When do you need a root canal treatment?

Root canal treatment, also known as endodontic treatment, is an effective solution for teeth with infected or inflamed pulp. Root canal treatment is also carried out in certain cases to save a tooth.

What is root canal treatment?

Inside the tooth, just beneath the enamel and dentin is a soft tissue called tooth pulp. This tissue contains blood vessels, nerves, and connective tissues that enable the tooth root to fully develop.
A mature tooth can function without the pulp as it can be nourished by the surrounding tissues.

Root canal treatment is a procedure aiming to remove the infected or inflamed pulp inside the tooth crown and root.
After being cleaned up, the pulp chamber will be sterilized, reshaped, and sealed closed using a dental filling called Gutta-percha.
The tooth crown that is drilled open for access to the pulp will be sealed up to prevent the infection from recurring in the future.

Root canal treatment offers many advantages, including:

• Enable more effective chewing
• Help bite force return to its original state
• Save natural teeth
• Protect teeth from excessive stress

When is root canal treatment needed?

You need to receive root canal treatment when the soft tissue inside your teeth is damaged or severely infected.
The tooth crown (the visible part above the gums) can be kept intact even though the pulp has died.
Removing the damaged pulp is the best way to protect your teeth.

The most common causes of pulpitis include:

• Untreated tooth decay
• Too many dental procedures done on a single tooth
• Tooth with cracks
• Oral injuries (due to accidents, falling, or fights). The pulp can still be damaged even when there is no visible crack on the tooth.

Common symptoms of pulpitis are tooth pain, swelling, and a burning feeling inside the gums.
When you see your dentist, they will examine teeth and carry out X-rays for an accurate diagnosis.
You will notice that the pain will gradually disappear with time. This is not because pulpitis has resolved itself but it has damaged the nerves inside the pulp, and hence, you won’t feel any pain.

However, more serious symptoms will start to appear, indicating that the infection has spread widely. These include:

• The gums surrounding the infected tooth get swollen
• The facial area near the affected tooth becomes swollen
• Pus comes out from the tooth or gums
• Tooth discoloration

Visit a dental clinic immediately when you experience tooth pain to prevent the infection from spreading and avoid more serious complications.
Keep in mind that tooth infection won’t resolve on its own. The more you hesitate to receive treatment, the lower your success rates.

How many root canals and roots are there in each tooth?

Typically, a tooth has 1 to 3 roots and this number is 4 for some teeth. Generally, the larger the tooth and the greater the bite force it’s supposed to handle, the more roots it needs.

The following table shows the number of tooth roots and root canals in different types of teeth:

Type of teeth	Number of tooth roots	Number of root canals
Upper incisor	1	1
Upper canine	1	1
First molar	2	2
Second molar	1 or 2	1 or 2
Upper molar	3	3, 4, or more
Lower incisor	1	1 or 2
Lower canine	1	1
Lower premola	1	1 or 2
Lower molar	2	3, 4, or more

Note that the innermost teeth, also called wisdom teeth are usually extracted for many reasons. However, some people don’t have these.
Each tooth root is separate from one another and has one or more root canals. It will take a dentist a few hours to remove all the pulp and seal the tooth closed.
Cleaning each root canal thoroughly is of the greatest importance. If any debris is left or the hole is not fully sealed, complications are more likely to occur.

The procedure of root canal treatment

Your dentist will likely follow 4 main steps of “saving” an infected tooth. It may take 2 to 3 visits to the dental office to complete this treatment, depending on the state of your teeth and the complexity of the root system of the affected tooth.

X-ray tests will help your dentist determine the extent of the infection. However, only when they get direct access to the damaged tooth root will your dentist be certain of the complexity of the procedure.

The procedure of root canal treatment varies, depending upon different dental clinics. However, most of the time, there are 4 main steps as follows:

1. Preparation

First off, your dentist will put you under local anesthesia in the affected area so you won’t feel any pain. You may be given an oral protective gear – a rubber sheet that fits your tooth and keeps it from the surrounding teeth and gums.

This protective sheet is used to:

• Protect the tooth from contact with the bacteria in your saliva
• Allow you to swallow saliva just as usual during the procedure
• Make sure you don’t accidentally swallow any dental material or tool

2. Create an access hole to the tooth pulp

Your dentist will drill a hole on top of the tooth (or in the backside if it’s an incisor) to get access to the pulp chamber and tooth root. Specialized dental tools will be used to remove the damaged or dead pulp inside the tooth completely.

As tooth roots are usually thin and curvy, it can take your dentist some time to detect the location of all the root canals to ensure complete removal of the damaged soft tissue. Your dentist will use a microscope and a light to have a close look inside the tooth.

If you have an abscess at the end of the tooth root, it will also be treated during this time.
Next, your dentist will use specialized tools to extend and reshape the root canals in order to easily seal them up.

3. Clean and sterilize the root canals

Now, the hole inside the tooth is thoroughly cleaned using water or anti-bacterial solution. This ensures a completely sterilized root canal.
If your case is complex and requires more treatment time than usual, your dentist will fill your tooth roots with several special solutions to kill all the remaining bacteria. After that, your tooth will be sealed temporarily to protect it until the next visit.

4. Seal the pulp chamber and tooth closed 

After the root canals are reshaped and cleaned up, your dentist will use a soft, sticky dental material to fill up these canals.
It is essential that the canals are filled completely or else the infection can come back.
When the pulp chamber is sealed closed, the hole will be filled to reshape the tooth crown through a normal tooth filling procedure.

5. Attach a dental crown (not required)

As the tooth will become weaker without its pulp, your dentist often advise you to get a dental crown for better protection. The crown can be made of porcelain or metals and will cover your tooth completely to prevent infection from coming back.

In order to attach the crown, your dentist will file down a bit of your tooth enamel. After taking impressions of your tooth, the crown will be attached on top. Your dentist will then adjust and put it in place, ensuring that it looks as natural as possible.

Complications following root canal treatment

Although the success rates of this endodontic treatment are comparatively high, some people may encounter several problems after the procedure. The complications due to root canal treatment can occur at any time, from a few days to years after the treatment.

Unsuccessful root canal treatment can be caused by:

• Dentist’s lack of experience in performing root canal treatment
• Incomplete  root canal (some debris is left)
• Cracks to the end of the tooth root
• Reinfection

In cases of complications, your dentist will re-examine your teeth to determine if another root canal will help. This second procedure is similar to the first one but is more complex due to the presence of filling materials.

The most common solution to unsuccessful root canals is tooth extraction. For those who don’t want to receive root canal treatment in the first place can choose to replace their damaged tooth with a dental bridge or implant.

How long will the results from root canal treatment last?

Endodontic treatment is a quite common dental procedure with comparatively high success rates. About 85% of root canal cases have stable results, lasting for 8 to 10 years with proper oral care.
Many people may encounter no problems for the rest of their life. If you are a smoker, quitting can prolong the results of most dental procedures in general.

A side effect from root canals is the tooth may get discolored over time. However, you can always receive teeth whitening procedures for shiny white, even-colored teeth.