Root canal treatment (endodontics) is a dental procedure used to treat infection at the centre of a tooth. Root canal treatment is not painful and can save a tooth that might otherwise have to be removed completely.
The infection at the centre of a tooth (the root canal) is caused by bacteria that live in the mouth and invade the tooth.
This can happen after:
A tooth is made up of 2 parts. The crown is the top part of the tooth that’s visible in the mouth. The root extends into the bone of the jaw, anchoring the tooth in position.
Teeth also consist of:
The root canal system contains the dental pulp and extends from the crown of the tooth to the end of the root. A single tooth can have more than 1 root canal.
Root canal treatment is needed when dental X-rays show that the pulp has been damaged by a bacterial infection. The pulp may become inflamed if it’s infected by bacteria, allowing the bacteria to multiply and spread.
The symptoms of a pulp infection include:
As the infection progresses, these symptoms often disappear as the pulp dies. Your tooth then appears to have healed, but the infection has spread through the root canal system.
You eventually get further symptoms such as:
It’s important to see your dentist if you develop toothache. If your tooth is infected, the pulp cannot heal by itself. Leaving the infected tooth in your mouth may make it worse. There may also be less chance of the root canal treatment working if the infection within your tooth becomes established.
Antibiotics, a medicine to treat bacterial infections, are not effective in treating root canal infections. They can though help to treat an infection that spreads beyond the root and causes swelling.
To treat the infection in the root canal, the bacteria need to be removed.
This can be done by either:
However, removing the tooth is not usually recommended, as it’s better to keep as many of your natural teeth as possible. Before having root canal treatment, you’ll usually be given a local anaesthetic. This means the procedure should be painless and no more unpleasant than having a filling. After the bacteria have been removed, the root canal is filled, and the tooth is sealed with a filling or crown. In most cases, the inflamed tissue near the tooth will heal naturally. Root canal treatment is usually successful. In about 9 out of 10 cases, a tooth can survive for up to 10 years after root canal treatment.
Find out how root canal treatment is done
It’s important to look after your teeth when recovering from root canal treatment. You should avoid biting on hard foods until your treatment is complete. After your final treatment, your restored tooth should no longer be painful, although it may feel sore for a few days. You can take over-the-counter painkillers, such as paracetamol or ibuprofen, to relieve any discomfort. Return to your dentist if you still have pain or swelling after using painkillers.
In most cases, it’s possible to prevent the need for further root canal treatment by:
Root canal treatment is carried out by your dentist over 2 or more appointments. Unless you’re entitled to free NHS dental treatment, you’ll have to pay for root canal treatment. Read about NHS dental charges and how to get help with dental costs. If the work is particularly complex, your dentist may refer you to a specialist in root canal treatment, known as an endodontist.
All registered dental specialists in the UK are listed on the General Dental Council (GDC) website.
Preparing for Root Canal Treatment
Before having root canal treatment, your dentist may take a series of X-rays of the affected tooth. This allows them to build up a clear picture of the root canal and assess the extent of any damage. Root canal treatment is usually carried out under local anaesthetic, a painkilling medicine that numbs your infected tooth and the gum around it. In some cases where the tooth has died and is no longer sensitive, it may not be necessary to use a local anaesthetic.
Removing the Pulp
Your dentist will place a rubber sheet (dam) around the tooth to ensure it’s dry during treatment. The dam also prevents you from swallowing or breathing in any chemicals the dentist uses. Your dentist will use a drill to open your tooth through the crown, the flat part at the top, to access the soft tissue at the centre of the tooth (pulp). They’ll then remove any infected pulp that remains. If you have a dental abscess, which is a pus-filled swelling, your dentist will be able to drain it at the same time.
Cleaning and Filling the Root Canal
After the pulp has been removed, your dentist will clean and enlarge the root canal. The root canal is usually very narrow, which makes it difficult to fill. Your dentist will use a series of small files to enlarge the canals and make them a regular shape so they can be filled. This part of the treatment may take several hours and may need to be carried out over several visits. Your front incisor and canine teeth (biting teeth) usually have a single root containing 1 root canal. The premolars and back molar teeth (chewing teeth) have 2 or 3 roots, each containing either 1 or 2 root canals. The more roots a tooth has, the longer the treatment will take to complete.
If the treatment needs to be carried out over several sessions, your dentist may put a small amount of medicine in the cleaned canal in between visits to kill any remaining bacteria. The tooth will then be sealed using a temporary filling.
If you have symptoms from the infection, such as a raised temperature or large swelling, you may be given antibiotics to help manage and prevent further infection.
Sealing and Fixing the Tooth
At your next visit, the temporary filling and medicine within the tooth will be removed, and the root canal filling will be inserted. This, along with a filling, seals the tooth and prevents reinfection. Root-filled teeth are more likely to break than healthy, unrestored teeth, so your dentist may suggest placing a crown on the tooth to protect it. In some cases, a root-filled tooth may darken, particularly if it’s died as a result of injury like a knock to the tooth. There are several ways your dentist can treat discolouration, such as whitening the tooth using chemicals.
Adding a crown
A crown is a cap that completely covers a real tooth. It might be necessary to use a crown after root canal treatment to prevent the tooth from fracturing.
Crowns can be made from:
The dentist will use a drill to reduce the size of your tooth and use the crown to replace what’s removed. A mould of your tooth will be taken to ensure the crown is the right shape and size and fits your tooth accurately. When fitting the crown, cement will be used to glue the crown to the trimmed-down tooth. If there’s only a small amount of tooth left after the root canal treatment, a post can be cemented in the root canal and used to help keep the crown in place.
Root canal treatment is usually successful at saving the tooth and clearing the infection. Around 9 out of 10 root-treated teeth survive for 8 to 10 years. Having a crown fitted to the tooth after root canal treatment is important for improving tooth survival rates. If you keep your teeth clean, your treated tooth should survive for a long time.
The survival of your tooth depends on several factors, including:
But if an infection does return, the root canal treatment can be repeated. Or if treatment has already been carried out to a high standard and the infection remains, a small operation to remove the root tip (an apicoectomy) may be carried out to treat the infection.
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