Article reviewed by:
Dr Irene Sim • Endodontist
Root canal treatment (RCT) is a dental procedure that dentists or endodontists perform to save a tooth by removing dying or dead nerve tissue and bacteria inside the implicated tooth and preventing reinfection.
To know more about RCT, let’s first examine the tooth’s structure to comprehend better what a root canal entails. The tooth consists of three layers – the outermost enamel, the dentin, and the innermost pulp. The thick layer of dentin and enamel provides a protective layer to the pulp, which contains nerves and blood supply to the tooth.
In this post, we cover ten commonly asked questions on RCT:
- When is root canal treatment required?
- Is root canal treatment suitable for people of all ages?
- How is root canal treatment performed?
- Is root canal treatment painful?
- What happens if you avoid a root canal treatment?
- When is re-root canal treatment necessary?
- How long can root canal treatment last?
- Do I require a dental crown after root canal treatment?
- Can I use Medisave or insurance for root canal treatment?
- How should I care for my root canal treated tooth?
When is root canal treatment required?
RCT is required when the tooth’s pulp gets inflamed by tooth decay or when bacteria enter the tooth through cracks. An inflamed pulp will cause a person to feel pain in the tooth, and if the inflammation is left untreated, the tooth may eventually be lost.
Some symptoms that make it necessary for RCT:
- A cracked tooth: This allows bacteria to make its way to the tooth pulp.
- Discoloration of the tooth: An infected pulp may cause your teeth to appear darker due to poor blood supply to the infected tooth.
- Prolonged sensitivity to hot and cold sensations: Especially when sensitive sensations last for more than a few seconds.
- Swollen gums: Pus accumulates in the swollen area of an infected tooth, causing considerable pain on the gums.
- Extreme pain while chewing: This usually equates to damaged nerves around the pulp.
- Pimple on the gums: Pus from the infected tooth usually develops into an unpleasant taste and/or smell.
Is root canal treatment suitable for people of all ages?
Yes, RCT can save the teeth of people of all ages. Global research has shown that it is typically performed on patients aged 12 to 64 years, with the age group 24 to 44 being the majority who receive consultations.
Young children with deep caries may also require root canal treatment (pulpotomy) to save their baby tooth. A paedodontist or an endodontist can do this procedure. Dr Irene Sim, endodontist at Specialist Dental Group, once had a four-year-old patient who fell asleep on the dental chair during his RCT!
If you are experiencing unbearable tooth pain, visit a dental specialist so that they can carry out a comprehensive examination for you and provide you with a customised treatment plan.
How is root canal treatment performed?
Depending on the patient’s case, RCT typically requires one to two appointments. This is how it takes place:
- Preparation:
The dentist or endodontist will carry out an assessment of your infected tooth by taking X-rays to determine if the implicated tooth is suitable for RCT.
– Extraction may be advised if the patient’s treatment prognosis is poor due to a lack of bone support or inadequate tooth structure.
– If the patient decides to save the tooth, RCT may be administered. - Pulp removal:
The patient will be given local anaesthesia to numb the affected area before starting treatment. The endodontist or dentist will then place a dam (a rubber sheet) around the teeth to ensure the site is dry during treatment. This also prevents patients from swallowing any chemicals. Once an opening is made at the top of the tooth (known as the crown), the infected pulp is subsequently removed. - Clean and filling of root canal:
After completion of pulp removal, the endodontist will disinfect, clean, and shape the root canal before sealing it with a temporary filling. - Sealing the tooth:
The temporary filling will be removed on your next visit and the root filling will be inserted. - Adding a crown:
A crown is a cap that covers the remaining structure of the natural tooth. After root canal treatment, a dental crown is often necessary to strengthen the implicated tooth.
Is root canal treatment painful?
As local anaesthesia is applied over the site during the procedure, RCT can be a pleasant experience. At Specialist Dental Group, it is not uncommon to see patients fall asleep during their treatment.
After the treatment, there may be some sensitivity for a few days due to the inflammation of the surrounding tissues. Mild painkillers will typically be prescribed to provide relief during this period.
Should the sensitivity last longer than a few days, it is recommended to highlight this issue to your endodontist.
What happens if you avoid a root canal treatment?
If your endodontist or dentist has determined a need for RCT, it indicates that a tooth is infected. The tooth remains infected until the treatment or extraction is carried out.
Without prompt treatment, the infection can spread and form an abscess. An abscess is an accumulation of pus (thick, yellowish fluid) formed naturally by the body to contain an infection and prevent it from spreading. It appears as a pink/red swollen area and is typically painful due to the built-up pressure of the pus.
While the pain may subside with medication, the infection will persist unless treated. We encourage all patients to seek treatment promptly to prevent continual infection, thereby causing damage to surrounding teeth and bone.
RCT is generally done under local anaesthesia so that there is minimal discomfort. For concerned patients, intravenous sedation is an alternative to complete their treatment comfortably. Discuss your concerns with your endodontist or dentist for advice on anaesthetic options.
When is re-root canal treatment necessary?
Although uncommon, root-treated teeth may get infected again due to bacteria remaining in the root canal or bacteria re-entering the tooth after treatment. They can be caused by:
- A filling that is defective and leaking or a crown that has dislodged
- A cracked tooth
- Gum disease or tooth decay
- The presence of persistent bacteria remaining in the root canal which may not be possible to eradicate due to the complexity of the root canal system
These instances may occur months or even years following the treatment. In such a case, going for a re-root canal treatment may provide the tooth a renewed life; however, removing these complex materials on the implicated tooth often requires specialised skills.
A retreatment is typically similar to the initial treatment. The endodontist will remove the previous fillings in the root canal before looking for any new infection to eradicate. After cleaning the canals, a new filling will be placed and sealed with a temporary filling in the tooth. Depending on your situation, you may need to return for a new crown placement to restore the tooth to fully functioning.
How long can root canal treatment last?
When performed accurately, RCT results can last for a prolonged period, possibly your entire life, if you practice proper oral hygiene.
Do I require a dental crown after root canal treatment?
Although a dental crown is not always necessary after a root canal treatment, a study from the Journal of Endodontics has shown a 90% survival rate for teeth inserted with dental crowns following RCT. In cases where a crown is not protecting a weakened tooth, there is a higher possibility of a broken tooth. A dental crown is typically necessary for a molar, premolar, or back grinding tooth that has just received treatment, as you will use these teeth continuously for eating. Your dentist or endodontist will advise whether you require a dental crown after your RCT.
Can I use Medisave or insurance for root canal treatment?
As RCT is not a dental surgery, Medisave cannot be utilised. This regulation is specified by the Ministry of Health (MOH). However, depending on your insurance coverage, you can make a claim if an accident happened and RCT is required.
How should I care for my root canal treated tooth?
Following RCT, keeping the affected area clean is crucial. Other than regular brushing and flossing, adopt a routine of using an antibacterial mouthwash throughout the day. If you have been treated with a temporary filling while waiting for your permanent crown, ensure you avoid chewing food on the treated tooth until your permanent crown is set in place. Reducing sugary food and drink consumption and regular cleanings also contribute to an infection-free set of healthy teeth.
