Need a root canal treatment? Look no further than our team of experts at Meri Sehat. Our doctors offer quality dental services at an affordable price. Schedule your appointment today!

Root Canal

A root canal is a dental procedure to clean the inside of a tooth. It is usually performed under local anesthesia to preserve a damaged or infected tooth rather than extract it.

Overview

A root canal is a dental procedure to remove infected or damaged pulp from inside a tooth and preserve the tooth by filling and sealing the space. 
&nbsp;

Unfortunately, root canals have a bad reputation as painful or dangerous, but this is not necessarily true. Root canal treatment relieves dental pain.&nbsp; Moreover, it has a high success rate of up to 98%<a href="#accordion">[3]</a>. It typically requires one or more appointments to complete. Avoiding the procedure means risking the situation getting worse and potentially losing the tooth. Postponing treatment not only causes more pain but also more expense in the long run.

While the global prevalence of individuals who have undergone root canal treatment is 55.7%, the rate of root canal treatment has decreased from 10.2% in the 20th century to 7.5% now in the 21st century<a href="#accordion">[11]</a>.

The highest rates of root canal treatment were found in Brazil and Europe, where 12% and 9.3% of the populations respectively have had the procedure. In Europe, 59.6% of the population has undergone root canal treatment.

These statistics highlight the growing trend of root canal treatment and how the prevalence of this procedure can vary between different regions and populations<a href="#accordion">[11]</a>. 
&nbsp;

There are 4 types of teeth in the mouth &ndash; incisors, canines, premolars, and molars &ndash; and each type of tooth has a different number of canals:

<ul>
	<li>Incisors have 1 canal each</li>
	<li>Canines have 1 canal each</li>
	<li>Lower premolars have 1 canal each</li>
	<li>Upper premolars usually have 1-2 canals each</li>
	<li>Lower molars have 3 canals each</li>
	<li>Upper molars usually have 3-4 each 
	&nbsp;</li>
</ul>

The number of canals can sometimes be more than stated above. In this case, the endodontist locates it and cleans it along with the other canals.

The root canal treatment is categorized into two main types based on the approach taken to treat the infected or damaged pulp tissue: 
&nbsp;

<ol>
	<li>
	<h5>Non-Surgical Root Canal Treatment</h5>
	</li>
</ol>

This is the most common type of root canal treatment, which involves removing the infected or damaged pulp tissue from the tooth and cleaning and shaping the root canals to prepare them for filling. The canals are then filled with a rubber-like material called gutta-percha, and a filling or crown is placed on the tooth to restore its function and appearance. 
&nbsp;

<ol start="2">
	<li>
	<h5>Surgical Root Canal Treatment</h5>
	</li>
</ol>

This type of treatment is usually considered a last resort when non-surgical treatment has failed or is not possible due to certain anatomical or pathological conditions. In surgical root canal treatment, an incision is made in the gum tissue near the affected tooth to access the root tip. The infected or damaged tissue is then removed, and the tip of the root is either resected or sealed with a filling material. The gum tissue is then sutured back in place, and the tooth is restored with a filling or crown. 
&nbsp;

Signs and Symptoms

The signs and symptoms that indicate the requirement for a root canal treatment are<a href="#accordion">[3]</a>:

<ul>
	<li>Persistent Toothache &ndash; Tooth pain can be caused by a variety of dental issues. If a person is experiencing discomfort deep within their tooth, such that it radiates to their jaw, cheeks, or other teeth, they may require root canal therapy. 
	&nbsp;</li>
	<li>Increased Sensitivity &ndash; If a person experiences toothache when drinking hot coffee or consuming ice cream, they may require root canal therapy. This is particularly true if the pain lasts more than a few seconds. 
	&nbsp;</li>
	<li>Gum Swelling &ndash; An infected tooth can have pus collected around it. This can cause tender, puffy, or swollen gums. 
	&nbsp;</li>
	<li>Pimple On The Gum &ndash; A pimple or a boil can develop on the gums. Pus from the infected tooth may drain from the pimple, leaving a bad taste or odor. 
	&nbsp;</li>
	<li>Swollen Jaw &ndash; At times, the accumulation of pus causes visible swelling and pain in the jaw. 
	&nbsp;</li>
	<li>Discoloration Of The Tooth &ndash; The tooth looks darker when the pulp inside the tooth is infected. 
	&nbsp;</li>
	<li>Pain &ndash; Discomfort while eating or touching the tooth indicates that the nerves surrounding the pulp are damaged. 
	&nbsp;</li>
	<li>Cracked Or Chipped Tooth &ndash; Bacteria can reach into the tooth pulp if a tooth is fractured in an accident, i.e., while playing sports or even while biting something hard. 
	&nbsp;</li>
	<li>Loose Tooth &ndash; An infected tooth will become loose. This is because pus from the infected pulp softens the bone that supports the tooth. 
	&nbsp;</li>
</ul>

As the infection progresses, pulp necrosis develops and the pulp eventually dies. The pain can subside after this, but the infection would have spread throughout the canals of the tooth. 
&nbsp;

Causes

Once a tooth&rsquo;s pulp or nerve tissue is damaged, it will break down. This usually happens after:

<ul>
	<li>Tooth Decay &ndash; If untreated, tooth decay can cause great damage. It spreads deeper into the tooth until it reaches the dental pulp and roots and causes pulp inflammation. 
	&nbsp;</li>
	<li>Fillings That Have Leaked &ndash; If a previous filling wasn&rsquo;t sealed properly or there was a gap between the tooth and filling, the bacteria enter the inner tooth and cause tooth decay. 
	&nbsp;</li>
	<li>Trauma To The Tooth &ndash; A cracked tooth is vulnerable to bacteria. 
	&nbsp;</li>
	<li>Habitual Teeth Grinding (Bruxism) 
	&nbsp;</li>
	<li>Multiple Dental Procedures On The Same Tooth 
	&nbsp;</li>
</ul>

Diagnosis

To diagnose dental caries, the dentist will note the complete medical history of the patient, including the location and duration of the pain they&rsquo;re experiencing.

The dentist will use a mouth mirror to look for any decay, swelling, pus, or damaged tooth structure. Also, an X-ray of the tooth is suggested to get a clear picture of the root canals and assess whether there is any infection in the surrounding bone. This information helps the dentist personalize the root canal treatment for the individual patient. 
&nbsp;

Treatment

<h5>Antibiotics</h5>

Antibiotics are commonly used to slow down the progression of an illness and reduce swelling before undergoing a root canal procedure. However, it is important to note that the use of antibiotics can have an impact on the effectiveness of local anesthesia during the procedure. In cases where the infection is severe, antibiotics may hinder the ability of the anesthesia to fully numb the area being treated, resulting in a painful experience for the patient.

Therefore, it is crucial to consult with a healthcare professional to determine the appropriate course of treatment to ensure that the root canal procedure is as comfortable and effective as possible. 
&nbsp;

<h5>Root Canal Procedure</h5>

Although medications reduce swelling and infection, they do not heal the tooth. The symptoms temporarily go away, but they will return shortly if the tooth is not treated with root canal therapy since the source of the problem, such as decay, has not been addressed. 
&nbsp;

The process involves several steps, each with a specific purpose<a href="#accordion">[8]</a>:

<ol>
	<li>Rubber Dam Placement: The dentist will place a sheet or rubber dam over the tooth to prevent contamination and to keep the area dry during the procedure. 
	&nbsp;</li>
	<li>Local Anesthesia: The dentist will use a local anesthetic to numb the area around the tooth so that the patient doesn&#39;t feel any pain during the procedure. 
	&nbsp;</li>
	<li>Drilling: The dentist will drill a hole in the tooth to access the pulp, which contains nerves and blood vessels. 
	&nbsp;</li>
	<li>Cleaning And Shaping: Each tooth has 1-4 canals depending on the type of tooth affected. All of the root canals will be cleaned, shaped, and disinfected. The dentist will remove any infected tissue, pulp, caries, pus, and debris to prepare the canals for filling. 
	&nbsp;</li>
	<li>Temporary Filling: It takes several appointments to clean and shape the hole in the tooth before placing a sterile filling inside. The dentist will use a temporary filling between treatments to seal the tooth and protect it from further infection. In some cases, a metal band may be placed around the tooth for additional protection. 
	&nbsp;</li>
	<li>Gutta-Percha Filling: Once the canals are cleaned and shaped, the dentist will fill the canal space with a material called gutta-percha. 
	&nbsp;</li>
	<li>Support Insertion: The dentist may insert a small support into the root canals to strengthen the tooth. 
	&nbsp;</li>
	<li>Crown Placement: The dentist places a cap on the tooth with an artificial crown to protect it and restore its appearance. 
	&nbsp;</li>
</ol>

Many times, patients tend to skip crown placement because they think it is unnecessary. This is a misconception as without crown placement, the tooth is weak and may not be able to endure heavy chewing forces over a long period.

The crown, which is made of metal and porcelain, provides ample support and increases the longevity of the tooth. The crown is customized and has the anatomical appearance of a healthy tooth, ensuring that its chewing functionality will also be efficient like a healthy tooth. 
&nbsp;

In general, root canal therapy is a procedure that is performed to save a damaged or infected tooth and prevent the need for extraction. Usually, it will take 30-60 minutes to complete and is hardly more painful than a regular filling. However, depending on the extent of damage or infection in the tooth, the size of the tooth, and whether there are multiple roots in the affected site, it may take multiple appointments and may be more uncomfortable than a regular filling.

Sometimes retreatment will solve the problem. However, surgery is required at times to save the tooth. Apicoectomy, or root-end resection, is the most common operation. It reduces inflammation or infection in the bony area surrounding the end of the tooth. The gum tissue is opened, the infected tissue is removed, and sometimes the very end of the root is removed during this surgery. To seal the root canal, a small filler may be used. 
&nbsp;

1. The most common complication of a root canal treatment is a recurrent infection or root canal failure. An infection can stem from the following:

<ul>
	<li>A canal is left uncleaned accidentally</li>
	<li>An undetected crack in the root of the tooth</li>
	<li>A faulty restoration</li>
	<li>Deterioration of the inner sealing substance over time 
	&nbsp;</li>
</ul>

2. If a patient does not get crown placement after a root canal, the tooth will break due to the force exerted while chewing or biting. 
&nbsp;

3. Sometimes the damage is too severe or the enamel is too weak to withstand the root canal procedure. This will result in tooth loss. 
&nbsp;

4. An abscess will form at the base of the tooth if the antibiotics are ineffective or if some of the infected material persists. 
&nbsp;

Note: A failed root canal presents as swollen gums, pain, tooth discoloration, and sinus problems. For instance, a normal tooth with a healthy pulp is yellowish-white in color. If the pulp-free tooth is sealed with a filling instead of a crown, it will turn gray with time. In that case, you should talk to your healthcare provider immediately about a possible retreatment or alternative procedures. 
&nbsp;

There are no apparent risk factors. However, certain circumstances can lead to the development of dental caries:

<ul>
	<li>Sports that cause tooth injury</li>
	<li>Improper oral hygiene 
	&nbsp;</li>
</ul>

A root canal can be avoided by:

<ul>
	<li>Brushing twice a day</li>
	<li>Flossing at least once a day</li>
	<li>Using a mouth guard to prevent sports-related injuries</li>
	<li>Stop chewing betel nut</li>
	<li>Reducing consumption of sweet foods and drinks</li>
	<li>Quitting smoking</li>
	<li>Visiting the dentist regularly 
	&nbsp;</li>
</ul>

The choice between root canal treatment and dental implant for a compromised natural tooth is complex. According to a study, both treatments have high success rates; while the implant therapy has a 98.3% survival rate, the root canal treatment exhibited a 72.7% survival rate. Both treatments also have the potential for failure and complications. 
&nbsp;

Root canal treatment is more affected by non-endodontic factors, such as recurrent carious lesions, crown or root fractures, and severe periodontal disease. Alternatively, implant treatment is affected by poor oral hygiene and other systemic factors, such as inadequate initial bone healing, tobacco use, poor plaque control, and bone atrophy. The study also showed that <a href="https://merisehat.pk/disease/anxiety">anxiety </a>and higher age were also significantly associated with the failure of both treatments<a href="#accordion">[9]</a>. 
&nbsp;

Key Points

<ul>
	<li>A root canal is a dental procedure to remove infected or damaged pulp from inside a tooth and preserve the tooth by filling and sealing the space.</li>
	<li>Unfortunately, root canals have a bad reputation as painful or dangerous, but this is not necessarily true.</li>
	<li>Avoiding the procedure means risking the situation getting worse and potentially losing the tooth.</li>
	<li>As the infection progresses, pulp necrosis develops and the pulp eventually dies.</li>
	<li>Many times, patients tend to skip crown placement because they think it is unnecessary. This is a misconception as without crown placement, the tooth is weak and may not be able to endure heavy chewing forces over a long period.</li>
	<li>In general, root canal therapy can take multiple appointments and may be more uncomfortable than a regular filling, but it is a procedure that is performed to save a damaged or infected tooth and prevent the need for extraction. 
	&nbsp;</li>
</ul>

[1] Slide show: Root canal treatment. Mayo Clinic.

[2] Stang D. Root canal: Purpose, procedure, and risks. Healthline.

[3] Root canal: What is it, diagnosis, treatment, Side Effects & Recovery. Cleveland Clinic.

[4] Root canals: Process, causes, problems, surgery, recovery, and more. WebMD.

[5] What is a root canal? American Association of Endodontists.

[6] Department of Health & Human Services. Root canal treatment. Better Health Channel.

[7] Smith Y. Root canal treatment procedure. News

[8] Root canal treatment. healthdirect.

[9] Author links open overlay panelGeorgios S. Chatzopoulos a, a, b, et al. Implant and root canal treatment: Survival rates and factors associated with treatment outcome. Journal of Dentistry.

[10] Nabavizadeh MR, Sahebi S, Nadian I. Antibiotic prescription for endodontic treatment: general dentist knowledge + practice in shiraz. Iran Endod J. 2011;6(2):54-59.

[11] León-López M, Cabanillas-Balsera D, Martín-González J, Montero-Miralles P, Saúco-Márquez JJ, Segura-Egea JJ. Prevalence of root canal treatment worldwide: A systematic review and meta-analysis. Int Endod J. 2022;55(11):1105-1127. doi:10.1111/iej.13822