Do you know the hard surface of our teeth is meant to protect the roots of our teeth? Underneath our teeth enamel are miniscule passages called canals, which hold blood vessels and nerves. In Endodontics, we treat these sensitive tissues of the teeth also known as the pulp in case of inflammation and pain arising due to potential infection in the tooth’s pulp. This treatment is popularly known as Root Canal Therapy (RCT) often required when the tooth’s pulp gets infected. Usually this can happen due to injury to the teeth or an unnoticed dental decay and the procedure involves making a small opening on the affected tooth, cleaning and sterilising the infected tissue, sealing it with sterile biocompatible filler, and closing the tooth to avoid the possibility of re-infection.


Why do I feel pain?
When the pulp becomes infected due to a deep cavity or fracture that allows bacteria to seep in, or injury due to trauma, it can die. Damaged or dead pulp causes increased blood flow and cellular activity, and pressure cannot be relieved from inside the tooth. Pain in the tooth is commonly felt when biting down, chewing on it and applying hot or cold foods and drinks.


Why do I need root canal therapy?
Root canal therapy is necessary because the tooth will not heal by itself. Without treatment, the infection will spread, bone around the tooth will begin to degenerate and the tooth may fall out. Pain usually worsens until one is forced to seek emergency dental attention. The only alternative is usually extraction of the tooth, which can cause surrounding teeth to shift crookedly, resulting in a bad bite. Though an extraction is cheaper, the space left behind will require an implant or a bridge, which can be more expensive than root canal therapy. If you have the choice, it’s always best to keep your original teeth.


What is a root canal procedure?
A root canal is a procedure done to save the damaged or dead pulp in the root canal of the tooth by cleaning out the diseased pulp and reshaping the canal. The canal is filled with a rubberlike substance called gutta–percha or another material to prevent recontamination of the tooth. The tooth is then permanently sealed, with possibly a post and/or a crown made of porcelain or metal alloy. This enables patients to keep the original tooth.


What is involved in root canal therapy?
Once your general dentist performs tests on the tooth and recommends therapy, he or she can perform the treatment or refer you to an Endodontist. Treatment usually involves one to three appointments. First, you will probably be given a local anaesthetic to numb the area. A rubber sheet is then placed around the tooth to isolate it. Next, an opening is drilled from the crown into the pulp chamber, which, along with the root canal, is cleaned of all diseased pulp and reshaped.
Medication may be inserted into the area to fight bacteria. Depending on the condition of the tooth, the crown may then be sealed temporarily to guard against recontamination, the tooth may be left open to drain or the dentist may go right ahead and fill the canals.
If you’re given a temporary filling, usually on the next visit it’s removed and the pulp chamber and canal(s) are filled with gutta-percha or another material to prevent recontamination. If the tooth is still weak, a metal post may be inserted above the canal filling to reinforce the tooth. Once filled, the area is permanently sealed. Finally, a gold or porcelain crown is normally placed over the tooth to strengthen its structure and improve appearance.


What are the risks and complications?
More than 95 percent of root canal treatments are successful. However, sometimes a procedure needs to be redone due to diseased canal offshoots that went unnoticed or the fracture of a filing instrument, both of which rarely occur. Occasionally, a root canal therapy will fail altogether, marked by a return of pain.


What happens after the treatment?
Natural tissue inflammation may cause discomfort for a few days, which can be controlled by an over-the-counter analgesic. A follow-up exam can monitor tissue healing. From this point on, brush and floss regularly, avoid chewing hard foods with the treated tooth, and see your dentist regularly.


Are there options to root canal therapy?
The only alternative to root canal therapy is to extract the tooth; however, this alone can cause the surrounding teeth to move, resulting in a bad bite. Though a simple extraction may be perceived as less expensive, the empty space left behind will require an implant or a bridge, which ultimately can be more costly than root canal therapy.

* Dr Hisham Muhammed, BDS, 
MDS (Endodontics), Endodontist, 
Aster Medical Centre-Al Rayyan