ENDODONTICS

General dentists can perform root canal treatment themselves, but in certain circumstances your regular dentist may not feel confident enough to perform the treatment successfully.

This may be because the first treatment was unsuccessful and needs to be performed again. Often teeth have complex curved or narrow roots that are very difficult to treat without specialized equipment. Referring a patient in this situation is good practice and shows that a practitioner wants to achieve the best for their patient.

Research suggests that specialists can achieve the highest success rates because they have the training, equipment and expertise to tackle difficult cases more effectively.

Tooth decay or a leaking filling are the main causes of inflammation of the dental tissue. Bacteria are usually the cause of the inflammation. Do your teeth feel sensitive when drinking cold or hot drinks? That could be the first signal.

Sometimes the inflammation causes no complaints, but severe pain can also occur. Your dentist must remove the inflamed tooth tissue, otherwise it will die. If the dental tissue is not removed, the inflammation can spread to your jawbone. This can cause jaw bone around the tooth to be lost. Eventually, so much jaw bone can disappear that the teeth loosen or become painful when chewing. Your tooth may therefore feel too high.

During a root canal treatment, the dentist removes the inflamed nerve tissue. Once inflamed, the nerve tissue has a very low chance of healing. Therefore, your dentist removes the inflamed tissue. A root canal treatment is also called canal or nerve treatment.

A root canal treatment is usually not painful with anesthesia. You should not experience any pain or discomfort during the procedure. It is not uncommon to have some discomfort in the jaw. The tooth may feel tender once the anesthetic wears off.

The duration of a root canal treatment depends on the number of root canals to be performed and their complexity. Teeth usually have one root. Molars often have 3 or more. We aim to complete the treatments in one session. The duration of a session varies from 1 hour to 2.5 hours. Sometimes you may have to return 2 or 3 times to complete the treatment.

Once the root canal treatment is complete, a permanent tooth-colored filling is placed to permanently seal the tooth.

In certain situations, such as a front tooth, no further dental treatment is required other than good oral hygiene, including brushing, flossing and regular checkups.

However, the rear (chewing) teeth are more susceptible to fractures after root canal treatment. These teeth may need further protection to extend their lifespan, often with an onlay or a crown.

During the assessment phase, advice will be given if it is likely that an onlay or crown will be required following root canal treatment.

We will send your dentist a letter explaining the treatment performed and advice on any further restorative work, if necessary. If the root-treated tooth is left without the recommended restoration, it can lead to tooth fracture and decreased tooth survival.

We invite all our patients to return for a one-year assessment appointment (no additional charge). The tooth can also be checked at your own dentist as part of a routine check-up. In complex cases we may ask you to return earlier for an assessment.

As with any dental or medical procedure, your tooth may not heal as expected after the initial treatment for a variety of reasons, including:

• narrow or curved canals were not treated during the initial procedure,

• complicated canal anatomy went unnoticed in the first procedure,

• the placement of the crown or other restoration is delayed after endodontic treatment,

• the restoration could not prevent saliva contamination on the inside of the tooth.

A new problem can also compromise a successfully treated tooth, such as:

• New tooth decay can expose the root canal filling material to bacteria, causing a new infection in the tooth,

• a loose, cracked or broken crown or filling can expose the tooth to new infections,

• a tooth suffers a fracture.
  

During the retreatment, the endodontist will reopen your tooth and remove the filling materials that were placed in the root canals during the first procedure. We then carefully examine the tooth, looking for additional canals or new infection. We will remove any infections, clean and shape the canals and place new filling materials. The opening is then closed with a temporary filling. The tooth must then be restored with a more permanent restoration to seal and protect it.

In some cases, the endodontist may be the one to seal the tooth more permanently in preparation for the placement of a crown by the general dentist.

Surgery can help save your tooth in several situations:

• Surgery can be used in the diagnosis. If you have persistent symptoms but no problems appear on your X-ray, your tooth may have a small fracture or canal that could not be detected during non-surgical treatment. In such a case, surgery allows your endodontist to examine the entire root of your tooth, find the problem and provide treatment.

• Sometimes calcium deposits make a canal too narrow for the instruments used in non-surgical root canal treatments to reach the end of the root. If your tooth has this "calcification," your endodontist may perform endodontic surgery to clean and seal the remainder of the canal.

• Typically, a tooth that has undergone a root canal can last the rest of your life and never require further endodontic treatment. However, in some cases, a tooth may not heal or become infected. A tooth can become painful or diseased months or even years after successful treatment. If this applies to you, surgery can help save your tooth.

• Surgery may also be performed to treat damaged root surfaces or surrounding bone.

• Although there are many surgical procedures that can be performed to save a tooth, the most common is called apicoectomy, or root end resection. If inflammation or infection persists in the bony area around the end of your tooth after a root canal, your endodontist may need to perform an apicoectomy.

Root canal treatments are not covered by basic insurance for adults (from 18 years of age) and are not reimbursed. If you have taken out additional insurance for dental costs, you can ask your health insurer whether a root canal treatment is covered by the reimbursements. It may be that part of the treatment (ie a number of procedure codes) is not reimbursed by your insurance.

Almost all health insurers reimburse the costs of treatment by the dental hygienist in whole or in part if you have additional dental insurance. For all children up to the age of 18, treatments are fully reimbursed from basic insurance. We recommend that you contact your health insurer to inquire whether you are eligible for any reimbursement.