Root Canal Therapy

What is Root Canal Therapy (RCT)?

I think that this is the most misunderstood procedure in dentistry and one of the most feared as most people have heard a bad story from someone they know who had root canal therapy (RCT) done and how bad it was and how painful it was.

Let me debunk the myths and clarify things for you. Firstly, what is RCT? RCT is basically a process of disinfecting the inside of a tooth, which has become infected as a result of the nerve dying. Once the disinfection process is completed, the inside of the tooth is then filled so as not to leave an empty void, with a material called Gutta Percha, which is essentially rubber.

When a patient presents with pain and symptoms indicative of needing RCT, their tooth may already have a dead nerve, or the nerve may be in the process of dying. If you start RCT on a tooth with a dead nerve, then the process is usually completely painless.

Patients usually at this point ask, “Why is my tooth painful if the nerve is dead?”. A very good question. The explanation is simple. When the nerve dies, as stated previously, an infection ensues. Think of this infection like a balloon being inflated very slowly. To begin with this balloon is very small. As the infection grows, the pressure increases, and has only one way out of the inside of the tooth and that is through the natural openings in the tips of the roots where blood vessels and nerves enter the tooth. As this pressure exits the tips of the roots, there really isn’t much space for it to spread so as the balloon inflates more, it causes more pressure to build below the tooth. This steady increase in pressure is what causes the constant pain and when the patient puts pressure on the tooth and the tooth hits the balloon of infection, that causes even more pain. Hence when a person has constant pain that does not go away, usually wakes them up at night, pain killers do pretty much nothing and he/she cannot put pressure on their tooth as its very painful, this is usually indicative of the nerve being dead and the tooth needing RCT.

If the nerve is in the process of dying, usually the pain will be constant and worse on temperature, usually heat and the cold then relieving the pain somewhat. This is also associated with painkillers not working and the patient being woken up at night with the pain, however there is normally no pain on putting pressure on the tooth as an infection has not yet developed and therefore no pressure.

This is usually the time when RCT can be painful when started. The best thing to do in this situation is to cut into the tooth (under local anaesthetic of course) and reach the nerve and dress it with a medicament that will settle the nerve. Upon the patient’s return 1-2 weeks later, the process of RCT is usually painless and can be continued without much discomfort for the patient.

Another common question is how many appointments it will take to do the RCT. I personally do it in one visit unless a tooth is heavily infected, which is when I will do the disinfection in the first visit and fill the tooth in the second visit. Some practitioners carry out the process over 2-3 visits as a matter of routine. There is no advantage either way, so long as the practitioner’s protocol works and is successful.

As with everything in life, there is a failure rate for RCT which is about 10% to the best of my knowledge. There are several factors that contribute to the success or failure of RCT into which I will not delve here. Suffice to say that experience, consistency and a robust protocol for RCT all contribute to a good outcome.

In some instances where RCT is very difficult for a variety of reasons or where an existing RCT has failed and needs to be redone, a patient may be referred to an RCT specialist, otherwise known as an endodontist.

Many, but not all teeth that have had RCT will need a crown, as the process of RCT inherently weakens the tooth and makes it more brittle and therefor more prone to breakage, especially that the majority of root treated teeth already have large existing fillings. If a patient is going to go to the trouble of having RCT done, if their tooth structurally fails catastrophically, then their only option is an extraction, rendering the money, time and effort spent to keep the tooth viable in the mouth through doing RCT, a waste of time.

As you can see from reading this section, there are many things to consider and factor in if you are going to have RCT. If you need a consultation is regards to RCT don’t hesitate to call us at MHP Dental to schedule a consultation on 98872044.