Getting to the Root of the Matter

By: Dr Richard Milner
Created on 07th June 2010

Dr Richard Milner of St Ann's Dental Clinic is a registered Specialist in endodontics, prosthodontics, periodontics and restorative dentistry. Here, he answers some of the more frequently asked questions about root canal therapy

What is an endodontist?
Endodontists are registered on the General Dental Council’s list of specialists and have completed postgraduate advanced specialist training in root canal therapy techniques. They have both the expertise and the day to day experience to enable them to predictably manage even the most complex of cases.

What is endodontics?
Endodontic — or root canal — therapy involves the removal of dead or infected pulp tissue from the root canals inside the teeth in order to prevent the spread of infection into surrounding tissues. The roots are then disinfected, dried, filled and sealed. This treatment is used to stop the pain of toothache and dental abscesses.

What are the benefits?
Endodontic therapy saves teeth that might otherwise be extracted. Alternative treatment options following tooth extraction would be their replacement with dentures, bridges or dental implants.

Why might you need endodontic therapy?
Pulp damage may be caused by tooth decay or as a result of tooth fracture due to
trauma. There is a risk of tooth devitalisation following the replacement of large fillings or as a result of teeth being prepared for crowns or bridges.

What should you expect following endodontic therapy?
Post-operative symptoms may depend upon how painful the tooth is prior to treatment. Symptoms are usually temporary and respond well to over the counter analgesics. It is normal to feel some tenderness around the tooth for a few days and patients often mention some jaw tenderness from having kept their mouth open for an extended period of time. The tooth may continue to feel ‘slightly different’ while healing is taking place.

Is endondontic therapy technically challenging?
Endodontists are often accused of ‘liking their gadgets’. However, speaking as an endodontist, an operating microscope, electronic instruments for measuring the lengths of roots, files that can navigate curved roots and warm root canal filling material enable your dentist to achieve the best possible treatment outcome.

Is the definitive tooth restoration important?
Endodontic therapy provides the foundation on which to return the tooth to full function. To ensure long-term success, it is very important that your dentist provides a good quality restoration. This may be a bonded filling, onlay or crown.

Rooting out the truth about RCT

Root canal therapy is the most feared dental procedure but these fears are often based on inaccurate information which prevents patients from making an informed decision

Myth #1:
Root canal therapy is painful
Root canal therapy is used to alleviate pain. Most people who have root canal therapy admit they did not experience any pain during the appointment and felt better afterward. This perception that root canal therapy is painful often stems from early treatment methods that are no longer used.

Myth #2:
Completing a root canal requires several appointments
In the majority of cases, treatment can be completed in a single visit. There are certain circumstances, for example a very infected tooth, in which further visits might be required.

Myth #3:
Root canal therapy causes illness
The idea that bacteria trapped inside an endodontically-treated tooth will cause illness, such as heart disease, kidney disease, or arthritis, stems from research conducted almost 100 years ago and recent attempts to confirm this research have been unsuccessful in proving that root canal treatment causes illness. Bacteria can be found in the mouth at anytime. Even teeth free from decay and gum disease have tested positive for bacteria.

Myth #4:
Teeth need to hurt before root canal therapy becomes necessary
Teeth that require root canal therapy are not always painful. In fact, teeth that are already dead may require root canal therapy to prevent the tooth from becoming infected.

Myth #5:
The benefits of root canal therapy don't last very long
A common misconception is that the benefits of root canal therapy don't last very long after the procedure has been completed. Prognosis is dependent on the condition of the tooth prior to treatment, the quality of the root filling and final restoration of the tooth. Occasionally
a tooth may not respond to treatment and further surgical endodontic treatment may be required. The response to treatment is monitored
symptomatically and with follow-up dental radiographs.

Unfortunately, when dealing with nature, there is no guarantee that patients will respond to the treatment. However, research has shown that the success rate for endodontic treatment that is carried out by specialist endodontists ranges from 90 to 97 per cent (which is similar
to the success rate for dental implants) and 70 to 89 per cent for endodontic re-treatment.

When considering that extraction of the tooth is a possible alternative treatment and successful endodontic therapy alleviates symptoms of toothache, it may well be a very good treatment option.