What happens during Root Canal Treatment

Root canal treatment (RCT), though it seems like an elaborate process, is a simple procedure to relieve patients of their dental pain and swelling. This process involves various steps that help provide complete elimination of the diseased condition of the tooth while preserving the tooth.

Need for RCT

• Continuous pain or intermittent pain

• Pain on taking hot and cold food

• Pain on exposure to wind

• Pain during night

• Pain on biting or tapping

• Dental caries approaching innermost layer of tooth or radiolucency near root of tooth during x-ray

✔️ Confirmation done using clinical examination, radiographs, and pulp vitality tests to check the vitality of the tooth

Step 1: Local Anesthesia

• Local anesthesia is provided through injection at or near the infected tooth

• It causes numbness and a feeling of swelling

• No pain is felt. Only pressure is felt

Step 2: Isolation of Tooth

• The tooth is isolated using a rubber-like sheet called rubber dam

• It helps to isolate the infected tooth from contamination by saliva during the procedure

• Prevents accidental swallowing of contents

Step 3: Drilling of Tooth

• The tooth is drilled to provide a small opening to access the pulp (innermost part of tooth where blood vessels are seen) where the infection lies

• The decayed part of the tooth is also removed during this process

Step 4: Pulp Removal

• The infected pulp is removed

• Small instruments called files are used to clean the root of the tooth

• The length of the canal inside the tooth is measured using radiographs

Step 5: Cleaning and Shaping

• The area of the canal may contain microbes which must be removed

• Irrigants like saline are used to flush out the contents and the remaining pulp

• The canal is shaped to remove a part of the infected tooth and also to allow the placement of filling material

• Further disinfection of the tooth is done using other agents

Step 6: Filling of Root Canal

• A non-resorbable material called gutta percha is placed inside the prepared space

• This provides a seal and prevents reinfection

• It is then sealed either temporarily or permanently

Step 7: Dental Restoration

• A permanent filling or crown restores structure

• Crowns protect weakened teeth from fracture

• Restoration choice depends on remaining tooth structure

Step 8: Post-Treatment Healing

• Mild tenderness may last a few days

• Over-the-counter analgesics usually suffice

• Normal chewing resumes after final restoration

Success Rates and Outcomes

• Root canal success exceeds 90 percent in many studies

• Proper restoration is critical for long-term survival

• Untreated canals risk abscess formation and tooth loss

Common Misconceptions

• Root canals do not cause pain; infection causes pain

• Tooth extraction does not eliminate infection risk

• Saving the natural tooth preserves function and bone

Key References

• Ingle JI, Bakland LK, Baumgartner JC. Ingle’s Endodontics.

• Cohen S, Hargreaves KM. Pathways of the Pulp.

• European Society of Endodontology. Quality guidelines for endodontic treatment.

• Siqueira JF. Microbiology of endodontic infections.

• Ng YL et al. Outcome of primary root canal treatment. Systematic review.