What is it? | Consultation | Preparation | Procedure | Recovery | Safety & Risks

What is a Root Canal?

Root canal therapy refers to the process by which a dentist treats the inner aspects of a tooth, specifically that area inside a tooth that is occupied by its “pulp tissue.” Most people would probably refer to a tooth’s pulp tissue as its “nerve.” While a tooth’s pulp tissue does contain nerve fibers it is also composed of arteries, veins, lymph vessels, and connective tissue.

A tooth is made up of three main components: a hard protective shell referred to as enamel, a softer and sensitive middle layer referred to as dentin and a soft tissue inner layer referred to as dental pulp.

Dental pulp is composed of nerve tissue, lymph tissue and blood vessels, and is considered to be the vital part of a tooth. If dental pulp is sufficiently traumatized – whether by exposure to oral bacteria via deep dental caries, a fracture in the tooth that enters the pulp or a forceful blow to the face – the tooth begins to die and root canal therapy is often required in order to prevent or eliminate infection and prevent tooth loss.

Root Canal Signs

It will take an examination by your dentist to determine if root canal treatment is indicated for your tooth. Not only must your dentist determine if the treatment can be an appropriate solution for your situation but also that the overall condition of the tooth in question warrants the time and expense involved.Certain signs may indicate that you have a diseased tooth or infected nerve and therefore may need a root canal. These signs include:

• Minimal to severe pain.

• Tooth discoloration.

• Swelling and irritation in the surrounding gum tissue.

• Signs of infection visible on a radiograph.

Dentists typically recommend a root canal in such situations to save the affected tooth and preserve its functionality.

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Consultation

During your first consultation the cosmetic dentist of your choice will ask you a number of questions and discuss the following health related topics, desires and lifestyle to evaluate your medical record:

1. Your medical condition, drug allergies and previous medical treatments.

2. If and what kind of current medications, vitamins, herbal supplements, alcohol, tobacco & drugs you use.

3. If and which previous surgeries you have already realized.

4. Your general health status and any pre-existing health conditions or risk factors.

5. Define if you´re a candidate for the specific procedure.

This will help the dentist to get a feel for what you want and understand your needs and concerns.

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Preparation for Procedure

At the first dental visit, you may be prescribed antibiotic treatment for a number of days before the root canal procedure is performed.At the beginning of the procedure, your dentist will anesthetize the tooth sufficiently to prevent pain while performing the root canal procedure.

A drill is then used to access the pulp chamber and associated canals of the tooth.

Using flexible nickel titanium pin-like files, the dentist will delicately (but thoroughly) cleanse the length of the canals and tip (or apex) of the root to completely remove all traces of infection or debris. This process is performed with a great deal of care in order to minimize damage or trauma to the surrounding ligaments and bone.

To accomplish this, the dentist may use additional tools to measure the root. These tools may include digital X-rays taken during the cleaning phase, an apex locator that works as a sonar probe to locate the tip of the root and a microscope providing up to 32-times magnification. Your dentist will then disinfect and seal the tooth. Some dentists and endodontists use a special type of heat gun to fill the canal with a material called gutta-percha. Gutta-percha is a natural, biocompatible, anti-bacterial material that expands and seals the hollowed area within the span of about 15 minutes. Other dentists and endodontists may use the bonding process to seal the tooth with a resin material.

The dentist then fills the canal’s access hole with a temporary or permanent filling. On occasion, a temporary filling is placed in the hole used to access the root canals in order to allow time for healing. Once the tooth is deemed to be healing properly and the root canal therapy deemed a success, a permanent restoration (such as a dental filling or crown) is placed. During the interim, you may receive medication to manage the soreness and discomfort that may result from the procedure.

Your Dentist will also inform you where your procedure will be performed. This facility, like an office-based surgical center, outpatient or ambulatory surgical center, or a hospital, is accredited and regularly audited by FlyClinic®.

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Procedure

Step 1 – Placing a rubber dam around your tooth.

After numbing your tooth but before beginning the actual process of performing the root canal treatment, your dentist will stretch a sheet of rubber around your tooth. Dentists call this sheet of rubber a “rubber dam.” It is held in place by a small clamp that grasps your tooth. The purpose of a rubber dam is as follows. Since one of the fundamental goals of root canal therapy is to clean bacteria out of a tooth, and since saliva does have bacteria in it, the placement of a rubber dam allows the dentist to keep your tooth saliva free so it doesn’t get recontaminated with bacteria while your root canal treatment is being performed

Step 2 – Gaining access to the nerve area of the tooth.

As a starting point for the process of performing your root canal treatment your dentist must first gain access to that area inside the tooth where the nerve tissue resides. This is accomplished by using a dental drill and making an “access cavity” that extends down to the pulp chamber of the tooth. On posterior teeth this hole is made on the chewing surface of the tooth. On front teeth the access hole is made on the tooth’s backside.

Step 3 – Cleaning the tooth out.

The next step of the root canal treatment process is for your dentist to clean out the interior of your tooth (the pulp chamber and all root canals). As we discussed previously, this cleaning process removes any bacteria, toxins, nerve tissue, and related debris that are harbored inside your tooth. For the most part the cleaning process is accomplished by way of using “root canal files” and copious irrigation. Root canal files look like straight pins but on closer inspection you would find that their surface is rough, not smooth. These instruments literally are files and are used as such. Your dentist will work a series of root canal files, each of increasing diameter, up and down in your tooth while simultaneously using a twisting motion. This action will scrape and scrub the sides of the tooth’s root canal(s), thus cleaning it out. As an additional part of the cleaning process, your dentist will wash your tooth out periodically (“irrigate” the tooth) so to help flush away any debris that is present. Traditionally, a number of different solutions have been used for this purpose. Nowadays, sodium hypochlorite (bleach, Clorox) is commonly used. An added benefit of bleach is that it is a disinfectant.

Step 4 –Placing the root canal filling material.

Once the tooth has been thoroughly cleaned your dentist can fill in and seal up its interior by way of placing root canal filling material. Sometimes a dentist will want to place the filling material the same day that they have cleaned the tooth out. Other times a dentist might feel that it is best to wait about a week before completing the root canal process. In the latter case your dentist will place a temporary filling in your tooth so to keep contaminates out during the time period between your appointments.

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Recovery from Surgery

The operation typically takes usually less than one hour to complete. This is an ambulatory procedure, which means that you will be able to go home after the surgery. Your physician will give you recommendations on surgery aftercare. The following rules give you an indication of aftercare requirements.

After your Root Canal Procedure you might encounter the following symptoms:
- tooth feels uncomfortable and slightly aches immediately after your root canal therapy. Within one week this usually disappears
- you feel increased sensitivity when biting on something or your tooth may feel loose. This is caused by an increased sensitivity of the nerve’s endings where the filler was placed after cleaning. It will disappear within a few days.
- you might feel a rough area where the access was made. A soft material was deposited that will most likely be worn away before your follow up visit.
- in some occasions a small “pimple” appears on the gum tissue up to several days after the procedure. This is caused by the release of pressure and bacteria around the tooth which are released. Within a few days this “pimple” will disappear.

You should:
- take some medication for pain relief before the anesthesia wears off. Usually one dose will be sufficient to treat pain immediately after the procedure. Your dentist will recommend the appropriate pain-relief medication. You should inform your dentist about medical conditions or gastrointestinal disorder that might exclude certain medications like Ibuprofen.
- when using your teeth, try to chew rather on the opposite side than the area just treated. Your tooth is still weakened by the procedure and might fracture.
- within the first week you should avoid chewing gum, caramels or other candy which could fracture your tooth or dislocate the temporary material.

When should you contact your dentist immediately?
- you are experiencing the described symptoms longer or more intensely than described
- the area around your tooth swells significantly after the procedure
- the temporary material is dislodged, loose or feels elevated when biting
- your tooth fractures
- if you have any other question or concern

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Safety & Risks

It is FlyClinic®´s concern to provide you comprehensive information about the surgery you want to choose, as well as important facts about the safety and risks of the procedure you selected.

Your dentist will familiarize you with the risks associated with the procedure. You will be asked to sign a consent form to ensure that you fully understand the procedure you will undergo and any risks or potential complications.
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