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The Dental Pulp

To understand root canal or endodontic treatment, it helps to first understand the anatomy of the tooth. The part of the tooth visible in your mouth is called the crown and the part covered by the bone and gum is the root.

The crown of the tooth is made up of the hard white enamel layer and a thicker dentine layer. Both these hard layers protect the innermost soft tissues of the tooth called the pulp. The dental pulp contains blood vessels and nerves within and extends from the crown to the tips of the root or roots.

Rubber dam isolation and access cavity

• Removal of the infected or inflammed pulp is the first step in saving the tooth. Under local anaesthetic, an opening is made in the crown of the tooth to get across to the infected or inflammed pulp within. 

X-ray showing files in root canal

• Using small, specially designed hard or rotary files, the root canals are cleaned and shaped to a form that can be sealed. Debris within the canals is removed by flushing with an anti-bacterial solution.

X-ray of a root filled tooth

• The canals are finally filled or sealed with an inert material called gutta-percha. The tooth should be restored to full shape and function by either a permanent filling or a crown, depending on how much of the tooth is left. This should be done as soon as possible as there could be a risk of tooth fracture due to biting forces.

All root canal treatment procedures are done by isolating the tooth with a rubber dam to provide a clean and saliva-free environment. Root canal treatment may be done in single or multiple visits depending on tooth complexity. In between treatment appointments, medicaments may be placed within the canals and the tooth is covered with a temporary filling.

Often, X-rays are taken to determine the length of the root and to monitor various treatment stages.

​Signs of pulp damage may include pain, prolonged sensitivity to heat or cold, discolouration of the tooth, swelling, tenderness of the overlying gums or a bad taste in the mouth. On the other hand, there may be no symptoms at all. If pulp inflammation or infection is left untreated, it can eventually cause pain, swelling and loss if the supporting bone.

X-ray showing inflammation at the root tips

Root canal treatment involves the removal of the pulp tissues from the tooth in the event that it gets infected or inflammed. The pulp can be infected or inflammed due to either deep decay or an extensive restoration that involves the pulp; cracked or fractured tooth due to trauma; excessive wear of enamel and dentine exposing the pulp and sometimes as a result of severe gum disease.

Try to avoid chewing or biting on the tooth being treated until you have it permanently restored with either a filling or a crown. Excessive pressure at this stage may crack or fracture the tooth.

Therefore, it is important to restore the tooth properly as soon as possible. Most endodontically-treated teeth last as long as natural teeth following a permanent restoration.

Practice good oral hygiene, including brushing and flossing at all times as root-filled teeth are as prone to decay as natural teeth. It is also important to have your root canal treated tooth reviewed regularly by your dentist.

What are the advantages of root canal treatment?

Root canal treatment saves teeth that would otherwise have been extracted.

After root canal treatment, the tooth is pulpless - it has no vital tissues within. However, there are vital tissues surrounding the root (e.g. the gum, periodontal membrane and supporting bone).

A root-canal-treated tooth can function normally and can be maintained with routine dental care and oral hygiene measures.

Is root canal treatment painful?

Root canal treatment procedures are relatively comfortable and often painless as the tooth is anaesthetised during treatment. After treatment, the tooth may be sensitive or tender for a few days due to inflammation of the surrounding tissues. This discomfort can be relieved by taking mild analgesics or painkillers available over the counter at the pharmacy.

However, if the pain persists, or gets worse (e.g. more intense; accompanied by swelling), you should contact your dentist as soon as possible.