Dr Pradeep UnnikrishnanAlthough the procedure is relatively painless when done properly, the root canal treatment remains a stereotypically fearsome dental operation.This procedure refers to the treatment of the pulp of a tooth to remove infection and to protect the remaining tooth structure from further destruction. Toothache is often the main reason one approaches a dentist. Toothache can range from a mild discomfort to excruciating pain.Dental caries is the most common cause of toothache. Decay begins on the outside of the tooth moving inwards destroying the visible enamel and the underlying dentin. At this point the pain is temporary and easily relieved. Decay that has reached the pulp of the tooth introduces bacteria into the pulp. The bacteria will not allow the pulp to heal; at this point the pulp is irreversibly damaged and will not recover from the damage. Once the infection reaches the pulp it is extremely painful and debilitating due to inflammation.Symptoms associated with irreversible pulpitis may include swelling, dull pain from hot or cold or spontaneous acute pain associated with swelling. Root canal therapyEndodontic therapy involves the removal of nerve and pulp tissue, cleaning, and decontamination of the chamber and the filling it with a cement.To cure the infection and save the tooth, the dentist enters the pulp chamber through the crown of tooth and removes the infected pulp and the nerve out of the root canal(s) with long needle-shaped instruments. 1. The dentist first assesses the condition of the tooth and whether decay is involving the pulp.2. The tooth is first cleared of all decay and then the dentist proceeds to enter the inner chamber of tooth to reach pulp.3. The root canal(s) is cleaned, enlarged, and shaped in order to be filled.4. the dentist fills each of the root canals and the chamber with an inert material and seals up the opening.5. Medications may be inserted into the pulp chamber and root canal(s) so as to eliminate harmful bacteria and prevent further infection.6. The pulp chamber and root canals are filled and sealed.7. The crown of the tooth is then restored.Endodontists are specialist dentists that deal with diseases associated with dental pulp. They generally deal with more complex endodontic procedures not handled by general dentists. This may include the re-treatment of root canals that have not healed completely. Myths and factsRoot canals are painful. FALSEA root canal does not cause pain. The root canal procedure itself is painless. A root canal is done to eliminate pain caused by an infection in the tooth. Root canal treatments are often initiated in circumstances of great pain.Your dentist may give you a local anaesthetic (a small injection) to numb the tooth and the surrounding area to relieve the pain caused by the infection. The perception that root canal treatments are painful is an old belief that began when it was introduced. Today, using the latest technologies and anaesthetics, root canal treatment is no more painful than getting a filling.Knowing what to expect while having a root canal can help ease a lot of anxiety. Root canal treatments are expensive. FALSEHaving a root canal and a dental crown remains less expensive than extracting a tooth and then replacing it with a bridge or a dental implant.Though bridges and dental implants may seem to be more economical (cheaper!) in the short run they require significantly more time during construction and maintenance.Artificial teeth can cause you to avoid certain food.Generally root canal treatment and preservation of the natural tooth requires less effort, is less time consuming and more economical. Most root canal-treated teeth last a lifetime. Root canals do not work. Even with a root canal the tooth will eventually have to be removed. Extraction is better than root canal. FALSE A root canal that is done well has a very high success rate. Nothing can replace natural teeth. Teeth are necessary for speech and eating and having healthy smile is also important for self-esteem. If an extracted tooth is not replaced with a denture or implant, the remaining teeth may shift creating spaces between teeth leading to a gap toothed smile which is neither hygienic nor aesthetically pleasing. If a tooth becomes infected again years after root canal has been done, it can often be retreated. A root canal “kills” the tooth. FALSEA root canal cleans and disinfects the inside of the tooth to allow it to heal. It does not kill a tooth but after endodontic surgery the tooth will be “dead.” The tooth is a hollow structure and within the cavity (pulp chamber) is contained nerve tissue and blood vessels. The nerve’s function is to cause pain when something is wrong with the tooth. Pain is therefore a defence mechanism that signals a person to seek help. A root canal means I’m having the roots of my tooth, or my whole tooth, removed. FALSEThe whole point of root canal therapy is to try to save a tooth, not to remove it. When endodontists perform the procedure they remove the pulp from inside of the tooth (and roots) but not the root itself. The tooth and roots are not removed. The canals are cleaned and shaped on the inside only. Pregnant women can’t have root canals. FALSEYes!! Pregnant women CAN have root canals. Preventive dental cleanings and regular dental exams are recommended during pregnancy. Preventive dental work is undertaken during pregnancy to avoid infections and gum disease, which has been linked to preterm birth. During pregnancy a root canal may be recommended in the case of a tooth infection. Conditions such a tooth abscess that need root canal therapy are usually accompanied by severe toothache. Continuous pain during pregnancy can be a really stressful condition with potentially negative effects to the mother and foetus. Severe toothache may prevent the mother from maintaining a healthy diet that is essential to the health of the unborn foetus.The safest course of action is to postpone all unnecessary dental work until after the birth (Or at least performed in the second trimester). Unfortunately, it may not be practical or advisable to postpone a root canal treatment until after pregnancy is over. Having a root canal does require a small X-ray however the radiation exposure is very minimal and it is aimed at the mouth and not the stomach area. Your dentist will also use a lead apron to cover your belly. The anaesthetics your dentist uses are also safe for pregnant women. The amount of anaesthesia administered would be as little as possible, but enough to make you comfortable. If you are experiencing pain, you may inform the doctor for additional numbing. The amount of stress on the baby is reduced when the mother is comfortable. Let your dentist know you are pregnant before starting any procedure. After having a root canal my tooth is completely restored. MAYBERoot canals are recommended when a tooth has been fractured or when decay has entered the nerve chamber. Teeth that need root canal treatment have very big cavities or big fillings and so are more at risk to be fractured. After the pulp has been removed the tooth becomes dry and brittle. For this reason, it is recommended to make an appointment with your dentist to have the tooth permanently restored after the root canal procedure. Root canal treatment is a very time consuming procedure with many appointments with the dentist. MAYBEWith today’s cutting edge technology uncomplicated root canals can be finished in one or two sittings. Root canal appointments may take between one and two hours if there are no complications. The number of appointments also depends on the condition of the tooth and the number of canals it has.If the infection is severe, your dentist may place a drug inside to help disinfect the interior of the roots, and then finish the root canal treatment a few days later. But if there is no infection or other complications, the procedure can be completed in one single appointment. My tooth doesn’t hurt so I don’t need a root canal. FALSEA tooth in need of root canal therapy should be addressed immediately. A delay might result in formation of an abscess at the root of the tooth that may result in loosening of the tooth after which it would be impossible to save the tooth. The infection may also spread to other areas of body causing swelling, blood poisoning and fever.Commonly, root canals are performed to relieve and treat severe throbbing toothache due to decay but at times a tooth can require root canal treatment when there is no pain present. Your doctor is the best judge of the health of your teeth. l The author is Specialist – Dentist at Aster Medical Centre, C-Ring Road.