Root Canals Blog

21 October 2016

Root Canals

For years, the term “root canal” has been associated with an unpleasant or painful experience at the dentist. While this may have been true in the past, modern dentistry has allowed advances that promote a pain-free experience, even during a root canal. Continue reading on more information of what a root canal is, as well as why dentists recommend them to their patients.

A root canal is essentially a filling of the root to ensure the integrity of the tooth from the inside. When the decay of a tooth, otherwise known as a cavity, reaches the root of the tooth, the cavity can not simply be filled with a simple composite filling. When the decay reaches the root, it causes extreme pain for the patient as well, as the root of the tooth is where the nerve resides. An exposed nerve causes what is commonly referred to as a “hot tooth”. Dentists recommend a root canal in this instance in order to preserve the life of the tooth, as well as to expel their patients’ pain.

There are multiple steps in the process of a root canal:

  1. An x-ray is taken of the tooth so that the tooth as well as its entire root is visible to the dentist.
  2. The patient is numbed up using local anesthetics to assure there will be no pain or discomfort during the procedure.
  3. A hole is drilled in the top of the tooth down into the canal. The nerve is removed from the tooth. Now the procedure can go one of two ways, depending on the doctor’s preference:
  4. An x-ray is taken with the drill in the tooth so that the doctor can see if they have reached the very tip of the root, otherwise known as the “apex”.
  5. Using a device called the “apex locator”, the dentist is able to see when they have reached the apex as they are working in the tooth.
  6. When the apex is located, the dentist begins the process of cleaning out the canal.
  7. Irrigation fluids are flushed into the cavity repeatedly to ensure the that canal is clean and sterile.
  8. Small paper points are used to dry the cavity so that the dentist can begin filling the tooth.
  9. The dentist places small paper points known as “gutta percha” into the tooth. At this point some dentists may prefer to take an x-ray to ensure that the gutta percha reaches the apex.
  10. If the gutta percha reach the apex, they are cemented into the canal to fill it. A dental instrument is heated with a hand-held torch, and is then used to burn off the superfluous ends of the gutta percha, which are removed from the mouth and discarded.
  11. A clay-like substance known as “cavit” is packed into the tooth to fill the remainder of the space. The cavit is then pressed in and wiped with a wet q-tip or cotton roll.
  12. The root canal is now complete. A final x-ray is taken to ensure that the entire canal has been filled.

In most cases, a root canal is done prior to placing a crown on the tooth. This is to ensure the life of a tooth that had very extensive decay. In some cases, a root canal is done on a tooth, and is left with no crown over the natural tooth. Every case is dependent on both the patient and the dentist’s recommendations.

Covid-19 and your care

We have now received clear guidance as to what dental procedures we can safely carry out and at what stages during the pandemic.

Below is a summary of the guidance as we understand it, although this may modify over the next few days as some small inconsistencies are clarified.

The government has set five different risk levels for the pandemic 1-5 (low to high), although this changes on a daily basis.

The treatments that we can carry out safely in dental practice will change with the risk level.

Treatments are significantly limited at level 4.

During the next few weeks, we will attempt to contact each patient that has contacted us with a significant dental problem during lockdown, and we hope to book an assessment appointment for those patients in the week commencing 8th June.

Practice doors will be locked at level 3, 4 and 5. Entry to the practice will be limited to pre-booked appointments.

There will be very clear criteria provided in due course as what is required before arriving at the practice, and what the procedure will be upon arrival. We will endeavour to ensure that each person knows exactly what to expect at their visit as this will be quite different to what you have been used to.

The appointment diary will be structured to take into consideration those patients who are shielding, may have underlying medical issues and so on.

The first week is expected to be a slow start as we ensure that the new protocols are working effectively for everyone’s safety. These protocols will be audited and modified until required.

At level 4 we should be able to carry out the following:

Dental assessment (initially restricted to patients who have current urgent need, or did and contacted us during lockdown).

X rays but only for patients who tolerate them well.

TEMPORARY re cementation of crowns. (We cannot dry the tooth effectively enough to cement a crown permanently with the restrictions we face).

Fabrication or repair of removable dentures.

Simple dental extractions. If a tooth breaks, it is probable we will have to leave the roots in place until we are at a lower level of risk. Naturally, we will assess the risk very carefully prior to treatment.

Tightening of loose dental implants if possible, without using a high-speed handpiece (drill).

Temporary fillings.

Draining of a swelling/abscess.

Provision of antibiotics.

Trimming of sharp orthodontic wires (not reliable re cementation of loose brackets, or replacement of missing brackets).

Treatment is only to be offered after careful assessment.

Cosmetic orthodontics

Cheshire Dental Centre provide many of these treatments. We may now be able to progress some of our Quick Straight Teeth cases. We will be in touch with each patient shortly, but please allow us to contact you; we hope that it is understandable that we will be prioritising patients with urgent dental need.

The PPE (personal protective equipment) requirements for the above are not too onerous, and we will not look too different to normal. As you are aware, the cross-infection control at Cheshire Dental Centre has always been exemplary and one of our top priorities.

Although we have been organised with the new PPE guidelines well in advance there may be the occasional time where we are awaiting stock. All practices are attempting to source the necessary PPE we need to keep you and us safe, but supplies are scarce and consequently very expensive.