Root canal treatments - your queries answered

root canal treatmentRoot canal treatments are one of the most dreaded of dental procedures. People often make excuses to skip an appointment despite a really bad tooth. So, why has this procedure managed to garner this reputation? Why is it necessary? Why does it take so many sittings for the treatment? We've attempted to answer some of the most frequently asked questions on this topic:

1. "I've heard root canal treatments are very painful. Do I really need it?"

Let's understand how a tooth gets infected in the first place - All teeth have root canals which have nerves and blood vessels nourishing the teeth. When dental decay progresses from the outer layers of the teeth to the root canals, these nerves and vessels get infected. They die and are replaced by infected material and pus. This causes pain and swelling necessitating a root canal treatment.

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If left untreated, they may cause damage to the bone surrounding the roots resulting in tooth abscess and draining pus.

Now, if a root is infected badly and if the root canal procedure is done without giving a course of antibiotics, it might lead to pain. If the tooth does not have active infection, it shouldn't pain. With modern anaesthesia, painless root canals are not a myth anymore.

2. "Isn't it better to just extract the teeth instead of opting for root canal treatment?"

No. One does not realize the value of teeth when one has them. No artificial tooth can ever replace the real one. Once a tooth is extracted, the neighbouring teeth move into the space created by the extraction and cause gum problems, difficulty in chewing etc.

3. "Why does it take so much time for the treatment?"

Firstly, if a tooth has active infection, you will be prescribed antibiotics to reduce the pain and infection. After three to four days, the dentist would start cleaning the roots with instruments (usually with local anaesthesia). Once the roots are clean, they are filled with a material to seal the roots and prevent them from getting reinfected. The tooth is then rebuilt with a dental material like composite after which a crown/cap is placed over it.

4."If there's no pain, why is a root canal treatment required?"

Teeth that require root canals are not always painful. Sometimes, teeth may be dead for months or years and may not pain at all. Only when they get infected and cause a considerable amount of damage in the tooth and in the bone holding them will they cause pain. If root canal is done at the right time before it starts causing pain, the prognosis of the tooth is always better.

5. "Once the doctor says the nerves are removed, why should I have pain?"

No. Some infected teeth might take a while to settle down after root canal treatment. Certain teeth which have not been in use for a while might feel tender and painful while chewing after placement of a cap/crown.

In a few cases, there might be certain complications leading to reinfection and hence pain.Whatever the case, your dentist will be able to help alleviate the pain.

6. "Root canal treatment takes too much time, too many sittings". Why is that so?

The root canal per se should not take more than two to three sittings. With modern equipment, endodontists (root canal specialists) can even finish the procedure in a single sitting. However, if the tooth is infected, has very difficult canals or if the patient compliance is less, it may require more sittings.

Moreover, the strengthening of the tooth after the procedure with filling and crowns/bridges may require more sittings.

7. "Aren't we killing the tooth during the root canal?"

Root canal treatments are done when a tooth is dying or is already dead. Dental pulp (blood vessels and nerves) in the tooth is removed during the procedure because it gets infected due to decay or gum disease.

8. "If I'm feeling alright after a root canal, why bother covering it with a crown/cap?"

Since the dental pulp which nourishes the tooth is removed during a root canal, the nourishment to the tooth is completely cut off making it brittle and vulnerable to fractures in areas of high pressure during chewing. To withstand these pressures and for optimum function, your dentist would usually advise you to do a core filling or rebuild the tooth after which a metal, ceramic or other crowns would be placed.

A cap/crown may not be necessary in very few cases where a large part of the tooth is still retained and/or the tooth is not located in areas of high pressure.

9. "I do not want ugly looking metallic crowns/caps". Aren't there other options?

No, there are many options for crowns or caps. Earlier, either unsightly gold or metal crowns were used. These days there are ceramic, resin or ceramic-fused-to-metal crowns which look very life-like and aesthetic. Ask your dentist for options.

10. "Why do my child's milk teeth require root canals? They are going to be replaced by permanent ones anyway."

No. Depending on how close the tooth is to exfoliation (being replaced by a permanent tooth), your child's dentist would suggest if a root canal is required for the milk teeth. It is very important to retain all milk teeth till their time since they act as very effective natural space maintainers for the permanent teeth to emerge. If extracted before their time, the teeth adjoining the area migrate in the space created reducing the space for the permanent teeth to emerge. This causes misalignment of the teeth requiring correction with braces.

We hope to have answered some of the common queries about root canal procedures. If you have any, please do post them as comments and we'd be glad to get them answered for you.

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