"We can save most teeth...
as long as there is enough
healthy tooth remaining."
Performed under microscope, with full local anaesthesia so you feel no pain... just relax and let us do the work.
We have performed thousands of root canal treatments and have an extremely high success rate. What makes us different is the fact we manage your situation all in house. So from simple or complex root canal treatment, to 3D imaging CT scanning and to the final crown we look after you every step. If your tooth cannot be saved... we can remove the tooth, preserve the bone and gum and place and implant should you wish. We even perform micro-surgical endodontic apicetomies where the tooth needs to be saved surgically if it has had existing 'successful' treatment.
WHAT IS A ROOT CANAL?
If decay, infection or trauma spreads to the nerve of a tooth your dentist will advise you (if the tooth is salvageable) to either have root canal treatment or failing this tooth removal.
Many patients can become very nervous when this procedure is mentioned to them, if anything the process should be relatively painless when anaesthetised correctly, although patients are generally warned of tenderness post operatively for 2-3 days. The process can take multiple appointments from start to finish but this can depend on the number of canals and the complexity of the treatment.
The aim for the dentist is to remove the affected pulp (nerve) in side the root/s of the tooth and then clean and shape the canal to allow room for the canal to be filled (normally with an inert rubber filling called gutta percha).
Once the root canal is completed the next important step is to seal the tooth with a filling and ideally a crown especially on the molar teeth. The benefit of this is to prevent the canals from becoming inflamed or infected again and a crown can protect the tooth from fracturing especially if a large filling is placed over the root canal.
Is it painful?
The procedure itself done by the dentist will be done under local anaesthetic so you should feel nothing once fully administered. We no longer perform general anaesthetic in dental practices therefore if you are very very nervous you may need to be referred to a hospital specialist. Although during the procedure you will be fine afterwards we normally state that it may take up to a week or so after for everything to feel normal again. Taking your usual painkillers such a paracetamol should be helpful.
My tooth is cracked what do I do?
If the fracture is small it may just need a simple filling or half crown. If extending into the nerve it may need a root canal and a crown. If the fracture extends all the way through the middle of the tooth and below the gum, the tooth may be un-restorable and need to be removed. If the tooth is also wobbly this normally suggests a poor prognosis and may result in the tooth being lost.
I have had lots of pain, infection or a big hole into the nerve of the tooth - what are my options?
1) Leave and do nothing.
Advantages: No expense. No treatment carried out by a dentist. You just keep living your life as you are. If you have no pain or the pain has settled there no guarantee that this will not develop in the future but as to when... we cannot predict it.
Disadvantages: If left the problem could get worse and any chances of possibly saving the tooth could go also. You could develop life threatening swelling or infection. This is not being over dramatic... it is a serious painful condition and must be treated as such. The longer you leave an infection, it could make anaesthetising the tooth harder and require more injections resultantly (whether you decide to save or remove it).
2) Try to save the tooth with root canal treatment.
Advantages: You get to keep the tooth for longer and avoid having a missing tooth or replacing it with a bridge, implant or denture. We normally say a good root canal and crown should last in the region of 10-15 years. This is not always guaranteed however, as there is no such thing as a 100% success forever in the field of dentistry. It is generally a painless procedure that can be completed in 1-2 visits.
Disadvantages: Cost... it is an expensive procedure due to amount of time, technical skill and expensive equipment needed i.e.microscopes. It can take a few visits for it all to be done due to the complexity of the process. At the end of your treatment we normally recommend a half or full crown to prevent the tooth from fracturing (which will add to the over all cost). Please read the answer to the question 'do I need a crown after a root canal?'.
As stated earlier there is no guarantee of a 100% success and how long it will be successful for (we do have an extremely high success rate but we do have a small failure percentage as we perform more complex treatments than most others). Sometimes after your treatment there could still be some infection that may require some antibiotics to clear it up. If it the tooth does not settle it may need further cleaning and the process repeated. If the tooth still has an infection, it may require surgery at the tip of the root to clean it out. If all other possibilities are exhausted or an extensive crack develops then the tooth may be lost.
3) Remove the tooth.
Advantages: Generally solves the problem of pain and symptoms. It is the quickest treatment solution. It is cheaper than having a root canal treatment. In time you can leave the space or replace the space with an implant, bridge or denture.
Disadvantages: Having a tooth it out is never a pleasant procedure. If the tooth is heavily broken down it may require surgical removal that can involve stitches afterwards. If you have osteoporosis, reduced immunity or poor healing it may take at least 3-6 months for the area to heal fully. Replacing the area with an implant, bridge or denture can become more costly over time than having a simple root canal treatment. We always advise where possible and practical to try and save teeth as nothing will ever perform as well in your mouth as your original healthy teeth.
Why do I need a crown (or half crown) on my tooth after a root canal?
Great question. The reason is that after a root canal procedure where we drill and file through the middle of the tooth it can become increasingly fragile. Therefore a crown will not only hopefully seal the tooth but also provide some added protection when you bite, eat and chew. We normally recommend having a crown done relatively soon (normally within the first 4-8 weeks) after the root canal procedure to provide this protection. The reason is that from experience, patient's have left it a little too long and then the tooth splits on eating one day and they end up losing the tooth. Therefore when we recommend this, it is normally for your own benefit especially if you have had a successful root canal performed already.
How successful is a root canal?
They are often very successful especially in teeth that have not been root treated before. As with all things there is a failure rate and no procedure has a 100% success rate.
Increased risks of failure can be:
- Reduced healing or immunity (certain medical conditions and infections can cause this).
- Previous root canal therapy on the same tooth.
- Previous placement of a metal post inside the tooth.
- An extensive micro-fracture in the tooth.
- Patients who clench, grind or traumatise their teeth.
- Patients undergoing complex orthodontics or surgery.
- If the tooth is heavily filled or has a large cavity - the more remaining tooth material left, the better the long term success.
- If the tooth has had previous apical root surgery (apicectomy).
- If the tooth is wobbly or has a very large infection (ie. loss of bone support or gum disease).
- If the tooth has had a root canal treatment but no crown has been placed on top.
- If the tooth has abnormal, complex or sclerosed (narrowed) root canals.
- If the tooth has a cyst or associated pathology (such as external/internal resorption - where it is being eaten away).
After root canal treatment the area will be sore for at least 3-7days. It may be swollen, bruised and tender. If a very large swelling or bruise develops, do contact your treating physician.
Most symptoms settle within the 7 day period and we just advise some painkillers and allow for natural healing. Sometimes people feel the odd 'niggle' or 'twinge' but this should be sporadic and not consistent.
If after 2-12 weeks you are still feeling some symptoms your clinician may advise the following:
i) To monitor the area or use antibiotic therapy to help remove residual infection.
ii) Going back inside the tooth and re-cleaning the area and checking for any missed canals or cracks.
iii) Root surgery (apicectomy). This is where we surgically cut the infected part of the root tip off to allow the area to heal.
iv) Crown placement. After a root canal, a tooth can be fragile after all the drilling, therefore we generally always recommend a crown to seal the tooth to prevent fractures and protect the root canal work.
If none of these options solve the situation, then the reality is that nothing may settle the tooth and that it may need removed. Sadly there is no guarantee or 100% success rate but in general as stated in the beginning, the success rate is generally quite high and teeth can last around 10-15 years if not much longer (if well looked after).
Why does my tooth need a root canal treatment?
As stated earlier often we need to carry out a root canal on a tooth for a number of reasons:
- An abscess has developed at the root tip (bacteria have spread through the tooth and collected at the root tip).
- The tooth has discoloured after trauma and the nerve has died (i.e it no longer feels the correct level of sensitivity to hot and cold).
- There is little tooth remaining and a post and core is required to enable a crown to stay on successfully.
- The tooth had a previous large filling or crown and the nerve was affected and has caused pain.
- The tooth has developed an extensive crack or decay into the root.
- A bacterial infection in the gum has spread into the root tip of the tooth.
Why do I need to have a crown (or half crown) after a root canal treatment?
As stated previously, a root canal normally involves the core of the tooth being drilled into and the roots filled. Although we do this procedure as minimally invasively as possible it can still create a lot of stress on the tooth. Therefore it is important to protect and seal the tooth from any further issues in the future. If left, there is a high risk of catastrophic fracture of the tooth which can lead to premature loss - essentially meaning the all the money, time and energy spent on the root canal will be for nothing!
Here are some of the reasons why a crown or half crown (overlay) is important:
- The tooth was heavily filled and a crown will replace this to protect the tooth from fracture.
- Once the root canal is cleaned as best as possible a crown helps seal the tooth from further bacterial invasion.
- If the cavity was heavily close to or under the gum, a crown will help create an easier to clean surface and better contact point with the neighbouring tooth (ie flossing and cleaning will be easier and prevent food trapping).
- We can make the tooth look like a natural unrestored tooth again - our white crowns are invisible.
- If you grind your teeth or have tooth wear we may recommend a special white extra strong zirconia crown or gold at the back.
- The crown may help restore your bite to the ideal position and maintain a balanced bite.
- A crown can help cover a discoloured tooth and be matched to the natural colour of the remaining teeth next to it.
How long does the procedure take and is it painful?
No the procedure should not be painful at all if correctly anaesthetised. Afterwards the area may feel swollen, tender on biting and bruised but we advise you to take your normal analgesia (painkiller) protocols. Depending on severity and complexity the procedure can either be completed in one appointment in under 60 minutes or take several sessions around 1-2 hours. We normally advise patients to watch our TV and go to sleep while we do all the work. Do not worry about keeping your jaw open the whole time - we will give you lots of breaks to go to the bathroom and relax your jaw muscles. You may be given a temporary filling or crown during this period until your treatment is fully completed (these temporaries are not meant for long term use and last around 2-4 weeks).