Are you about to get a root canal treatment done? This is everything you need to know before you get in the chair.

What is a root canal treatment, and who performs it?

A root canal is a commonly performed dental treatment to try and save a damaged, decayed, or infected tooth. It involves drilling inside the tooth to gain access to the "pulp", which is where all the nerve endings are. Precise instruments are then used to clean the tooth out all the way through to its root tip, disinfect it, shape it, and then fill it up with biocompatible sealing materials.

Root canal treatment can be performed by any trained dentist, as it is taught as a skill during undergraduate training. Not all toot canal treatments are the same, though, and some may require more skill and precision. In such cases, an endodontist is the preferred doctor to see.

An endodontist is someone who has specialized in root canal treatment and is well versed with the latest advances, techniques, as well as materials available for the procedure. Endodontists also exclusively practice root canal treatment and are trained to navigate potential pitfalls and complications that might arise during root canal treatment.

When is root canal treatment done?

Root canal treatment is performed for a variety of reasons. The most common one is tooth decay (dental caries). Once tooth decay has progressed beyond the outer layers of the tooth, it starts to reach the nerves that lie within the pulp. This collection of nerves extends through the tooth to the root tip.

Tooth decay extending this far deep into the tooth causes inflammation of the pulp, which results in pain and discomfort. As the infection takes root, swelling, discoloration of the tooth, and bad breath can also arise. All of these symptoms point to the need for a root canal treatment.

A fracture of the tooth due to a direct injury or treatment required for prosthetic purposes can also require root canal treatment. In some cases, the patient may not have any pain or other discernible symptoms because the tooth has died.

To put it simply, root canal treatment is done to remove bacterial infection from the tooth and its surrounding areas. Pain may lead a patient to visit their dentist, or a person may be told about needing this treatment after a clinical examination.

Interesting facts about root canal treatment

Here are some numbers from the American Association of Endodontists "to chew on":

  • Approximately 15 million root canal procedures are performed each year
  • On average, endodontists perform around 25 root canal treatments every week
  • A study evaluating the five-year outcome of over 1.5 million root canal treated teeth found that 93 percent of the treated teeth had survived and were functioning in the mouth.
  • 89 percent of patients are satisfied after seeing an endodontist for their root canal treatment
  • About 50 percent of the root canal cases that go to a general dentist are referred to an endodontist

What are the symptoms that indicate you need a root canal treatment?

The most common symptom that a patient suffers from when they need root canal treatment is pain. The pain is usually severe in nature and increases on eating or drinking anything that is too hot or cold. People also notice that the pain increases at night or at any other time while lying down for a protracted period of time.

The pain that indicate you need a root canal treatment also typically radiates to different parts of the face like the ear, the forehead, or the back of the neck. In a lot of cases, patients find it difficult to localize the exact tooth from which the pain is radiating. Swelling of the gums or on the face, pus in the mouth or discoloration of the tooth are some of the other symptoms that you need an RCT.

How do dentists diagnose that you need root canal treatment?

Dentists diagnose the need for root canal treatment through a combination of clinical examination, patient history, x-rays, and accumulated experience of dental practice over the years. A dentist can usually recognize that you need a root canal without x-rays, but that doesn't mean one shouldn't be taken.

What are the different root canal treatment techniques?

The technical process of performing root canal treatment as well as the kind of instruments that are now at the disposal of the dentist have undergone a radical change in recent times. The biggest difference between traditional RCT and how root canal treatment has changed in recent decades is that it has gone from being a "blind" procedure to a highly predictable process where each and every step of the procedure can be visualized and tracked.

In the past, root canal treatment procedure was performed with hand files. This required more time and effort from the dentist and resulted in canal shapes that were not standardized. Now, rotary files are the standard method of performing root canal treatment. This has made the process of cleaning and shaping the root canals quick, easy, and standardized.

As a result, the final act of filling the canals with biocompatible material called guttapercha can also be done more efficiently and with a greater degree of success.

Other advances such as RVGs, which allow the dentist to take digital x-rays and make measurements on the computer to help aid in the root canal procedure, or apex locators, where the root length can be measured without any x-rays needed at all have also made the root canal procedure easier for dentists.

Nowadays, the latest area of development is endodontic microscopes. These are magnification devices developed specifically to provide a clear view of the root canals, something which was unimaginable just a few years ago.

All of these devices are becoming less expensive and thus more readily available around the world. They are also increasing in accuracy and being better understood as more and more dentists use them.

This is why the root canal treatment provided today is very different than from even a few years ago. The materials used for filling the root canals after the shaping and is infection are over have also gone tremendous improvement. All of these changes taken together have made root canal treatment more successful and predictable than ever before.

Can root canal treatment be done in one sitting?

Root canal treatment was traditionally carried out over two to three sittings depending on the clinical state of the tooth. Single-sitting root canal treatment that is completed during one appointment is now very popular. This saves the patient time and makes life easier for the dentist as well. Single sitting root canal treatment can easily be performed in the vast majority of the cases. There are certain clinical situations where this is not possible, which the dentist should tell the patient at the time of treatment.

Is root canal treatment painful? Do you need anesthesia?

There is a perception of root canal treatment being very painful. This is not true in 99.99 percent of the cases — root canal treatments typically don't cause much pain. In very few cases, infection or patient apprehension may make pain control difficult but there ware ways to get past those clinical situations as well.

Root canal treatment is next to impossible without proper anesthesia being administered first. There are a large number of nerve endings in the pulp and this is why some amount of pain can occur if the tooth is very infected or not properly anesthetized.

What is the aftercare of root canal treatment?

Root canal treatment can take more than one sitting and so patients need to be careful during the entire process. Eating anything too hard from the side where the root canal treated tooth is or applying a lot of biting pressure to the tooth being treated is not recommended.

Once the root canal treatment has been completed, patients must get a crown or cap on top of the tooth to protect it in the long term. Apart from this, just take care not to bite the tongue or injure yourself until the anesthesia wears off.

What is the average RCT failure rate?

There are a number of studies which have been performed around the world measuring the success rates of root canal treatment over different time spans. Most of these studies have found:

  • A failure rate of around five to 10 percent over the first three to five years after root canal treatment
  • An eight to 13 percent failure rate 10 years after completion of root canal treatment.

There are a number of factors that influence the success of root canal treatment not all of which can be quantified, and this is why these numbers must be taken with a pinch of salt.

How long will a tooth with a root canal treatment last?

There is no time limit after which a tooth with root canal treatment will fall out. Teeth with root canal treatment can last an entire lifetime if they are cared for properly, or they may end up "failing" within a few years. On average, though, it is estimated that a root canal treated tooth will last for about 10 to 13 years in the mouth.

Root canal treated teeth which are covered with a good cap have a much better survival span than those that are not. Similarly, teeth in the front of the mouth have a longer survival span than teeth in the back of the mouth.

Can you avoid root canal treatment? What are the alternatives?

If you want to know how to avoid a root canal treatment, practicing proper dental hygiene and visiting your dentist twice a year are the first places to look.

Once a tooth has decayed to a certain point, root canal treatment becomes the only option to try and save that tooth. The only real alternative to root canal treatment is the extraction of the tooth. This is why dentists and public health systems advocate prevention of dental problems or at the very least their early detection.

Newer treatment modalities like stem cell stem treatment to regenerate the pulp or even the complete tooth are being worked on but they are very far from being introduced as treatment options to the public right now.

What are the potential complications of root canal treatment?

Complications from root canal treatments are rare. The entire procedure is limited to the root length and there are no systemic effects of the treatment. There has been a rise in baseless rumors about the "complications" of root canal treatment but that seems to be the world we live in these days.

The only real complication, if one were to call it that, is an increase in brittleness of the tooth following root canal treatment. The procedure involves drilling inside the tooth till the tip of the root and this makes the tooth easy to fracture. This is why a cap must be placed on almost all root canal treated teeth.

Root canal treatment in children?

Root canal treatment is performed routinely in children. Milk teeth have a big pulp chamber and the outer protective layers of the milk teeth are not as strong as those seen in the permanent teeth. The level of oral hygiene in children is poor so root canal treatment is often needed.

RCT can be performed without any trouble in children. The only difference is in the final filling material. In children, this final filling material must be destroyed with the primary tooth when it is replaced by its permanent successor.

Root canal treatment in cancer patients?

Root canal treatment can safely be performed in cancer patients. In fact, patients who are undergoing radiation therapy or are taking chemotherapeutic drugs cannot get extractions done and so root canal treatment may be the only option available to them.

Extra care has to be taken about sterilization protocols in cancer patients because their immunity might be a bit compromised.  

Root canal treatment in pregnant women?

Ideally, root canal treatment in pregnant women should only be performed during the second trimester. However, the need for root canal treatment may not always come during that time. If needed, root canal treatment can be provided at any time of the pregnancy to give relief to the woman and prevent the spreading of infection in the body.

Care must be taken to keep the appointments short for the pregnant women and to adjust the chair positions in accordance with the advised lying down position. A go-ahead from the attending gynecologist must also be taken before commencing with root canal treatment.  

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