Root Canal Treatment

Root canal treatment (endodontics) is a dental procedure used to treat infection at the centre of a tooth (the root canal system).

The infection is caused by bacteria that live in the mouth and invade the tooth. This can happen after:

  • tooth decay
  • leaky fillings
  • damage to teeth as a result of trauma, such as a fall

A tooth is made up of two parts. The crown is the top part of the tooth that's visible in the mouth. The root extends into the bone of the jaw, anchoring the tooth in position.

Teeth also consist of:

  • enamel – the hard outer coating
  • dentine – a softer material that supports the enamel and forms most of the tooth
  • cementum – a hard material that coats the root's surface
  • dental pulp – the soft tissue at the centre of the tooth

The root canal system contains the dental pulp and extends from the crown of the tooth to the end of the root. A single tooth can have more than one root canal.

Root canal treatment is only required when dental X-rays show that the pulp has been damaged by a bacterial infection. The pulp will begin to die if it's infected by bacteria, allowing the bacteria to then multiply and spread.

The symptoms of a pulp infection include:

  • pain when eating or drinking hot or cold food and drink
  • pain when biting or chewing
  • a loose tooth

As the infection progresses, these symptoms often disappear as the pulp dies. Your tooth then appears to have healed, but the infection has in fact spread through the root canal system.

Further symptoms eventually occur, such as:

  • pain when biting or chewing returning
  • swelling of the gum near the affected tooth
  • pus oozing from the affected tooth
  • facial swelling
  • the tooth becoming a darker colour

It's important to see your dentist if you develop toothache. If your tooth is infected, the pulp can't heal by itself.

Leaving the infected tooth in your mouth may make it worse. There may also be less chance of the root canal treatment working if the infection within your tooth becomes established.

Antibiotics – medication to treat bacterial infections – aren't effective in treating root canal infections.

To treat the infection in the root canal, the bacteria need to be removed. This can be done by either:

  • removing the bacteria from the root canal system (root canal treatment)
  • removing the tooth (extraction)

However, removing the tooth isn't usually recommended as it's better to keep as many of your natural teeth as possible.

After the bacteria have been removed, the root canal will be filled and the tooth sealed with a filling or crown. In most cases the inflamed tissue near the tooth will heal naturally.

Before having root canal treatment, you'll usually be given a local anaesthetic. This means the procedure shouldn't be painful and should be no more unpleasant than having a filling.

Root canal treatment is usually successful. In about 9 out of 10 cases a tooth can survive for up to 10 years after root canal treatment.

It's important to look after your teeth when recovering from root canal treatment. You should avoid biting on hard foods until all of your treatment is complete.

After your final treatment, your restored tooth shouldn't be painful, although it may feel sensitive for a few days.

Over-the-counter painkillers, such as paracetamol or ibuprofen, can be used to relieve any discomfort. Return to your dentist if you continue to experience pain or swelling after using painkillers.

In most cases it's possible to prevent the need for further root canal treatment by:

  • maintaining good oral hygiene
  • not consuming too much sugary food
  • giving up smoking if you smoke

Dental Crowns

A dental crown is a tooth-shaped "cap" that is placed over a tooth - to cover the tooth to restore its shape and size, strength, and improve its appearance.

The crowns, when cemented into place, fully encase the entire visible portion of a tooth that lies at and above the gum line.

A dental crown may be needed in the following situations:

  • To restore an already broken tooth or a tooth that has been severely worn down
  • To hold a dental bridge in place
  • To cover misshapened or severely discoloured teeth
  • To cover a dental implant
  • To make a cosmetic modification
  • To cover and support a tooth with a large filling when there isn't a lot of tooth left
  • For children, a crown may be used on primary (baby) teeth in order to:
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  • Save a tooth that has been so damaged by decay that it can't support a filling.
  • To protect a weak tooth (for instance, from decay) from breaking or to hold together parts of a cracked tooth

What Types of Crowns Are Available?

Permanent crowns can be made from stainless steel, all metal (such as gold or another alloy), porcelain-fused-to-metal, all resin, or all ceramic.

Porcelain-fused-to-metal dental crowns can be colour matched to your adjacent teeth (unlike the metallic crowns). However, more wearing to the opposing teeth occurs with this crown type compared with metal or resin crowns. The crown's porcelain portion can also chip or break off. Next to all-ceramic crowns, porcelain-fused-to-metal crowns look most like normal teeth. However, sometimes the metal underlying the crown's porcelain can show through as a dark line, especially at the gum line and even more so if your gums recede. These crowns can be a good choice for front or back teeth as well as long bridges where the metal is needed for strength.

All-resin dental crowns are less expensive than other crown types. However, they wear down over time and are more prone to fractures than porcelain-fused-to-metal crowns.

All-ceramic or all-porcelain dental crowns provide better natural colour match than any other crown type and may be more suitable for people with metal allergies. All-ceramic crowns can be used for front and back teeth.

Temporary versus permanent. Temporary crowns can be made in your dentist's office, whereas most permanent crowns are made in a dental laboratory. Typically, temporary crowns are made of an acrylic-based material or stainless steel and can be used as a temporary restoration until a permanent crown is constructed by a lab.

Dental Bridges

Dental bridges are false teeth, which are anchored onto neighbouring teeth in order to replace one or more missing teeth.

The false tooth is known as a pontic and is fused in between two crowns that serve as anchors by attaching to the teeth on each side of the false tooth, thereby bridging them together.

There are three main types of dental bridges:

This is the most commonly used type of bridge and consists of a pontic fused between two porcelain crowns that are anchored on neighbouring teeth or implants. The pontic is usually made of either porcelain fused to metal or ceramics. These are fixed and cannot be removed.

These are chosen when the gap to be filled is in between the front teeth, or when the teeth on either side of the missing tooth are strong and healthy without large fillings. The false tooth is made of plastic and is fused to metal bands that are bonded to the adjacent teeth using resin that is hidden from view.

These are opted for in areas such as the front teeth that are susceptible to lower stress. Cantilever bridges are used when there are teeth present on only one side of the space, where the false tooth is anchored to one or more adjacent teeth on one side.

A dental bridge essentially consists of:

  • A pontic or false tooth used to replace the missing tooth, which is made from gold, alloys, porcelain or a combination of these materials.
  • Two crowns - serving to anchor the false tooth in place.

Missing teeth can be replaced for many reasons:

  • To improve your appearance.
  • To reduce the strain on the teeth at either side of the missing tooth.
  • To prevent the neighbouring teeth from leaning into the resulting gap and altering the bite.
  • To prevent gum disease and tooth decay due to accumulation of food in the gap.

Bridges are recommended when there are one or more teeth missing that affect:

  • Your smile and appearance.
  • Your bite, as a result of adjacent teeth leaning into the space and altering the way the upper and lower teeth bite together.
  • Your speech.
  • The shape of your face.
  • The rate of gum disease and tooth decay as a result of food accumulated in the gap.

Bridges may be made of

  • Porcelain.
  • Porcelain bonded to precious metal.
  • All-metal dental bridges (gold).