Root Canal Treatment (Endodontics)

Why a tooth needs it

Inside every tooth is a chamber containing nerve and blood vessels — the pulp. Deep decay, a fracture, repeated dental work or trauma can let bacteria reach it. Once infected, the pulp cannot heal on its own: the inflammation is trapped inside rigid walls, pressure builds, and the result is the characteristic throbbing pain, sensitivity to heat, and eventually an abscess at the root tip as infection escapes into the surrounding bone.

At that point there are two options: remove the tooth, or remove the infected pulp and keep the tooth. Modern endodontics makes the second option predictable, and a natural tooth root maintains bone and proprioception in a way no implant fully replicates.

What the treatment involves

The tooth is anaesthetised and isolated with a rubber dam — a sheet that seals the tooth off from saliva. This is not a formality. Saliva carries bacteria, and a canal disinfected and then recontaminated during the same appointment has not been treated at all. We do not perform endodontics without a dam.

An access cavity is made, the canals located, and their length measured to the root tip using an electronic apex locator and radiographs. Rotary nickel-titanium instruments then shape the canals while irrigating solutions — sodium hypochlorite, EDTA, sometimes activated ultrasonically — dissolve tissue and kill bacteria in the branches too small to instrument. Chemical disinfection does most of the real work; the files mainly create space for it to reach.

Once clean and dry, the canal system is filled three-dimensionally with gutta-percha and a sealer, and the access cavity closed. A back tooth then needs a crown or onlay: an endodontically treated molar has lost structural integrity and will eventually split under load if left unprotected.

The microscope

Canals are narrow, curved and frequently more numerous than the textbook diagram suggests — a second canal in the mesiobuccal root of an upper molar is present in the majority of cases and is the most commonly missed cause of failure. Under an operating microscope, with coaxial illumination, those canals can be seen rather than inferred. Calcified canals can be negotiated, fractures identified, and separated instruments retrieved. It is the single piece of equipment that most changes endodontic outcomes.

One visit or two

Uncomplicated cases with a vital pulp can often be completed in one appointment. Where there is an established abscess, heavy infection or a canal that will not dry, we place calcium hydroxide medication and a sealed temporary, then complete the filling one to two weeks later. Deciding this by the state of the tooth rather than by the schedule is what separates thorough treatment from fast treatment.

Does it hurt?

The pain that brings patients in is caused by the inflammation; the treatment relieves it. Under proper anaesthesia the procedure itself is comparable to having a large filling. Mild tenderness on biting for a few days afterwards is normal as the ligament around the root settles, and responds to ordinary painkillers. Severe or increasing pain is not normal and should be reported.

Success, and what to do if it fails

Well-executed root canal treatment succeeds in roughly 85–95% of cases. Failures are usually caused by a missed canal, a leaking coronal restoration or a vertical root fracture. A failing tooth is not automatically lost: retreatment — removing the old filling material and re-disinfecting — or a small surgical procedure at the root tip called an apicectomy can often save it. Extraction should be the last option considered, not the first.