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ENDODONTICS: ROOT CANAL TREATMENT

This term covers a series of procedures aimed at saving a tooth which would otherwise require extraction.

The pulp chamber and root canal system of the tooth contain a mixture of nerves, blood vessels and connective tissue and help to keep the dentine ( the bulk of the tooth tissue ) healthy and flexible by providing fluid to it.

The pulp can be damaged by several processes, such as decay or mechanical fracture, which allow bacteria to infiltrate the pulp space, causing pain and inflammation followed ultimately by a dental abscess which could seriously ruin your day.

We can use antibiotics to control the infection in the short term, but until the bacteria and the dead tissue on which they are feeding are removed, the inflammation and pain will inevitably recur.

One way of removing the dying pulp tissue is to extract the tooth. This is pretty much guaranteed to solve the problem, and is sometimes unavoidable where the remaining tooth is so broken down that rebuilding it afterwards would not be possible.

Many patients realise that it is preferable in the longterm to keep their teeth, so we attempt root canal treatment to this end. I use the word “ attempt “ as this is without doubt one of the most complicated treatments within dentistry, and as such many dentists prefer to refer all but the simplest cases.

The internal anatomy of our teeth is both variable and complex, with extremely fine, curved canals and we use a variety of advanced instrumentation and techniques to identify and enlarge the canals. The canal lengths are measured to within 0.5mm using a digital device, and the canals enlarged using a combination of rotary and hand instruments the finest of which is only 0.06mm in diameter.

This often requires use of magnification and OCD, and while my lovely patients watch fish swimming on a coral reef, I’m twisting and turning, upside down and back to front in the full and certain knowledge that I made the right decision when I set up my new practice directly below my Physiotherapist’s treatment room.

Once the canals are open and clean, we use various disinfectants to irrigate the canals to remove any residual bacteria, spores, supermarket trollies, etc ( some of these canals are in a mess ! ) then dress the canals with various potions depending on the presentation.

The dressing finishes off any remaining bugs, and two weeks later we remove the dressing, recheck our measurements, then carefully fill the canals using a natural, biocompatible rubber material, then arrange to restore the tooth in the longterm or return the patient to their own dentist for this to be done.

We routinely accept referral patients from colleagues seeking the best outcome for their patients.

This might be due to NHS restrictions on the treatment of more complex clinical cases, where the very expensive diagnostic equipment and single-use instruments may not be available due to real-term cuts in funding over the past decade.

Your own dentist will assess the treatment complexity based on canal curvature, obstructions in the canals, accessibility etc and decide whether or not it would be appropriate to attempt root canal treatment or refer to a more appropriate facility.

In any event, this transfer of the duty of care is temporary and only for the referred treatment.

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