your teeth regularly checked by a dentist because you may not even be aware you have a hole until it's huge. X-rays also help with this. (See our video on why x-rays are so useful at detecting small holes in teeth). Once a hole starts in your tooth, if you do nothing the hole gets bigger and bigger, and makes its way closer and closer to the nerve in the middle of the tooth.
When the hole is small, and you have it fixed with a filling then the nerve is able to settle down. This is good. However, when the hole is big, or the tooth has had lots of fillings already, the nerve can't settle down anymore and has a tantrum. This tantrum results in the nerve dying, and becoming infected. The dying tantrum nerve can cause quite a lot of pain. It can hurt on and off, wake you up from your sleep, hurt with hot or cold, or hurt to chew on. Once the nerve has died, you can get an abscess (pus) in the bone and gum around your tooth.
Other reasons you may need a root canal are if you have had a knock to your tooth (which may have interrupted the nerve and blood supply into the tooth), or gum disease.
To fix a tooth that has gotten sore, the inflamed/dying nerve inside needs to be removed. This can be done in two ways - firstly by removing the tooth with an extraction. Secondly, the tooth can stay and only the nerve gets removed. This procedure is called a root canal. So, a root canal procedure means you keep your tooth.
Above: the inside of a tooth showing the nerves and blood vessels. Known as the 'pulp'
Above: diagram showing how a large decay in a tooth leads to inflammation of the nerve 'pulp' in the middle of the tooth, and how the inflamed nerve then becomes dead and infected with an abscess
OK, I think I need a root canal treatment. What's Involved?
Root canal treatment is usually performed over 2-3 visits. You will be numbed up and have radiographs throughout the treatment.
The first visit will be to get you out of pain! This usually involves making a small opening through the top of your tooth, and cleaning out the root canal space and putting in antibiotic/anti-inflammatory medicine. This step also involves removing any old crowns or fillings that are on the tooth. This is important because sometimes important things are hiding under old fillings and crowns that can affect the outcome of your root canal treatment! Important things like cracks and decay! A temporary filling will be used to seal the tooth. The time between this visit and the second visit is a couple of weeks.
The second visit involves shaping the root canal space with special files and reamers and flushing them out. The aim of this step is to sterilize the root canal space. More medicine is left inside the canals at this time. The time between this visit and the third visit can be 2-10 weeks. The extra time allows the medicine to spread into all the nooks and crannies of the root canal space.
The third visit is the finishing of the root canal treatment! The canal spaces that have been cleaned are flushed out of all the medicine and filled up with rubber. The top of the tooth then generally requires a protective covering like a crown to prevent the tooth from splitting and requiring extraction. A well sealed filling on top of the tooth also helps elongate the life of your root canal, by preventing reinfection of the root canal space!
Above: molar tooth during second stage of root canal treatment getting sterilized with a special file
What will it feel like?
People are often worried about having root canal treatment. Local anaesthetic injections numb the tooth up. We then use a rubber dam (also known as a rain coat/umbrella) to keep everything nice and tidy. If you feel anxious about treatment, we have laughing gas and other options to help you feel more relaxed. If your tooth is very sensitive during the treatment, we STOP the procedure!
After the procedure, your gum and tooth might feel a little tender. This is usually manageable with paracetamol and nurofen. You should be able to go back to your normal life the day after your treatment. Just wait until you have the crown placed on your tooth before you start chewing too hard!
The root canal treatment is finished, what now?
Once your root canal treatment is finished your tooth will need a protective capping. This will usually be a ceramic (or gold) crown or onlay (conservative crown). The long term success of your root canal is strongly influenced by the seal at the top of the tooth. Crowning your tooth after the root canal helps to form a strong long term seal, and really helps to protect your tooth from cracking!
Because our teeth don't need the nerve, you should be able to use your tooth as normal!
Above: final stage of root canal procedure on a molar with rubber (gutta percha) filling in the canals, a core filling, and crown on top.
What are other things to know about root canal treatment?
Things to know before you start;
if your tooth is very painful before the procedure begins, you may experience discomfort during treatment. If this is the case for you we STOP the treatment and resume at a later day
after your anaesthetic wears off you might experience a bit of discomfort. This is usually temporary and settles in a couple of days. You can use panadol (paracetamol) and nurofen (ibuprofen)
the canals can be very tiny and difficult to find (especially if your tooth has had lots of fillings), if we can't find all the canals you may be best off having treatment with a root canal specialist
there is a chance an instrument may separate (break) inside your canal. If this happens your root canal can still usually be completed but may be best off finished with a root canal specialist