Managing Dental Pain: All About Root Canal Treatments
Do I need root canal treatment? When is it required?
Written by NoFrills Dental
This dental article has been curated by the clinical team @ NoFrills Dental 🙂
September 13, 2021
Introduction: Root Canal Treatment
We often hear about infections affecting many different parts of our body – such as the common cold, food poisoning and sore throats. Did you know that bacteria can also invade the internal parts of our teeth?
Many patients get a lump in their throat or a stomach full of butterflies when their dentist brings up the words “you may need to consider root canal treatment”. They often shut down in fear when their dentists explain further. As such, many don’t have the full picture of what root canal treatment really is.
In this article we will provide you with all the essential information about the process, costs and reasons behind getting root canal treatment in Singapore. It is a safe, painless and effective procedure that many dentists perform on a daily basis to save teeth that might otherwise need to be extracted. Read on more to find out!
What is root canal treatment?
Root canal treatment, or endodontic therapy deals with removing bacteria and infection from our root canals. This involves drilling into our tooth to access our dental pulp (the innermost portion of the tooth) to clean and disinfect the root canals.
The term endodontics is derived from Latin and Greek origins:
- Endo = Inner;
- Odon = Tooth.
To acquire a firm understanding of endodontic treatment, it will be ideal to have some basic knowledge about the anatomy of the tooth.
Our teeth consist of three major dental tissues:
- Dentine and
Enamel is the white and hard outermost layer covering our teeth. It is the hardest substance in our body and functions as the protective layer of the tooth.
Dentine consists of hard tissue and is the second layer of our tooth. It protects the pulp and acts as a shock absorber to prevent enamel fractures.
The innermost portion of the tooth is called the pulp. It consists of nerve fibres, blood vessels and connective tissue. It is responsible for keeping our teeth alive.
The pulp is vital in the development and growth of the tooth, as it supplies the surrounding tissues with nutrients and moisture. As the tooth gradually reaches maturity, it is dependent on the pulp for survival as it begins to derive its nutrients from the surrounding tissues. The pulp extends from the crown of our tooth to the tips of our roots. The ends of the roots communicate with the tissues surrounding the root (known as periapical tissues). When the surrounding pulpal tissues are damaged, bacteria from the oral cavity and periapical tissues invade and multiply rapidly inside the pulp chamber.
This triggers a low-grade infection within the pulp. Patients often complain of a toothache or in more serious cases, a ‘pimple’ on their gums (also known as a dental abscess). Your dentist will swoop in to save the day and relieve your pain by cleaning, disinfecting the inflamed pulp chamber and subsequently seal the space using filling material. This prevents bacteria from re-infecting the canals.
When is root canal treatment necessary?
Tooth Decay: Bacteria in our mouths use the food we consume on a daily basis as an energy source to survive. They release acid as a by-product, breaking down our tooth structure, causing a cavity to form. Decay that is severe often erodes the pulp. Bacteria and their products can penetrate these tubules with ease as dentine is a permeable tissue. This irritation results in inflammation of the pulp, leading to pulpitis which may be reversible or irreversible. If prompt dental action is not taken, infection can make its way into the pulp, causing it to become necrotic overtime.
Dental Trauma: Patients who have suffered trauma to the facial region are susceptible to pulpal injury. When the tooth has been damaged by physical trauma, it is possible for the pulp to die as a result of the impact and injury. The prevalence of dental trauma is increasing worldwide. Statistics from many countries report that approximately a third of preschool children, a quarter of school children and a third of adults have suffered from injuries involving the oro-facial regions and teeth at least once in their lifetime.
Common causes of dental trauma include playground accidents, sporting injuries, road traffic accidents and assaults. The two main subtypes of dental injuries that can potentially damage the pulp chamber are periodontal trauma and tooth fractures.
Periodontal Trauma: The tips of our roots are connected to an arterial blood supply, venous and lymph drainage, all of which help to keep our teeth alive. A strong blow to the face causes the tooth to rotate downwards, shearing off the blood supply entering the pulp chamber. The pulp is left functionally ‘dead’ and severely damaged as a result of this impact and injury.
Tooth Fractures: Enamel-dentine-pulp fractures involve loss of tooth structure in the enamel and dentine, and exposure of the pulp. This results in rapid bacterial ingress and severe pulpal injury. Swift dental action is required to preserve the pulp and keep it alive. However, in most cases, root canal treatment or extracting the tooth in its entirety would be more appropriate.
Cracked tooth: A cracked tooth refers to an incomplete fracture of a tooth with a vital pulp. You may experience a sharp shooting pain on biting, which is worse on release and exposure to cold stimuli.
They commonly affect our back teeth (molars) as we use them to bite on hard foods. Crack lines extend from the chewing surface of the tooth vertically towards the root. If not identified and diagnosed early, they tend to propagate towards the pulp, making it very easy for bacteria and debris to invade, causing an inflammatory reaction.
Crack lines are difficult to see with the naked eye. Your dentist will have to utilize special microscopes and loupes to magnify the crack and treat accordingly.
Dental Abscess: A dental abscess is a collection or pocket of pus associated with a tooth. They present as a small ‘pimple’ on your gums. When the pulp dies, an inflammatory response is triggered. Bacteria travels out of the root canals into our periapical tissues. As our immune system fights off bacteria, cells making up our periapical tissues die, creating a small hole which gathers pus, thereby forming an abscess or a small ‘pimple’ adjacent to the affected tooth.
Large Fillings: The average lifespan of a filling is about 10-15 years. Large fillings extending across more than one tooth surface affects its overall structural integrity. The weakened tooth surface is more susceptible to secondary decay and if it progresses towards the pulp, infection can arise.
What are some signs that I might need root canal treatment?
Here are a list of signs that indicate that you may need to consider root canal treatment:
- Localized pain at a specific region(s) in your mouth;
- Toothache that keeps you awake at night;
- Tooth sensitivity limited to or localised to only a specific region in your mouth
- Sensitivity or pain that lingers on for over 30 seconds after exposure to hot or cold food/drinks
- Pain on biting and release on biting (this might indicate a cracked tooth);
- Fractured teeth;
- Pain on hot/cold that lingers, even after the stimuli has been removed;
- Teeth that have been displaced due to dental trauma;
- Dental abscess (‘pimple’ on your gums);
- Swellings in your gums or facial tissues.
If you are experiencing any sort of dental pain, please see your dentist immediately. Most people will try to endure the pain in the hopes that it will get better, but in most cases, it will spiral into even worse pain. Early intervention minimizes the risk of complex and invasive treatment.
The root canal treatment process
Root canal treatment is a safe and effective procedure with a success rate of about 95% . Many teeth that are endodontically treated can last a lifetime.
Endodontic treatment is usually spread over 2-3 appointments.
During the first appointment, your dentist will perform a series of tests which involve:
- Blowing a puff of cold air on your teeth
- Palpating the gums adjacent to your tooth;
- Gently tapping on the tooth;
- Holding a cold cotton pellet against the tooth to test for sensation.
Radiographs will also be taken to determine the severity of infection and to check for any underlying infection.
After seeking your consent to proceed with root canal treatment, your dentist will utilize this appointment to locate and measure the length of your root canals. They will subsequently disinfect and remove the bacteria in the canals in its entirety.
You will then return two weeks later to get the root canals filled with a special material. During the final appointment, your dentist will then place a definitive restoration over (usually a crown) which will then complete the treatment plan!
The general sequence of root canal treatment is as follows:
Visit 1 (90-120 minutes)
- Local anesthesia is administered to numb the tooth and its surrounding tissues. Your dentist will make sure that you are completely numb before proceeding with treatment.
- A small rubber sheet (called a rubber dam) will be placed over your tooth to isolate it from the rest of the oral cavity. This keeps bacteria and saliva away from the tooth during the procedure. Root canal treatment can now be carried out in a sterile environment.
- A small access cavity is drilled starting from the chewing surfaces of your teeth vertically downwards to access the pulp chamber.
- Small, fine instruments (called endo files) are used to shape the canal. The controlled removal of dentine tissue produces a specific shape in the canal so that it can be easily disinfected.
- The canals are then cleaned and disinfected using a combination of antibacterial solutions and endo files of varying sizes. This step is one of the most crucial parts of root canal treatment, because it focuses on the removal of organic pulp debris, microorganisms and toxins from the tooth. The disinfection process is repeated multiple times to ensure the complete removal of bacteria.
- An interappointment medicament made of non-setting calcium hydroxide is placed inside the canals to reduce and prevent the multiplication of microorganisms that remain in the canal following successful cleaning and shaping.
- A temporary filling is placed over the tooth.
Visit 2 (90-120 mins)
- Rubber dam is placed again.
- The access cavity is reopened and canals are disinfected and cleaned again.
- Your dentist will fill the canals with a rubber-like biocompatible material called gutta percha (GP). GP is placed in the canals with a sealer to achieve a fluid-tight seal from the external environment.
- A temporary filling material or permanent restoration is placed to seal the access cavity.
Visit 3 (60-90 mins)
- A crown or any other permanent restoration will be placed to replace the lost tooth structure, protect it from getting re-infected and to restore its structural integrity.
- Ta-da! Your treatment plan is completed.
Cost of root canal treatment in Singapore
The costs of root canal treatment are highly variable. It depends on the following factors:
- Endodontic specialist vs dentist;
- Root canal tooth location;
- Extent of damage of the tooth;
- Painkiller and antibiotic medication costs to prevent infection.
The costs of root canal treatments will be higher if you see an Endodontic Specialist
All general dentists are equipped with the skills and knowledge to perform root canal treatment. Endodontists undergo three extra years of residency training to qualify as a specialist in Singapore. They are experts in dealing with toothaches and trained to perform more complex root canal cases. In addition, endodontic practices are equipped with special dental microscopes which enhance their ability to view all the canals in the tooth. This useful tool greatly increases the effectiveness and precision of treatment.
Fees from an endodontist will naturally be higher to reflect the experience and expertise of a specialist.
Root canal treatment on a molar will cost more than treatment on your front teeth
The cost of root canal treatments also depends on the location of your tooth in the mouth.
Our teeth are all anatomically different with varying numbers of roots and root canals. Molars typically have 3 roots and 4 root canals; premolars have 1-2 roots with an average of 2 canals. Incisors are single rooted teeth with 1-2 canals. It will take your dentist more time and effort to access, shape, clean and seal four root canals as opposed to one. Therefore, molar root canals are more costly as compared to your front teeth.
Some dentists have fixed endodontic charges based on the number of canals they manage to locate when they drill open the tooth.
Here is a rough guide to all the cost outlines for root canal treatments at NoFrills Dental:
- Initial Consultations: $50
- Single Rooted Tooth: $500 – $900
- Multi-Rooted Tooth: $900 – $1,600
Benefits and risks of root canal treatment
Every dental treatment option presents with its pros and cons. It is your dentist’s responsibility to explain and talk through all these benefits and risks so that you can play an active role in this shared decision-making process.
Besides the high success rates, one of the greatest benefits of root canal treatment is that you get to save your natural tooth. This comes with many advantages:
- You get to retain the natural appearance of your tooth;
- You can chew and exert normal biting forces when eating;
- Your root canal treated tooth helps to protect other teeth from excessive wear or strain by sharing the load.
Another obvious reason is that it gets rid of your toothache completely! Root canal treatment aims to get rid of all the infection so you can say goodbye to those sleepless nights!
On the flipside, it is a huge commitment. Appointments last for an average of 90 minutes, and you will have to return at most 2-3 times to complete your treatment plan. This might be a hassle especially if you are pressed for time; we can only advise you to plan your schedule in advance to fit your appointments!
With every invasive dental treatment, there is always a risk that treatment may fail, and symptoms may persist.
Root canal treatments may fail because of:
- Persistence of bacteria in the canals
- Canals are poorly cleaned and shaped;
- Poor fit of final restoration (crown or filling) which causes secondary dental decay around the tooth;
- Canal anatomical difficulties (existence of curved or narrow canals that are very difficult to clean and shape).
In this case, root canal retreatment is the most viable treatment option if you really want to keep your tooth.
Root canal re-treatments are more complicated than first time conventional root canal treatments as your dentist will have to spend a considerable amount of time removing the final restoration and root canal filling material (gutta percha). The canals will have to be instrumented and filled again, making the process much more time consuming.
Endodontists are specialty dentists that are very well trained in performing root canal treatments re-treatments in their scope of practice. They will have all the special equipment and tools needed to execute this procedure in the safest and most efficient way possible.
Root canal re-treatments have an average of 77% success rate.
“Root canal treatments are painful!”
It is quite the contrary! Root canal treatment relieves your dental pain by removing the source of infection. The process is pain free as your dentist will make sure you are completely numb with local anesthetic before placing working on your tooth.
Getting a root canal treatment does not hurt! On the contrary, root canal treatments help stop your tooth pain.
“Root canal treatment is one of the most expensive dental treatment options! I’d rather get my tooth extracted! It’ll be so much cheaper and fuss-free that way!”
Extracting the tooth will leave a gap in your dental arch that may or may not be acceptable functionally or aesthetically. Teeth drift on a daily basis. Your adjacent teeth will shift to fill in the gap that was once filled by the missing tooth. This will potentially lead to tooth misalignment and an uneven bite in the long run.
As such, it is highly advisable to consider a prosthetic replacement in the form of an implant or bridge to fill the gap. Implants cost around $4,500 on average which add up to be more costly than the root canal treatment and crown combined! No doubt implants are aesthetic and have many long-term benefits, but nothing can replace the look and feeling of your natural tooth.
“Root canal treatment will kill my tooth. My tooth is essentially lost and dead.”
Removing the pulp does not mean that the tooth will be lost. It just means that the tooth has lost its protective function, we call this “non-vital”. The definitive restoration provides your root treated tooth with adequate functional and structural integrity.
“What are the side effects of root canal treatment? How should I take care of my root treated tooth?”
You will experience numbness in your jaws for about 2-3 hours till the local anesthesia wears away. Be very careful when eating or drinking, make sure you don’t accidentally bite your cheeks or tongue! You may also feel slight sensitivity, mild swelling or inflammation in your tooth for a day or two after treatment. If any of these symptoms persist, please see your dentist immediately.
Remember to brush and floss your teeth as you normally would and be sure to visit your dentist twice a year for your regular check-ups and cleanings.
Root canal treatment is not as scary as people make it out to be. It is a very common procedure that dentists carry out week on week with relatively high success rates. Whenever possible, you should always aim to save your tooth – it’s the only ones you have! It can greatly enhance your quality of life and make your smile look more natural and beautiful.
- American Association of Endodontists. n.d. Root Canal Explained | American Association Of Endodontists. [online] Available at: <https://www.aae.org/patients/root-canal-treatment/what-is-a-root-canal/root-canal-explained/> [Accessed 29 Aug 2021].
- Glendor, U., 2008. Epidemiology of traumatic dental injuries – a 12year review of the literature. Dental Traumatology, 24(6), pp.603-611.
- Dentaltraumaguide.org. n.d. Enamel-Dentin-Pulp Fracture – Dental Trauma Guide. [online] Available at: <https://dentaltraumaguide.org/free-dental-guides/permanent-teeth/enamel-dentin-pulp-fracture/> [Accessed 29 Aug 2021].
- American Association of Endodontists. n.d. Cracked Teeth | American Association Of Endodontists. [online] Available at: <https://www.aae.org/patients/dental-symptoms/cracked-teeth/> [Accessed 29 Aug 2021].
- NHS UK. 2019. Abscess. [online] Available at: <https://www.nhs.uk/conditions/abscess/> [Accessed 29 Aug 2021].
- Yousuf W, Khan M, Sheikh A. SUCCESS RATE OF OVERFILLED ROOT CANAL TREATMENT. J Ayub Med Coll Abbottabad. 2015;27(4):780-783.
- Specialist Dental Group. n.d. Root Canal Treatment In Singapore. [online] Available at: <https://www.specialistdentalgroup.com/services/root-canal-treatment/> [Accessed 29 Aug 2021].
- National Dental Centre Singapore. n.d. Consultation Charges. [online] Available at: <https://www.ndcs.com.sg/patient-care/consultation-charges> [Accessed 29 Aug 2021].
- Moh.gov.sg. n.d. MOH | Average Fee For Dental Procedures. [online] Available at: <https://www.moh.gov.sg/cost-financing/average-fee-for-dental-procedures> [Accessed 29 Aug 2021].
- Tabassum, S. and Khan, F., 2016. Failure of endodontic treatment: The usual suspects. European Journal of Dentistry, 10(01), pp.144-147.
- Ng, Y., Mann, V. and Gulabivala, K., 2008. Outcome of secondary root canal treatment: a systematic review of the literature. International Endodontic Journal, 41(12), pp.1026-1046.
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