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Root canal treatment is one of the most commonly administered treatments in the dental clinic. Learn exactly what it is, what it is done, and what you can expect from the procedure.

The word root canal treatment is the stuff of nightmares for a large majority of patients. Some of them have experienced painful root canal treatments or have heard about it from other people, while others have fallen prey to the representation of dental treatment in popular media.

Let us set the fact straight about what exactly root canal treatment is, why it's done, how its done, and how much pain you can expect to go through.

What is root canal treatment?

Every single tooth in our mouth has two parts. The crown and the root. The crown is the portion that is visible inside the mouth, while the root is what is embedded in the jawbone underneath the gums. While these parts may be different clinically speaking, they are still one tooth that is continuous and joined together.

At the center of every tooth (from the crown till the tip of the root) runs a canal which carries the nerve endings and blood supply. It is this central part, called as the pulp, which needs to be treated during root canal treatment [1].

The front teeth usually have one single root and one canal whereas the back teeth have multiple roots and multiple canals. A lot of variation is seen in the root anatomy of teeth and unexpected placement of canals or the number of canals can make the case more challenging [2].

Why is root canal treatment done?

Root canal treatment is done for a variety of reasons. The most common reason is tooth decay reaching the pulp chamber and causing pain. Once the decay has reached the center of the tooth, the infection can spread to the tip of the root and even lead to the formation of an abscess [3].

Root canal treatment may also be carried out for cracked teeth, injured teeth, sensitive teeth, teeth that need to be reduced in size for the formation of a crown or a bridge, or those that are causing an infection in the jawbone [4].

People walk into the dental office seeking relief for pain or worried about the appearance of a swelling in their mouth on most occasions when a treatment plan of root canal treatment is arrived at.

To put it simply, root canal treatment is carried out in order to save the teeth because often the only other alternative is to extract the tooth.

How is root canal treatment done?

The instruments and techniques used to perform root canals have undergone a massive change in the last decade or so but the basic idea remains the same. The tooth has to be drilled to gain access to the canal (s) in the tooth, the pulp is removed, canal is disinfected, and then filled with a biocompatible material [5].

The tooth technically becomes ‘dead’ after the completion of a root canal because all of its blood supply and nerve endings have been removed.

Root canal treatment may be carried out in one appointment or several appointments depending upon the state of the tooth before treatment began. Intentional root canal treatment in a non-infected tooth can be carried out in one appointment predictably while severely infected cases need to be treated slowly over three or more appointments [6].

Each appointment is usually 15-20 minutes long.

Root canal treatment was performed by hand instruments in earlier decades but now rotary instruments have made the task much quicker, efficient, and predictable. Newer techniques to disinfect canals, microscopes to be able to see the canal in detail that was not possible before, and better restorative techniques have made it possible to save teeth with root canal treatment that would have been extracted without a second thought a decade or so back [7].

Is root canal treatment painful?

In the overwhelming majority of the cases, root canal treatment is not painful. The entire treatment is performed under local anesthesia to ensure that the patient is as comfortable as possible. Remember, that in most cases the patients already come with pain when they get the treatment started. Tooth pain, when associated with an irritated pulp, can be severe and even be referred to the ear, the head, or other teeth [8].

It is this pain that people associate with the treatment but that is not true at all.

Patients will find a marked relief in pain after the first appointment when most of the pulp will be removed and the canal begins to be disinfected. The second appointment where the canal is cleaned and shaped should result in a complete cessation of pain [9].

In some cases, though, the tooth may be too infected to save or may not respond to treatment. In such cases, the dentist may recommend extracting the teeth after attempting to save it via RCT. It should be remembered that such instances are less than 3-4% of the total cases treated in most clinics.

Root canal treatment being formed in a tooth where incomplete treatment was provided before or a re-infection has occurred is also more likely to result in pain than the first time treatment is being performed. This is because the severity of the infection is more and also the technique required to perform re-treatment is a lot more challenging [10].  

Is a crown necessary after root canal treatment?

The decay that affects a tooth causing it to need root canal treatment and the very nature of the treatment procedure which involved drilling away a lot of the tooth structure makes a root canal treated tooth weak. If the tooth being treated is one that has to bear the load of chewing forces then there is a very high chance of it being fractured under these loads.

If a root canal treated tooth gets fractures then it almost always needs to be extracted and all the work, money, and effort spent on a successful root canal treatment will go to waste. This is why it is recommended that every root canal treated tooth be fitted with a crown afterward [11].

While a root canal treatment technically ends when the canal is filled, the clinical restoration of the tooth is when it becomes functional again.

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