This is the procedure in which the pulp (nerve) of a tooth is removed and the root canal of a tooth filled with material.
Once inside the tooth, the dentist will clean out the damaged tissue from the root canal system and seal the root canal system to prevent re-infection.
In order to do this, your dentist will need to take x-rays of the tooth and will use files and reamers to cleanse the root canal system.
The root canal system is then sealed with filling material to prevent re-infection.
When a practitioner is providing root canal therapy, the first step is to obtain consent and to give options for treatment. Alternatives include extracting the diseased tooth and replacing with an implant and crown.
Common reasons for a root canal
Any trauma or infection to the canal will result in the need for root canal therapy. Common reasons for root canal therapy include:
- Tooth decay invades the tooth, penetrating through the enamel and then the dentine into the pulp.
- A tooth has become abscessed and infected.
- Trauma, such as a chipped or broken occurs and results in the exposure of the nerve.
- A tooth is slowly dying due to ageing or past trauma that did not result in the need for treatment at the time of the injury
Procedure
Root canal therapy can be performed in single or multiple visits. Normally, your dentist should advise you of the number of appointments necessary to complete the canal. If you have an infection or abscess in the tooth, you may be started on a course of antibiotics before completing the root canal. You will normally be given a local anaesthetic before the dentist commences work. He will also undertake an x-ray of the tooth.
The dentist will place a rubber dam over your mouth. This is used to keep the tooth isolated from your saliva. The dentist will then begin the procedure by drilling a small hole through the tooth into the area known as the pulp chamber and this is where the nerve of the tooth is located. You dentist will begin using tiny files to remove the nerve from the tooth. During the procedure, your dentist must ensure that the entire nerve is removed to prevent toothache after the procedure and re-infection of the tooth, which may result in the need for re-treatment or extraction of the tooth.
Once the dentist is confident that the entire tooth has been cleaned out, the rubber material is placed inside the tooth which it seals. Your dentist will then remove any remaining decay from the tooth and will decide to either put a temporary filling on to close your tooth or proceed with placing a permanent filling.
Sometimes things can go wrong. The dentist can root fill the wrong tooth or he can perforate the root. Sometimes root filling material is not positioned at the correct length. It’s either too short or too long and the tooth infection can return. Sometimes the instrument fractures whilst accessing the root canal. Small files or reamers are normally used by hand or in a rotary instrument and during the cleaning and widening procedures of the root canal, these reamers or files can fracture, leaving a portion of the instrument in the root canal.
The fracture of a file or reamer during root canal therapy is not in itself below an acceptable standard of care. Broken root canal instruments are notoriously difficult to remove and any reference to an instrument left must be contemporaneously recorded on a patient/’s dentist record card. However what is regarded as below an acceptable standard of care is the failure to inform the patient that an instrument has fractured in the canal. Not only must the patient be informed of this occurrence, but also be given treatment options such as to leave in situ or offer a referral to an endodentist.
If an instrument used during root canal procedures is inhaled and a rubber dam is not in place to protect the airway, then this may lead to a claim. Swallowing or inhalation of an instrument will also lead to claims.
Other areas of claims are when sealing materials passes through the apex of the tooth. Some sealing materials can cause adverse reactions if the material passes through the apex of a tooth. This can cause immediate swelling resulting in cellulitis. Some sealing materials have led to damage to the inferior dental nerve which could lead to ongoing paraesthesia.
