Root Canal Treatment is a simple chairside procedure done to save the tooth that has been affected by caries severely, infecting the pulp of the tooth, and sometimes extending beyond the apex of the root of the tooth, infecting the surrounding peri-radicular tissues, and also in some other cases.
The most common complaint that the patients come up with to a dentist is toothache and the frequently heard term by them is root canal treatment. It is a simple chairside procedure done to save the tooth that has been affected by caries severely, infecting the pulp of the tooth, and sometimes extending beyond the apex of the root of the tooth, infecting the surrounding peri-radicular tissues, and also in some other cases as discussed below.
Once the carious process reaches the third layer (soft tissue-pulp) of the tooth, the only two options left to save the tooth in a mature adult tooth are either extraction or root canal treatment (RCT). The tooth needs to be assessed and evaluated to check for the prognosis and decide the treatment.
As the name suggests, RCT is associated with treating the canals of the root of the tooth. The procedure can be divided mainly into three processes, namely, getting access to the canal, cleaning, and shaping of the canal and finally refilling the space within the canal with an inert material. After doing all the required basic history taking (personal, medical and regarding the complaint of the patient), doing clinical and radiological examinations (OPG or IOPA X-rays), diagnosing and treatment planning, the procedure is carried out.
Being a chairside procedure, it is done under local anesthesia. Once the tooth is anesthetized, the dentist opens and cleans the cavity, reaching the canal opening. After which, the remnants of dead pulp and debris are removed followed by cleaning and shaping of the canal and disinfecting it. Sometimes, when the infection is chronic or has reached beyond the tooth within the bone, the first appointment ceases here with the application of intracanal medicament (Calcium hydroxide dressing). In other cases, it can be completed within a single visit. The second visit or the last process involves filling of the cleaned and shaped canal with an inert material (Gutta-percha) in order to prevent any reinfection, mainly any retrograde infection.
Following all this, the cavity is sealed with a temporary filling for 5 to 7 days and if there are no symptoms within those days, it is changed to a permanent filling and a crown is placed. Again, simply a crown or post and core is based on the remaining tooth structure and other prognostic factors.
Most of the time, the RCT term being a cliched one, brings in fear in the patient. But, though the procedure seems to be vast, there is nothing dangerous or painful to be worried about. All the concerns of the patient are taken into consideration by the dentist and the patient is always welcome to talk about the doubts and fears to the doctor.
There can be various causes leading to root canal treatment and they are as follows:
It is necessary to do the RCT in such scenarios as leaving behind the infected, necrosed or diseased pulp within tooth might cause infection, pain and swelling in future and might even communicate to other vital spaces and structures making the condition more serious.
The complications can be largely divided into the one dentist faces and the one the patient faces. The dentist while treating the tooth can come across various hindrances which are as follows:
The dentist is trained enough to overcome these complications and do the needful and bring comfort to the patient. Sometimes, there may be some complications following this procedure in the patient which are temporary and can be overcome easily. They are as follows:
1. Continuous pain:
There may be a dull aching pain post RCT for 3 to 5 days (maximum 7 days) which is common during the healing period, but if the pain is severe and continues for a prolonged time or the pain subsides but recurs again after 5-7 days, it is advisable to consult your dentist again. For the dull aching mild pain, the analgesics prescribed by your dentist can be taken in the prescribed doses. It is very important to continue and finish the antibiotic course prescribe by the dentist even if the pain, swelling, and infection subside.
2. Any hematoma (localized blood collection) or swelling or paresthesia (partial numbness even after the effect of anesthesia goes off). These are very rare complications and should be brought to the notice of the dentist as soon as possible.
The injection of this solution beyond the apex of the tooth may lead to toxic tissue reaction and show the following symptoms: Severe immediate pain, swelling, bleeding from tooth as well as within tissues. To manage this, ice pack compression can be done for 24 hours (15 minutes interval) to reduce swelling and post that warm, moist compression can be done (15 minutes interval). Analgesics prescribed by your dentist can be taken for pain relief.
4. Unnoticed crack in root or missed lateral canals: These can be a source of reinfection and need the attention of the dentist.
The major cause to face RCT is tooth cavity which can be prevented if taken proper measures, like maintaining good oral hygiene, visiting the dentist once a year for a regular dental checkup and getting caries (cavities) filled in the initial stages itself, if any. In case of any trauma to the tooth, visit the dentist as soon as possible.
The major fear and dilemma among the patients regarding the RCT is due to pain and neglecting the importance of the tooth. It is always a better option to save the tooth instead of removing and replacing as the function of the natural tooth can never be mimicked by artificial tooth. It is important to be aware of the precautionary as well as the treatment aspects of tooth-related conditions.
As the online medical platforms have made the patient-doctor communication much simpler and convenient, when in doubt or if you have any symptoms or notice anything different or unusual from normal in your oral cavity, it is advisable to consult your dentist online with just mentioning the details of complaint, sharing images and X-rays to get detailed knowledge about the condition and the available treatment for the same.
In root canal treatment, an access hole is made in the crown portion of the tooth through which the dentist can reach the root portion. After which, the infected pulp from the root is removed, and any abscess present is drained. The tooth is then filled with a from the root portion.
Before starting a root canal procedure the tooth and the area where the root canal is performed is numbed with the help of local anesthesia. The only pain felt during the procedure is while giving local anesthesia and the procedure is done only after the tooth is completely numb so the root canal procedure involves minimal to slight pain.
Anti-inflammatory drugs like Ibuprofen, Aspirin, etc., are given before and after the root canal treatment. They help in reducing pain before, during, and after the procedure. In some cases, antibiotics are given as prophylaxis and after treatment to reduce the infection in the surrounding tissues.
The bacteria present in dental caries produce a foul smell that is felt during the root canal procedure. Moreover, cutting off the infected enamel and dentin produces an unpleasant smell during the root canal procedure.
Root canal procedure removes infection and caries from the tooth. Root canal treated teeth with crown placement, along with regular maintenance and checkups, can last lifelong.
During the root canal procedure, only the infection from the tooth is removed. Inflammation and swelling in the surrounding structure will take some time to heal. Henc, there might be light pain for a few days after the root canal, which will subside on its own.
In certain situations, even a root canal procedure will not be able to save the teeth. In such situations it is better to avoid a root canal. For example:
- When the remaining tooth structure is not enough to restore the teeth.
- When there is perforation in the pulpal floor due to caries or trauma.
- When there is root resorption involving one-third of the root.
- When there is severe mobility of the tooth due to the loss of surrounding bone structure.
It is better to take a soft diet after root canal treatment until the pain subsides. Very hot foods, very cold foods, sticky foods, hard and crunchy foods, etc., have to be avoided after a root canal treatment. Once the pain is completely settled and a crown is placed, a normal diet is advised.
There are no restrictions in brushing the teeth or flossing after a root canal procedure. It is always better to brush and floss the teeth to maintain good oral health. So once the numbness wears off, brushing can be done without putting more pressure on the root canal-treated tooth.
Medications like anti-inflammatory drugs and antibiotics are prescribed to help patients manage pain caused by an infected pulp until a root canal procedure is done. The patient is also asked to keep the tooth clean and avoid hot or cold foods to prevent pain.
If the tooth can be saved with a root canal, it is always better to do a root canal and save the tooth instead of getting it removed, as no replacement option is as good as a natural tooth. Once the tooth is removed, it should always be replaced to maintain oral harmony.
Last reviewed at:
01 Jan 2019 - 5 min read
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