The soft tissue in the centre of a tooth that contains the nerves, blood vessels and connective tissue is called the pulp. Endodontics or root canal treatment is treatment carried out to either maintain the health of the pulp or remove it to prevent or treat infection - commonly termed, an abscess.
If the pulp in your tooth is not healthy, either because it is inflamed, infected or has died, it needs to be removed, the space cleaned, then filled and finally the tooth can be restored.
Sometimes, if a tooth is very broken down, root canal treatment is required to gain space in order to build the tooth back up again - think of it as the ‘foundation’ for the crown. On occasions, a post may be used to do this.
A post is part of the filling that extends in to the root canal on top of which a crown can be placed.
Local anaesthetic is used to numb the area. A barrier or rubber dam is placed around the tooth to isolate it from the rest of the mouth. This prevents instruments and materials falling in to your mouth or airway and also prevents bacteria naturally present in your mouth, from entering the tooth. To get to the root canals, a small hole is made in the crown of your tooth through which the root canals are cleaned and filled. This is initially carried out using instruments that you will have experienced if you have had a regular filling before. Fine files are then used to reshape the inside of your tooth.
Your dentist will have suggested that you see a Specialist Endodontist, someone who has received further training in root canal treatments (endodontics) and is registered as a Specialist in Endodontics with the General Dental Council, the governing body for dentistry. After the initial consultation appointment with the endodontist, treatment typically takes one or two, 90-minute long appointments. Please ask when you book the consultation because it may be possible to schedule the treatment immediately afterwards, this means the whole process may only take one visit but of course treatment would only proceed with your consent.
Root canal treatment can be extremely technically demanding (fiddly). It therefore takes time, patience and good technical skills to do the work thoroughly, that’s where the time is spent.
Each tooth is different. Your treatment will be discussed and only carried out if you agree (consent). You will receive an individual, itemised treatment plan including fees for all treatments.
Root canal treatment, as a general rule, has the best chance of success when done well the first time. If you are having it done again, it really depends on why. Below are some examples of why you might need root canal treatment again (root canal retreatment).
- Leakage of bacteria from the crown of the tooth such as if the crown or the filling in the tooth has come out.
- The previous root canal treatment could be technically improved.
- Something was broken in the tooth before and it needs to be removed.
Normally root canal treatment can be carried out through the crown of the tooth. If there is a filling or a crown already in place, it may be leaking which has resulted in the root canal treatment being required. It is better in these cases to remove the crown or filling, carry out the root canal treatment and have a new one placed by your dentist. An added advantage of removing the filling or crown is the tooth underneath can be inspected closely for cracks or decay and it also confirms that your dentist will be able to restore (rebuild) the tooth afterwards.
If the crown or filling is to be left in place, a hole is either made through it (as if it wasn’t there) or surgery is carried out whereby the crown is not touched and access is gained to the root of the tooth by lifting the gum up in a surgical procedure and the infection accessed directly that way.
All treatment will be carried out under local anaesthetic so there should be no reason that the treatment should hurt.
Sometimes discomfort may be felt after each appointment. This is because we are generally dealing with already inflamed tissue and by carrying out the treatment, we are stirring things up further. As a general rule, you are more likely to have pain after the appointment if you had pain before the appointment. Rather than causing discomfort, root canal treatment often treats or prevents pain occurring.
If you need something for discomfort afterwards, whatever you take for a headache such as ibuprofen or paracetamol tends to work well. Antibiotics are only very rarely required as we only need to allow time for the body to manage the inflammation.
Rather than thinking of the root canals as tubes within the tooth, think of them more like trees in autumn, without the leaves. There are lots of little branches and ‘hiding places’ for the bacteria within the root. Unlike say a chest infection, where the bacteria are within reach of circulating blood and antibiotics within it, the areas in a tooth where the bacteria are, are not exposed to the circulation. During times of acute infection, where the bacteria ‘spill out’ in to the tissues beyond the root, antibiotics can have some benefit in the short term, however, the long term solution is to get rid of the source of the infection i.e. the bacteria within the tooth, by carrying out root canal treatment or indeed an extraction.
Your treatment includes at least one follow-up appointment 6-12 months after the initial treatment is complete to ensure the treatment is working. If further appointments are required this will be explained.
Further root canal treatment, if required, will be carried out by us but normally once the root canal treatment is complete, the tooth should be restored as soon as possible and you will be discharged back to your dentist to have this carried out.
If a tooth is knocked it may become pink due to bleeding that occurs within the crown of the tooth. This may only remain for a couple of days in which case, no treatment is required. If this remains for longer or the tooth becomes discoloured grey or black (which can be up to 2 years after the injury), bleaching may be required to restore the tooth to a more ‘normal’ appearance.
If a tooth has been knocked, it may become discoloured a yellow-brown colour. This is because the inside of the tooth may become calcified, affecting the way light flows through the tooth. This can be very difficult to treat and indeed, even if the colour can be regained, the amount of light able to pass through the tooth, may remain affected.
An itemised bill will be provided for you depending on what is required but you can see our fee structure using the tab at the top of the page.
Fees vary depending on location. They will always be made clear to you for each case, but as a guide:
|Incisors & canines:
|Any other treatment
||£350* - e.g. coronal disassembly, non-surgical perforation repair etc.
|Surgery prices from
||£900* - case specific rates apply
Consultations followed immediately by treatment are available with prior arrangement
Non-surgical endodontic treatment and retreatment fees are the same
|Intravenous sedation is available from £350 per session
Root canal treatment has the highest success when there is no infection for example after trauma. Success rates are well in excess of 90% in these cases. In the presence of infection, such as after an abscess, success rates generally reduce. This reduces further if the root canal treatment is being carried out for the second time but it will depend specifically on why the root canal treatment is required.
Once the pulp of the tooth is damaged, there are only 2 options. Root canal treatment or an extraction. Either could be considered the ‘right thing’ depending on how keen you are to save your teeth. An extraction is usually relatively quick and simple. You are then left with a gap which may or may not be acceptable. The gap does not necessarily need to be filled, but if you choose to do so, you could have a denture, a bridge or an implant. Speak to your dentist about your specific options.
If it doesn’t work, you still have the option of an extraction, you could have the root canal treatment redone in a similar way to the first time or an alternative is called apical surgery.
This approaches the infection ‘head-on’ by a small surgical procedure where the gum is lifted up and the tip of the root including the surrounding infection is removed, leaving the rest of the tooth intact. This process might also be used if the root is damaged but can be repaired. Recession of the gum line, exposing more of the neck of the tooth can sometimes occur so care needs to be taken during the operation. Very small stitches are placed which need to be removed about 3 days later. A good crown and good quality root canal treatment will result in the most successful outcome.
As a general rule, root canal treatment is demanding and time-consuming. The most efficient way of managing the process is by asking someone who does it all day, everyday to do it. That’s where the endodontist comes in.
There are several reasons your tooth might be sore after the treatment. Most commonly, it’s because the tissue around the tooth is inflamed and the body needs time to sort it out, just like a bruise, it will get better on its own. This pain will get better after a couple of days but pain killers in the meantime such as those you take for a headache will help.
The body has remarkable healing potential. The tooth is no different. Despite the presence of bacteria or inflammation, once the balance is shifted in favour of the body, healing should occur and that’s the aim of the treatment!
Because the inside of the tooth has been cored-out, the tooth is structurally weaker. This is the reason you should have the crown restored as soon as possible by your dentist who referred you.
Feel free to ask any question at any time either using the link, asking in person or via the blog.
We strive to achieve the very best experience and care and therefore take complaints very seriously. In the first instance, please let us know if our service has fallen below the mark. We are confident we will be able to resolve your concern. If you feel your concern is not dealt with appropriately, The Dental Complaints Service exists to assist private dental patients and dental professionals resolve complaints about private dental services.
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