Root canal treatment

At the centre of a tooth is the ‘pulp’. This contains blood vessels, connective tissue and a nerve supply to the tooth. This gives the tooth feeling, sensitivity and keeps the tooth ‘alive’. It is possible however, for the pulp to get inflamed, or infected, eventually leading to pulp death (necrosis). There are several key reasons why this may happen:

If the nerve becomes inflamed, you might experience some sensitivity or tooth ache. Eventually, the nerve will start to die, often causing a more severe, constant pain and an abscess might develop. Once the pulp is dead, the space it is in can become filled with bacteria, meaning the infection doesn’t clear up by itself.

The tooth might have to be removed, or your dentist might be able to offer you a root canal treatment. This involves cleaning out the dead pulp and filling up the hollow space with rubber, to block out any more bacteria from entering. Different teeth have a different number of ‘canals’, there can be four or more pulp chambers to clean in one tooth. The tooth might be weak from having the inside cleaned out and it is important that no more bacteria can creep in to the tooth from the top, therefore a ‘crown’ might be recommended to cover and seal the tooth.

The common steps for a root canal treatment are as follows:

Because the files being used are very thin and delicate (Figure 1), sometimes they can break inside the tooth. This is uncommon but does reduce the success of treatment. Microscopic gaps in the rubber and underneath the final crown/filling can mean bacteria get back in to the space and cause another infection. Although a re-root canal treatment might be possible, the chance of it being successful is lower.

Figure 1: Some endodontic files. Image courtesy of S. Ruck, München.

Next section: Endodontics