Root canal treatment

The root canal system runs from the crown of the tooth down to the tip of the root, and contains the nerve — the soft tissue at the centre of the tooth. Root canal treatment removes that nerve tissue once it's infected or inflamed. Symptoms that lead to it include pain, sensitivity to hot and cold, soreness, swelling, or a tooth that has darkened.

Treatment takes one to three appointments, depending on how severe the infection is and how difficult the canals are.

First, the tooth is opened to reach the nerve and pulp tissue, and the canals are cleaned and shaped with fine files. An anti-inflammatory and antibacterial dressing may be placed inside to settle the inflammation and infection, sealed under a temporary filling, and left for three to four weeks depending on severity. Discomfort in the first couple of days is common but not universal — paracetamol, ibuprofen or whatever we recommend will usually handle it.

Then, once the tooth has settled, the canals are filled and the inside of the tooth is sealed. The bone around the root can take a while to heal fully, so follow-up visits may be needed to check that it has.

Saving the tooth with root canal treatment means:

• A better bite and more efficient chewing.
• Keeping your own natural tooth.
• Protecting your other teeth from the extra wear that follows losing one.

Treated well and maintained, a root-treated tooth may last many years, and possibly the rest of your life.

It's important to attend every appointment and complete the treatment. Leaving more than three to four weeks between the first and second appointment puts the tooth at risk of becoming reinfected — and if that happens, refresher root canal treatment is needed, at additional cost.

Common:

• Mild temporary pain from inflammation of the tissues around the tooth.
• Tooth fracture, because a root-treated tooth is less strong and durable. This may mean the tooth has to come out. A crown substantially reduces the risk.
• Sensitivity or tenderness of the tooth or the gum around it.

Uncommon:

• A file separating inside the canal. The fine metal files used to clean the canals can break and remain in the tooth. That may mean referral to an endodontist, or removing the tooth.
• Perforation — depending on the size and shape of the roots, there's a risk of making a hole through the side of a root during cleaning.
• Severe or persistent pain — come back and see us.
• Infection — come back and see us.
• Treatment failure. The tooth may need further treatment, or removal if it can't be saved.
• Numbness of the lip, tongue, chin or gum — transient, and on rare occasions permanent.

• Removing the tooth, then replacing it with an implant, a bridge or a denture — or accepting the gap.
• Referral to an endodontist, a specialist in root canal treatment, which we'd suggest for retreatments and difficult anatomy.
• Doing nothing. The nerve doesn't recover on its own. An untreated tooth typically leads to an abscess, and dental infections occasionally spread in ways that become serious.

If root canal treatment fails, the first option is to retreat the canal, or to remove the root tip surgically — possibly with a referral to a specialist. If that doesn't work, the tooth is removed. You can also choose to have the tooth out at an earlier stage instead.

Attending your follow-up appointments lets us monitor and assess healing. Beyond that, the tooth needs daily care at home and a check-up every 6 months, which isn't included in the cost of the root canal treatment.

• Follow all the instructions you're given about looking after the tooth and gums.
• Clean your teeth and gums thoroughly, as instructed.
• Come in for examinations and cleans every 3 to 6 months as your dentist advises. There's a fee for these visits.
• Take care not to abuse the tooth, and tell us straight away if you notice a problem.

If the work isn't maintained and you don't attend your 6-monthly appointments, problems can develop to the point of being difficult, costly, or impossible to treat — and you would be liable for the full cost of correcting them.