Frequently asked questions to a Bristol Endodontist | Alan Holland Specialist

Why do I need a root filling?

You may have heard the expression `the nerve is dying or dead'. The blood supply and nerve supply are contained within a small chamber inside the tooth which extends down the root canal tube into the bone - commonly called the 'nerve' although your dentist will call it the `pulp'. If bacteria invade this chamber either in dental decay, or directly from the mouth when a filling is lost then the blood supply may stop and the bacteria will have a warm, moist environment in which to grow.

Once bacteria are established in the nerve [pulp] chamber you will need a root treatment to clean out the chamber and tubes, and obliterate the space by sealing the chamber with a special rubber material called Gutta Percha. Antibiotics WILL NOT kill these bacteria.

How do I know I need a root filling?

The extreme case is very obvious. Your face is swollen, red and extremely painful and you will probably be running a temperature.

However, the first indication of trouble is sensitivity to COLD and HOT. Once the tooth becomes sensitive to HOT then the pulp is irreparably damaged and the bacteria have invaded.

What is an abscess?

When the bacteria have invaded the root canal, chamber, and root, they multiply and produce toxins [poisons] which cause pain, and swelling as these toxins pour through the end of the root canal into the surrounding bone. The body tries to defend itself from this bacterial attack and sends the cavalry into battle. The cavalry are the protective cells in the blood which defeat invaders, they are called `white blood corpuscles'.

What is a chronic abscess?

Your dentist will take a routine X-Ray to check on your teeth, roots and bone every 2-5 years. It is possible and not unusual to find quite large infections in the jaw bone with no outward symptoms at all, not even minimal discomfort. The infection in the jaw bone around the end of the root is caused by bacteria and toxins leaking out of the end of the root. The body's defences are containing the infection, but only just. The chronic abscess is visible as a dark area on the X-Ray at the end of the root.

What is a gum boil?

A gum boil or SINUS is the easiest path of escape for the infection at the end of the root. It is usually through the gum at the level of the infection, A gum boil will swell and then release the toxins [pus] from time to time. The gum boil may remain swollen all the time or may intermittently swell then disappear.

This is a `TIME BOMB' - waiting to explode into an acute abscess at any time, with pain and swelling.

Who can do root canal treatment?

Your regular general dentist can carry out root canal treatment in most straight forward cases. There are situations where special techniques and equipment are required to satisfactorily complete a root canal filling. There are specialist dentists called ENDODONTISTS, who carry out this treatment.

What is a root canal?

Above the gum and visible in the mouth is the CROWN of the tooth, Below the gum supporting the crown is the ROOT, The root has a tube running from its tip in the bone to a chamber inside the crown of the tooth, This tube is lined with special cells which made the tooth develop starting at the time of birth. As we get older these cells (ondontoblasts) produce more and more root material and the root canal [tube] gets progressively smaller with age.

Different teeth have differing numbers of roots and a variable number of tubes (or root canals) in each root. Normally, the incisor and canine teeth have one root and one root canal. Premolars can have one or two roots and molars two or three roots, with up to 5 roots canals.

How is a root treatment done?

Firstly an access hole is cut into the top of the tooth to expose the small nerve [pulp] chamber within the tooth. Then very fine instruments called files are used to clean the walls of the root canal and then they are flushed with several different disinfecting solutions, dried and filled with a custom designed root filling material called Gutta Percha or in special cases MTA (a very hard cement).

If the root canal is very infected you may need to have a special sedative dressing placed in the pulp chamber and canals between the two appointments required to complete the root filling

Often the root filling can be completed in one visit.

What is apical surgery?

Sometimes it is not possible to enter the root from the top end or crown of the tooth [the part of the tooth visible in the mouth] so we enter through the bottom end of the root, Gently lifting the gum and cutting off the infected part of the end of the root, removing any infected tissue in the surrounding bone and then sealing the end with a cement which sets very hard.

Occasionally these root end (apical) infections develop into cysts which are removed and sent for a hospital report.

What is a re-treatment?

When a root filling has been done and there is still infected material within the root canal system, the anatomy prevented complete filling of the canal or there is a separated instrument (not an uncommon hazard of root canal treatment).

Then removal of the existing root filling, and any other obstacles, is carried out and a new root filling obliterating the entire root canal system is placed to eliminate any spaces where bacteria may lurk. This requires special skills and equipment and is often carried out by the Specialist Endodontist.

How long does it take?

This will depend on the complexity of the root canals and any problems that are encountered. To achieve success it is important that the procedure is not rushed. Appointments are between one and two hours and treatment is normally completed in one visit. Re-treatment cases usually take a little longer than first time treatments. It may be necessary to follow up on the treatment on a regular basis to monitor healing.

How much does it cost?

The cost varies depending on the number of roots in the tooth to be treated and whether it is a first treatment or a retreatment. Take a look at the Fees Guide and if you are unsure about anything call and speak to our knowledgeable, and understanding reception staff. Be assured you will only be charged the fee agreed prior to treatment being started.

Should we encounter any unforeseen complications we will stop immediately and discuss the situation. We will only proceed if you are entirely happy.

Will it be painful?

Local anesthetic is used at every stage of the procedure to ensure your comfort. Following treatment, the tooth may feel a little tender for a few days, but this can be normally controlled with the same medication that you might use for a headache. You will be advised of the need for medication at the end of the appointment.

If you have any anxiety about treatment, intravenous conscious sedation using a very safe drug called Midazolam is available, but charged for separately. It is completely safe and the effects are totally reversible after treatment. You will need a consultation appointment prior to treatment. See Intravenous Sedation