Root canal treatment: how it works and the myths to forget

Why does a tooth need root canal treatment?

Inside every tooth is the pulp, living tissue made up of blood vessels and nerves, which fills the pulp chamber and the root canals. When the pulp is irreversibly inflamed or infected, it cannot heal on its own. Root canal treatment, also called endodontic treatment, involves removing it, cleaning and disinfecting the inside of the tooth, then sealing it.

The most common situations are:

• deep decay that has reached the nerve;
• a fracture or crack that exposes the pulp;
• a past injury after which the nerve has died;
• an infection at the tip of the root, sometimes found on an X-ray without any pain at all.

Certain signs should prompt a visit: pain that lingers after cold or heat, pain at night or that comes on by itself, a tooth that is tender when chewing, swelling or a small spot on the gum. Only an examination and an X-ray can confirm that root canal treatment is needed.

The procedure, step by step

Treatment follows a series of precise steps, which can vary depending on the tooth and the situation:

• Diagnosis: examination, sensitivity tests and an X-ray to see the roots and the surrounding bone.
• Local anaesthetic for the tooth and the area around it.
• Isolation of the tooth, usually with a dental dam, a thin flexible sheet that keeps saliva out and stops you swallowing the rinsing solutions.
• Opening the tooth to reach the pulp chamber.
• Cleaning and shaping the canals with fine instruments and disinfecting solutions.
• Filling the canals with a biocompatible material to stop bacteria from getting back in.
• Sealing the tooth with a temporary or permanent filling, followed by a check X-ray.

Molars, which have several roots and sometimes narrow or curved canals, usually take longer than front teeth. Practical details are set out on our root canal treatment page.

Anaesthesia: what you feel during treatment

Root canal treatment is carried out under local anaesthetic, just like a filling. Once the anaesthetic has taken effect, the treatment should not be painful: you will mainly feel vibration, pressure and the discomfort of keeping your mouth open. If you feel pain, raise your hand: the dentist can give more anaesthetic.

A very inflamed tooth can sometimes be harder to numb. The dentist then has additional techniques available and may, if necessary, work in two stages: first relieving the pain, then completing treatment at a later session.

If you feel anxious, say so at the start of the appointment. Understanding each step and agreeing on a signal to pause often helps people approach the treatment more calmly.

One visit or several?

Depending on the situation, root canal treatment can be completed in a single visit or over several. The number of appointments depends in particular on:

• the number of canals and how complex they are;
• whether there is an infection or abscess, which may call for an antibacterial dressing between two sessions;
• how inflamed the tooth is at the first appointment;
• whether a previous root canal treatment has to be redone.

Between sessions, the tooth is closed with a temporary filling. Avoid chewing hard foods on that side and keep your next appointment: a temporary filling is not designed to last, and a poorly sealed tooth can become reinfected.

After treatment: a crown is often needed

In the days that follow, tenderness when chewing is common and usually eases gradually; an over-the-counter painkiller is normally enough. Pain that gets worse, swelling or fever are reasons to call the practice.

A root-treated tooth has often lost a lot of structure, because of the decay or fracture that led to treatment and the opening needed to reach the canals. It becomes more vulnerable to chewing forces, especially premolars and molars. That is why the dentist will often recommend protecting it with a dental crown, sometimes after rebuilding the core of the tooth.

Do not put off this final restoration: a root-treated tooth left for a long time with only a temporary filling is at risk of fracturing or becoming reinfected.

Three myths to forget

"Root canal treatment is extremely painful." This reputation dates from a time when techniques and anaesthetics were less effective. Today, treatment is carried out under local anaesthetic. The pain people dread is mostly the pain of the diseased tooth before treatment, which is exactly what root canal treatment aims to relieve.

"A root-treated tooth is dead, so it is useless." A root-treated tooth no longer has a nerve, but it stays anchored in the bone by its root and supporting tissues, which remain alive. Once properly restored, it lets you chew normally and helps preserve the bone and the position of the neighbouring teeth.

"It is simpler to just pull the tooth out." An extraction may seem quicker, but it leaves a gap that usually needs filling, with a bridge or a dental implant, to prevent neighbouring teeth from shifting and bone from being lost. When a tooth can be kept in good condition, keeping it is generally the preferred option. Extraction is still the right choice when the tooth is too badly broken down, fractured in the root, or has a poor outlook: it is a decision made case by case.

Root canal treatment in Rabat

Before any treatment, the dentist explains the diagnosis, the expected number of sessions, the restoration that will follow and the possible alternatives. Sometimes a tooth that has already had root canal treatment needs retreatment if an infection persists or returns: this option is also discussed at the consultation.

At German Dental Clinic in Agdal, examinations are supported by digital X-rays. If you have toothache or have been told you need root canal treatment, you can book an appointment for an assessment, whether you live in Agdal or elsewhere in Rabat.

Sources

• What is a Root Canal?, American Association of Endodontists
• Root canal treatment, NHS
• Root Canals, MouthHealthy, American Dental Association