Endodontic Treatment
What is endodontic treatment?
Endodontic treatment, commonly known as root canal treatment, is the treatment of disease or infection found inside the tooth. The word endodontics comes from the Greek words “endo” and “odont” – literally meaning “inside tooth”. Endodontic treatment tries to salvage seriously infected teeth that would otherwise require extraction.
Enamel, which is very hard, makes up the outermost part of the tooth, and under this lies a slightly softer layer called dentine. Below dentine is a delicate centre containing nerves, blood vessels and connective tissue. This is referred to as the 'pulp’, which extends downwards from the crown to form the root canal. There is a very close association between the dentine and the pulp.
In childhood, the primary role of the pulp is to assist tooth growth and development. Once the tooth is matured, the pulp can provide nourishment for the tooth and also help form more dentine in response to trauma or tooth decay (caries). However, a person can risk losing their tooth if the pulp becomes inflamed or infected. Endodontic treatment removes the inflamed/infected pulp and can save your tooth.
What are the signs and symptoms of pulp damage?
Some of the signs and symptoms of pulp damage (which may highlight the need for endodontic treatment) include:
- A serious level of caries
- Swelling or tenderness in the gum
- A ‘pimple’ on the gum adjacent to the tooth (usually a sign of a chronic abscess)
- A tooth injury that causes increasing pain or tooth darkening
- The development of pain or sensitivity when consuming hot or cold beverages/food
- Spontaneous pain or throbbing
- Pain when biting
- Some tooth discolouration
If you are experiencing any of the above issues, we strongly recommend you schedule a consultation with your general dental practitioner to identify the cause and discuss possible treatment.
Please note that sometimes pulps can die and become infected without any symptoms at all, which is why regular dental check-ups are so important.
Why am I required to see an endodontic specialist?
Endodontic treatment can be carried out by both general dentists and endodontic specialists in a bid to relieve oral pain, prevent further damage and resolve infection or disease in the tooth. However, there are instances when a general dental practitioner will refer their patients to an endodontic specialist when more advanced treatment is required.
Endodontists have completed additional years of specialist endodontic training on top of their mandatory general dental education. They have greater understanding and experience in preventing, diagnosing and treating diseases and injuries that affect the pulp tissues. They can therefore competently perform complex endodontic procedures, including certain forms of surgery, and are equipped with the advanced equipment and knowledge to do so. They are also experienced at diagnosing the origins of oral pain.
Is endodontic treatment a solution for me?
Endodontic treatment on a tooth is not a guarantee for keeping that tooth for life. Often the limiting factor is the structural integrity of the tooth and this is something that the endodontist takes into account when deciding on the best course of action. Once the endodontic treatment has been deemed to have worked, back teeth will also require crowning to help give long-term structural success.
It should be noted that although no root-filled tooth has a lifetime guarantee, neither does any other treatment option, including implants. So keeping a tooth for as long as possible will effectively lengthen the lifespan of an implant or another treatment option.
If you have any concerns, raise them with your endodontist, who can help determine if endodontic treatment is appropriate. We will discuss the options with you and advise you on a course of action.
What's involved during an endodontic procedure?
Your endodontist’s aim is to relieve your suffering and remove the infected or inflamed pulp from within your tooth.
After achieving local anaesthesia, an opening will be made in the crown of your tooth. Special instruments are used to remove pulp from the pulp chamber and root canals. The canals are then shaped and disinfected, and filled with a material named gutta-percha, to seal the root canals. A composite core will be placed inside the tooth, followed by either a permanent filling or a temporary filling in the crown opening (access cavity).
Treatment is done under a microscope, which offers very high magnification and illumination of the root canal system. Without this level of magnification it would be impossible to see vertical fractures (this type of fracture cannot be seen on X-rays), fine anatomical details, or other potential complications. CBCT scans are often employed to help visualise a tooth 3-dimensionally, to help achieve the best possible outcome.
When a temporary filling is used to seal the access cavity, this is normally due to other fillings in the tooth needing replacing as well, so you will return to your dentist who will do this work and place a large permanent restoration on the tooth to protect and restore it to normal function. A year later, the endodontist will review the tooth, and if all has healed well a crown is often recommended for back teeth to restore them to full strength.
Does endodontic treatment hurt?
Our aim is to minimise any discomfort. We use topical anaesthetic prior to injections, and our injection technique is very slow, so as to make it as comfortable as possible. Modern local anaesthetics are very good, and so it is very rare to feel anything during treatment. We place a rubber sheet (or non-latex if necessary) over the tooth to isolate it from the rest of the mouth, and patients become quite unaware as to what is going on inside their tooth. Coupled with your choice of music, most patients tend to doze off at some point during the procedure!
Can I be sedated or put to sleep during the procedure?
At this point we do not offer any sedation or general anaesthetic services, and most patients find the procedure a lot easier than anticipated. The closest endodontist that can provide sedation as well is in Wellington.
Will there be pain after the endodontic procedure?
It is very rare to experience severe or long-term pain after endodontic treatment. Most patients experience little to no discomfort, and this usually resolves within a week. Over-the-counter or prescription medication can treat this pain. Dr Goga can provide advice and arrange medication for you. If pain does persist, please contact us.