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Root canal treatment

Root canal treatment involves removing infected tissue from your tooth, cleaning the root canal and then filling it to prevent further damage or infection. Root canal treatment can save your tooth from having to be taken out.

You will meet the dentist carrying out your procedure to discuss your care. It may slightly differ from what is described here as it will be designed to meet your individual needs.

In the middle of each tooth there is a core of blood vessels and nerves called pulp. The pulp sits inside a space called the root canal. Each tooth can have one or more root canals. Your front teeth often have just one root canal, whereas your back teeth may have three or more.

The pulp in your tooth can become infected with bacteria if your tooth becomes damaged.

This can happen in a number of ways. These include:

  • severe tooth decay
  • an injury, such as a blow to your mouth
  • cracked or loose fillings, or repeated fillings in your tooth
  • gum disease

If the pulp in your tooth becomes infected this can spread to the root canal and your tooth may become painful. If the infection spreads further it can cause a tooth or dental abscess, which is a collection of pus. This can be painful and tender when you bite down on your tooth and can cause swelling around your tooth and jaw.

Sometimes your tooth may look darker in colour than your other teeth, which means that the nerve inside your tooth is dead or dying. Without treatment the infection may spread further into your jawbone and you may need to have your tooth taken out.

The aim of root canal treatment is to remove the damaged pulp and the bacteria that is causing the infection. Your dentist will drill a hole into the tooth to the root canal and remove the pulp and infected tissue. He or she will then clean and fill the empty root canal and put a permanent seal over the top of your tooth.

Root canal treatment can save a tooth which would otherwise need to be taken out. When a tooth is removed it can affect how you look and also how well you chew. Although your dentist will remove nerves and blood vessels from your tooth when the pulp is taken out, your tooth will continue to live. This is because the surrounding tissues provide it with the blood and nutrients it needs.

Root canal treatment can often be done in one session, or you may need to have treatment over more than one session. How long your treatment takes will depend on how severe your dental problem is and the type of tooth in question. If your affected tooth is a molar with two or three root canals, the treatment may be more difficult and involve more sessions.

All dentists can carry out root canal treatment. However, if you need repeated root canal treatment on a tooth that has already had it (this is called re-treatment), or if your tooth is difficult to treat, your dentist may refer you to an endodontist. This is a specialist in root canal treatment.

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An image showing the area treated when you have root canal therapy

Details

  • Preparation Preparing for root canal treatment

    Your dentist will ask about your symptoms and examine you. He or she may also ask you about your medical history and any previous treatment you have had on your teeth.

    Your dentist will also take an X-ray of your tooth. This can help to show how far any infection has spread, if there is an abscess and how many root canals your tooth has.

    Root canal treatment is usually done under local anaesthesia, which means that it won’t hurt. This completely blocks pain from your jaw area and you will stay awake during the procedure. If you’re concerned about having a local anaesthetic, talk to your dentist.

    Your dentist will discuss with you what will happen before, during and after your procedure, and any pain you might have. This is your opportunity to understand what will happen. You can help yourself by preparing questions to ask about the risks, benefits and any alternatives to the procedure. This will help you to be informed, so you can give your consent for the procedure to go ahead. You may be asked to sign a consent form before your treatment begins.

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  • Alternatives What are the alternatives to root canal treatment?

    Sometimes damaged teeth can’t be repaired with root canal treatment. This is usually if your tooth is badly damaged or if you have severe gum disease which prevents your tooth from healing or being well supported after treatment. In this case your dentist may suggest you have the tooth removed (extracted).

  • The procedure What happens during root canal treatment?

    If you need a local anaesthetic, your dentist will give it to you a few minutes before the procedure, to give it time to work. He will separate your tooth from the rest of your mouth using a thin sheet of rubber, called a dam. This helps to stop the spread of any infection. It also prevents you from swallowing or breathing in any small instruments or fluids used during the procedure.

    Your dentist will make a hole in the top of your tooth and remove the dead or diseased pulp. He or she will then clean out the empty hole using a fluid that also helps to get rid of any infection. The hole in your tooth may need to be widened to make sure it can be filled properly. Your dentist will do this using small files. This can take several hours and may have to be done over more than one visit. If your root canal is severely damaged, this may be all the treatment you have during your first visit.

    Your dentist will put a temporary filling in your tooth to keep it sealed until you go back for the next stage of your treatment. However, if your tooth isn’t severely damaged your dentist may put a permanent filling in and seal the tooth. He or she may take an X-ray to check it before your tooth is filled.

    If your root canal treatment involves more than one appointment, your temporary filling will be removed by your dentist on your next visit, before he or she carries out further root canal treatment. When your root canal work is finished, your dentist will seal your tooth to prevent infection and further damage. If there’s a risk your tooth may become damaged again your dentist may suggest having a crown fitted. This is an artificial cap that fits over your tooth.

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  • Aftercare What to expect afterwards

    You will usually be able to go home when you feel ready. After a local anaesthetic, it may take several hours before the feeling comes back into your mouth.

    You may need pain relief to help with any discomfort as the anaesthetic wears off. If you need pain relief, you can take over-the-counter painkillers such as paracetamol. Always read the patient information leaflet that comes with your medicine and if you have any questions, ask your pharmacist for advice.

  • Recovery Recovering from root canal treatment

    Your root canal treatment should be checked by your dentist after a year. You will have an X-ray and your dentist will check for any pain, swelling or signs of infection or damage. You may need to have further checks over the next four years if there‘s any sign of damage, or if your tooth doesn’t heal properly. Some people need to have further root canal treatment.

    After your treatment, it's important to take care of your repaired tooth. Brush your teeth twice a day, floss between your teeth every day and have sugary foods or drinks only at mealtimes. You can also take care of your teeth by visiting your dentist regularly for a check-up. Your dentist will advise you about how often you should have a dental check-up. On average, this may be every six to 12 months, but it depends on your individual circumstances and your dental health.

  • Risks What are the risks?

    As with every procedure, there are some risks associated with root canal treatment. We have not included the chance of these happening as they are specific to you and differ for every person. Ask your dentist to explain how these risks apply to you.

    Side-effects

    Side-effects are the unwanted but mostly temporary effects you may get after having the procedure.

    Cleaning your teeth may cause slight tenderness, but this is only temporary. If you have severe pain or any pain or discomfort that gets worse, see your dentist.

    Complications

    Complications are when problems occur during or after the treatment.

    Nine out of 10 times, root canal treatment is successful, but sometimes further problems can occur. For example, your tooth might not heal properly, become damaged or infected. Antibiotics may be prescribed to treat your dental infection. In some instances, you may be advised to have root canal treatment again. This is called re-treatment.
    It’s also possible for symptoms to return years after you’ve had root canal treatment and re-treatment may be suggested.

  • FAQs FAQs

    I am having root canal treatment. How long will the restored tooth last?

    Answer

    After root canal treatment the restored tooth should last as long as your other teeth. It’s important to look after your teeth and gums and to see your dentist regularly.

    Explanation

    Your treated tooth will stay healthy as long as the root is nourished by the tissues around it. This means your tooth could last a lifetime.

    After your treatment, it's important to take care of your repaired tooth as you would any other. For good mouth and dental hygiene, follow the points below.

    • Brush your teeth twice a day for two minutes, using fluoride toothpaste.
    • Floss between your teeth at least once a day.
    • Have small amounts of sugary foods and drinks, ideally at mealtimes only.
    • Have regular check-ups at your dentist.

    Will I have to pay for root canal treatment?

    Answer

    The cost of having root canal treatment varies. Ask your dentist to provide you with a written estimate of the costs involved before you start your root canal treatment.

    Explanation

    If you see an NHS dentist, you may be able to get your treatment for free or at a reduced cost. This will vary depending on your circumstances. For example, if you’re under 18, pregnant or receiving certain benefits, you will receive free treatment.

    If you see a dentist privately, you will need to pay all of your treatment costs. The costs of private root canal treatment will vary from dentist to dentist. It will also depend on how severe the problem is and the type of tooth being treated.

    Ask your dentist for information about costs before you start your treatment.

    Will I need to have a crown put on after root canal treatment?

    Answer

    You may need to have a crown fitted over your tooth that has had root canal treatment. This is because it can help to strengthen and protect your tooth from further damage. Crowns are caps made out of a material like porcelain, which fit over your tooth to protect it.

    Explanation

    Crowns are used to cover teeth that have been broken, or have been weakened by a large filling, decay or after root canal treatment. If your tooth has been badly damaged, you’re likely to need a crown after root canal treatment.

    Your dentist will take an impression of your tooth using a soft, mouldable material. He will have your crown made based on the impression to make sure it’s the right shape and size. You will be given a temporary crown while the permanent one is made. This isn’t as strong as a permanent crown but you should still be able to chew your food with it in place.

    Your dentist will then fit the permanent crown. He will make sure you can bite comfortably with it in and then secure it into place. If a lot of your tooth is missing, your dentist may insert a peg into your root canal to hold the crown in place. It should last for many years if you look after your teeth well. You can look after your teeth by brushing your teeth for two minutes twice a day with fluoride toothpaste. Use dental floss or interdental brushes too to clean between your teeth daily.

    Cut down on eating sugary foods or drinks and have them only at mealtimes. You can also take care of your teeth by visiting your dentist regularly for a check up. Your dentist will advise you on how often you should go.

  • Resources Resources

    Further information

    Sources

    • Quality guidelines for endodontic treatment; consensus report of the European Society of Endodontology. Int Endod J 2006; 39:921–30 doi:10.1111/j.1365-2591.2006.01180.x
    • Mitchell L, Mitchell DA. Oxford handbook of clinical dentistry. 5th edition. Oxford: Oxford University Press, 2013:254–5, 276–291
    • Teeth. The Merck Manuals. www.merckmanuals.com, published September 2013
    • Caries. The Merck Manuals. www.merckmanuals.com, published September 2013
    • Dental abscess. NICE Clinical Knowledge Summaries. cks.nice.org.uk, published September 2012
    • Pulpitis. The Merck Manuals. www.merckmanuals.com, published September 2013
    • Guidelines for surgical endodontics. Royal College of Surgeons. www.rcseng.ac.uk, published 2012
    • Methods of diagnosis and treatment in endodontics: a systematic review. Swedish Council on Health Technology Assessment. www.sbu.se, published November 2010
    • Further information. British Endodontic Society. www.britishendodonticsociety.org.uk, accessed 6 January 2014
    • Pain management in dentistry. Medscape. www.emedicine.medscape.com, published 3 February 2012
    • Root canal treatment. British Dental Health Foundation. www.dentalhealth.org, accessed 6 January 2014
    • Dental recall. National Institute for Health and Care Excellence, October 2004. www.nice.org.uk
    • FAQs. BDA Smile (British Dental Association). www.bdasmile.org, accessed 7 January 2014
    • Caring for my teeth. British Dental Health Foundation. www.dentalhealth.org,accessed 7 January 2014
    • Analgesics. British National Formulary (online). www.medicinescomplete.com, London: BMJ group and Pharmaceutical Press, accessed 7 January 2014 (online version)
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    Reviewed by Natalie Heaton, Bupa Health Information Team, February 2014.

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