Misconceptions Regarding Root Canal Treatments

There are many misconceptions surrounding Root Canal Treatments, and it would be fair to say they have a bad reputation. When done correctly, a Root Canal Treatment should not be painful. They require the same level of anaesthesia as would be used for a simple filling. They are also often thought of as having low success rates. However the British Endodontic Society states RCT’s should have success rates of up to 90% when “carried out to a good standard”. At The Keith Dental Practice, our success rate over the previous 6 years (from 1/1/12 to 1/1/18) was 97.18%. We are fortunate to have a microscope and other equipment, which greatly helps the dentist locate, access and treat more difficult canals. There can be no guarantee of success when beginning RCT. This can be because: the tooth has difficult anatomy such as severely curved, narrow or unreachable accessory canals; it may have had previous unsuccessful root canal treatment; or it may have extensive calcification inside the pulp chamber making access to the canals exceptionally difficult or even impossible.

Why might you need Root Canal Treatment?

Teeth can become affected by decay or fractures which expose the pulp tissue to bacteria from saliva. If not treated promptly, this can then lead to infection of the bone supporting the tooth, abscess formation and ­­­­pain.

Root canal treatment or extraction is advised when the tooth has reached a stage called irreversible pulpitis. This means that the tooth can no longer recover.  Extraction of a tooth could create a functional problem such as chewing or an aesthetic problem, particularly if the tooth is visible when the patient smiles or speaks. Restoring the lost tooth may involve making a prosthetic replacement such as a denture, bridge or a dental implant, the costs of which are variable. Root Canal Treatment removes the infected tissue from the tooth which allows the patient to keep their own tooth.

So what is Root Canal Treatment?

Root Canal Treatment (or RCT) is the process by which infected or damaged pulp tissue is removed from inside the tooth and roots in order to prevent a tooth from being extracted.

What does Root Canal Treatment involve?

It involves firstly, a dental radiograph which allows us to locate the canals, and also to measure the length of the canals.  After successful anaesthesia is achieved, the tooth is isolated using a rubber dam. This is a sheet of thin material, usually nitrile, allowing us to isolate the tooth from saliva and protect the surrounding tissues while we work. An access cavity is made in the tooth through which we can access the canal(s). A series of small instruments are then used in sequence to widen the canals and remove infected tissue, as well as irrigation with specialised solutions. Once the dentist is certain that the canals are clean and that there is no longer pain, the canals are dried, sealed and filled with a suitable filling material. When done correctly, this ensures that bacteria cannot re-enter the canal space and cause pain again. It is important to note that when RCT is started, it must be completed and have a permanent restoration to avoid re-infection. Permanent restorations vary but it is very important to have a permanent restoration after RCT as this also helps to prevent re-infection.

In certain cases, RCT’s can take place over a few visits. An antibacterial endodontic dressing is placed between appointments which helps to prevent re-infection between appointments.

When the canals are all filled, the dentist will then restore with a suitable restorative. This is dependent on the strength of the remaining tooth structure.

Teeth that have been root-treated sometimes do not settle down immediately. This can be because of the reasons listed in the beginning. In this case, teeth can be re-treated (re-RCT) which means that the original root filling material is removed and the canals are re-cleaned, re-dried, re-sealed and re-filled.  As a result of this, the success rate of re-treatments is lower.

There is no substitute for our own teeth and their supporting structures, and therefore Root Canal Treatments allow us to preserve our natural teeth and prevent extraction.

Written by Miss Faye Law
Senior Dental Nurse at The Keith Dental Practice
22/01/2019
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