What are the other Names for the Procedure?
- Endodontic Therapy (Root Canal Treatment)
- Endodontic Treatment (Root Canal Treatment)
What is Root Canal Treatment?
A Root Canal Treatment is a highly effective treatment method to save a badly infected or diseased tooth, especially when both the crown and root canals are involved. Since the existing tooth is repaired and retained, the procedure can help in the following manner:
- Help retain the previous dental arch appearance; the mouth profile is unaffected
- Biting and chewing is relatively unaffected
- And, excess wearing of other adjacent teeth can be avoided
- Relieve symptoms of severe pain and discomfort caused by an infected tooth
What part of the Body does the Procedure involve?
Root Canal Treatment involves the affected tooth and gums.
Why is the Root Canal Treatment Performed?
Root Canal Treatment procedure may be performed for the following reasons:
- In order to save the affected tooth and relieve symptoms (severe pain and swelling)
- Trauma to tooth causing severe pulp and root canal damage, when tooth is cracked
- Dental cavity is very severe to affect the roots
- Multiple dental treatments to same tooth have been already undertaken
- When X-rays show loss of bone in the infected teeth
- In some cases, to maintain the profile of teeth (dental arch)
What are some Alternative Choices for the Procedure?
Root Canal Treatment is typically the preferred treatment to avoid extraction of the diseased tooth. However, in some cases, the individual/dentist may opt for dental bridges, implants, or even a complete removal of the affected tooth.
What are the Recent Advances in the Procedure?
There are no recent advances in the Root Canal Treatment procedure.
What is the Cost of performing the Root Canal Treatment?
The cost of Root Canal Treatment procedure depends on a variety of factors, such as the type of your health insurance, annual deductibles, co-pay requirements, out-of-network and in-network of your healthcare providers and healthcare facilities.
In many cases, an estimate may be provided before the procedure. The final amount depends upon the findings during the surgery/procedure and post-operative care that is necessary.
When do you need a Second Opinion, prior to the Procedure?
- It is normal for a patient to feel uncomfortable and confused by the information regarding a Root Canal Treatment procedure and on what needs to be done
- If the patient needs further reassurance or a second opinion, a physician will almost always assist and also recommend another physician, if required
- Also, if the procedure involves multiple surgeries or has many alternatives, the patient may take a second opinion to understand and choose the best one. They can also choose to approach another physician independently
What are some Helpful Resources?
Complete Guide to Symptoms, Illness & Surgery; Written by H Winter Griffith, M.D.; Revised and updated by Stephen Moore, M.D. and Kenneth Yoder, M.D.; The Berkley Publishing Group, 5th Edition, New York, 2006
http://www.colgate.co.in/en/in/oc/oral-health/procedures/root-canals (accessed on 01/03/2018)
https://www.aae.org/patients/2017/11/09/endodontic-treatments-procedures/ (accessed on 01/03/2018)
https://www.rootcanaltherapy.net.au/root-canal-treatment (accessed on 01/03/2018)
Prior to Root Canal Treatment:
How is the Root Canal Treatment Performed?
The Root Canal Treatment is performed in the following manner:
- The dental professional undertakes an accurate assessment of the tooth. A visual identification of infection, abscess formation, or tooth damage is made
- The tooth in concern is isolated using a dental dam and local anesthesia administered
- An opening into the concerned tooth is drilled and infected pulp removed; the entire diseased pulp within the tooth is removed (from both the crown and root canals)
- The empty pulp chamber/space is cleaned (the root canals are also cleaned) and disinfected
- The chamber is then planed to remove any infected tooth part and/or to shape the root canals and prepared for receiving the filler material (called gutta percha)
- The inert filling is placed inside the chamber, replacing the pulp, and sealed with a suitable cement adhesive
- A custom-made synthetic crown is then used to cap the remaining portion of tooth (this aligns with the existing teeth profile)
- Antibiotics are given to prevent any infection
- The procedure may take several sessions to complete, and until then a temporary filling is used
A follow-up is recommended as decided by the endodontist.
Where is the Procedure Performed?
A Root Canal Treatment is usually performed in an out-patient surgery center facility, a dentist’s or endodontist clinic/office, or a hospital.
Who Performs the Procedure?
A dental professional expert or an endodontist performs the Root Canal Treatment.
How long will the Procedure take?
The time for procedure depends on the underlying reason for Root Canal Treatment. However, it may take anywhere between 1-2 hours, over several sessions.
What do you need to tell your Physician before the Procedure?
It is very important to provide the following information to your healthcare provider. This enables your healthcare provider in assessing the risks for the Root Canal Treatment and helps avoid unnecessary complications.
- Provide a complete list of medications you are currently taking to your physician. This information is useful for a variety of reasons. For example, it can help your healthcare provider prevent complications due to a drug interaction
- If you are allergic to any specific medication or food items
- If you are taking blood thinners such as aspirin, warfarin, herbal supplements, or any other such medications
- If you or your family members have a history of bleeding disorders, or if there is a tendency to bleed more than normal
- If you have diabetes, high blood pressure, chest pains, or have previously suffered from a heart attack
- If you have ever been diagnosed with blood clots in your leg (deep vein thrombosis) or lung (embolism of lung)
- If you have a history of frequent bone fractures (this may affect bone-healing if bones are involved as part of your procedure)
- A list of all previous surgical procedures you have undergone, for example: Removal of appendix, gallbladder, or any other part, of your body; surgical repair of any body part, such as hernia repair, perforation of bowel wall, etc.
What Preparations are needed, prior to the Procedure?
- The physician may evaluate the individual’s medical history to gain a comprehensive knowledge of the overall health status of the patient including information related to the medications that are currently being taken
- Some medications increase a person’s chances of bleeding and it may be recommended to discontinue them for a period of time before the procedure is performed
- Blood tests may be performed to determine if there is a bleeding tendency or any other medical conditions that prevents the person from undergoing the procedure
- Inform the physician if you are allergic to any local anesthetics, lidocaine, etc.
- Avoid application of any cosmetics, deodorant, or topical medicines on the area prior to the procedure
- It is advisable to quit smoking and the use of any nicotine based products for a while before the surgery
- Consumption of alcoholic drinks must also be avoided for a period of time, as instructed
- The patient must avoid eating or drinking at least 8 hours prior to the surgical procedure, depending on when the procedure is arranged
- For individuals suffering from diabetes, it is important that the blood sugar stays within the normal range; if not, their diabetologist may have to control blood sugar by recommending insulin and/or a combination of oral medicines
What is the Consent Process before the Procedure?
A physician will request your consent for Root Canal Treatment using an Informed Consent Form.
Consent for the Procedure: A “consent” is your approval to undergo a procedure. A consent form is signed after the risks and benefits of the procedure, and alternative treatment options, are discussed. This process is called informed consent.
You must sign the forms only after you are totally satisfied by the answers to your questions. In case of minors and individuals unable to personally give their consent, the individual’s legal guardian or next of kin, shall give their consent for the procedure.
What Tests are needed, before the Root Canal Treatment?
Before a Root Canal Treatment, the patient has to undergo certain tests such as:
- Examination of the affected tooth
- Routine blood and urine analysis
- X-rays of the mouth
What are some Questions for your Physician?
Some of the basic questions that you might ask your physician are as follows:
- What is a Root Canal Treatment?
- Why is this procedure necessary? How will it help?
- How soon should I get it done? Is it an emergency?
- Who are the medical personnel involved in this procedure?
- Where is the procedure performed?
- What are the risks while performing the procedure?
- What are the complications that might take place during recovery?
- How long will it take to recover? When can I resume normal work?
- How many such procedures have you (the physician) performed?
- Are there any follow-up tests, periodic visits to the healthcare facility required after the procedure?
- What are the costs involved?
During the Root Canal Treatment:
What kind of Anesthesia is given, during the Procedure?
Local anesthesia by injection is administered prior to the Root Canal Treatment procedure.
How much Blood will you lose, during the Procedure?
The blood loss during a Root Canal Treatment is usually minimal.
What are the possible Risks and Complications during the Root Canal Treatment?
There are general factors that increase the risk of getting complications during surgery and they include:
- Obesity: Generally, the greater the degree of obesity, the greater the surgical risk
- Smoking: The longer the smoking history (in pack years smoked), the greater the surgical risk
- Advancing age
- Poorly controlled diabetes, as evidenced by a high hemoglobin A1c and a high fasting glucose
- Poorly functioning kidney, as evidenced by increased BUN (blood urea nitrogen) and blood creatinine
- Poorly functioning liver, as evidenced by increased blood liver function tests
- Hypertension (increased blood pressure), especially if it is poorly controlled
- Poor nutritional status (malnutrition with mineral and vitamin deficiencies)
- Poor lung function, as evidenced by abnormal lung function tests
- History of bleeding disorders
- Longstanding illness, such as autoimmune disorders and chronic infections
- Poor immune system due to a variety of causes
The possible risks or complications that may arise during the Root Canal Treatment are:
- Excessive bleeding
- Infection of the surgical wound that may involve the jaw bone
- Anesthetic complications
- Damage to tooth during the procedure, leading to its loss
What Post-Operative Care is needed at the Healthcare Facility after the Root Canal Treatment?
At the healthcare facility, usually there is no requirement for any post-procedure care, unless any complications arise.
After the Root Canal Treatment:
What are the possible Risks and Complications after the Root Canal Treatment?
The possible risks and complications that may arise after Root Canal Treatment are:
- Excessive bleeding
- Severe facial swelling
- Necessity for another root canal treatment
- Infection that involves the bone, or that which was not fully treated (re-infection risk)
- Poor alignment of the replaced synthetic crown
What is the Prognosis after the Surgery?
In a majority of cases, the prognosis of Root Canal Treatment is usually excellent and long-term benefits are reaped; a life-time guarantee may be offered, if proper dental care and hygiene is maintained.
It has to be noted that the Infection causes the pulp to die resulting in pus formation affecting even the jawbone. However, even though the entire pulp is removed, the permanent tooth gets nourishment from the surrounding tissues and gums.
When do you need to call your Physician?
Do contact your physician if you notice any of the following symptoms:
- Worsening pain and swelling of the surgical wound
- Bleeding or fluid drainage from surgical wound
- The occurrence of any symptom that causes uneasiness such as nausea or vomiting
- Numbness or cold sensation of the gums
- Signs of an infection
- Fever, feeling sick
- Complications associated with prescription medications used in treatment
What Post-Operative Care is needed at Home after the Root Canal Treatment?
At home, the following post-operative care may be recommended after a Root Canal Treatment:
- Use ice packs to relieve pain; if necessary, pain-relief medication may be prescribed
- Apply ice packs to reduce facial swelling, if necessary
- Complete the course of prescribed medication/antibiotics as advised by the physician
- Individuals are advised to have to soft foods after surgery for a few days
- Keep mouth clean/clean teeth using suitable toothbrush and toothpaste
How long does it normally take to fully recover, from the Procedure?
A full recovery from the Root Canal Treatment procedure may take up to a week, after the sessions are completed.
What happens to tissue (if any), taken out during the Procedure?
- If any tissue is removed, it is taken for further examination and later disposed as per the standard medical procedure
- Majority of the times, the tissue that is removed is not sent for examination. But if the dental professional determines it should be, then it is sent
When should you expect results from the pathologist regarding tissue taken out, during the Procedure?
If a specimen (tissue) is submitted for exam, then the following steps are involved:
- The tissue removed is processed in the laboratory under a pathologist's supervision
- Slide(s) are prepared once the tissue is processed and is examined by a pathologist and a pathology report issued
- Depending on the complexity of the case, issue of the report may take anywhere between 72 hours to a week's time
Who will you receive a Bill from, after the Root Canal Treatment?
It is important to note that the number of bills that the patient may receive depends on the arrangement the healthcare facility has with the physician and other healthcare providers.
Sometimes, the patient may get a single bill that includes the healthcare facility and the consultant physician charges. Sometimes, the patient might get multiple bills depending on the healthcare provider involved. For instance, the patient may get a bill from:
- The outpatient facility, dentist’s or periodontist clinic/office, or a hospital
- An anesthesiologist (if anesthesia was administered)
- A dental professional expert or an endodontist
- A pathologist (if the tissue was sent for analysis)
The patient is advised to inquire and confirm the type of billing, before the Root Canal Treatment is performed.
Thanks and Gratitude:
We sincerely acknowledge and thank Dr. Douglas J. Jones for reviewing the article. His valuable input and feedback has helped enrich the contents of this article.
Douglas J. Jones, MD FACS
Board Certified General Surgeon and Faculty Member
University of Illinois, College of Medicine at Urbana-Champaign
506 S. Mathews Ave., Urbana, IL 61801, USA