The Dreaded "Root Canal"

November 01, 2012 | Posted in Endodontics

The "root canal" is the most misunderstood dental procedure. Many of you have probably heard people refer to a difficult task by saying, "It was worse than having a root canal" or "I would rather have a root canal than...".

How did this procedure get such a negative connotation when it has such a positive result?

Part of the problem is that most patients are unaware of what this procedure actually is. Another problem is that most often, when a "root canal" treatment is required, the patient is in pain. When a person experiences pain, their judgement and even their personality can be affected.  Combine the negative connotation of a "root canal" and a patient in pain and then it becomes difficult for a patient to see beyond the immediate need to remove pain and see the importance of saving their tooth. Dr. Haslam has actually removed this term from the office vocabulary; we no longer refer to this procedure as a "root canal", but rather as an endodontic treatment (its true name) or by describing it as "removing the pulpal tissue from the tooth". By doing this, the patient has the chance to see the treatment as it is rather than as it has been percieved to be.

What is an endodontic procedure and when is it necessary?

When a tooth receives a trauma that causes irreversible damage to the vital tissue inside the tooth, the vital tissue must be removed to prevent pain and infection in and around the tooth. This procedure is known as endodontics. The trauma may be from an impact injury, a deep cavity (carious lesion), severe periodontal disease, excessive wear from acid erosion, bruxism (parafunction), tooth fracture, dramatic thermal injury, etc. Any of these situations may cause the vital tissues inside the tooth to be irreversibly inflammed. As the tissue inflammation increases, the pressure inside the tooth increases and this is felt as a "toothache". Often, it is described as a throbbing sensation that increases in intensity with time. If left untreated, this pain can become severe. Eventually, the vital tissues inside the tooth will become necrotic and at this point, infection begins. This infection is often very localized to the periapical region of the tooth, until it spreads to the surrounding soft tissues resulting in an abscess.

To treat the tooth, local anesthetic is applied just as when a basic restoration is to be completed. The tooth is isolated with a rubber dam and then the pulp of the tooth is accessed using a dental bur. The pulp tissue is cleaned out if the pulp chamber and then the canals inside each root using small cleaning instruments and a disinfecting solution. The canal spaces are then sealed using a plastic filling material (gutta percha) and sealant and the tooth is restored with an appropriate filling material.

This procedure has a 97% success rate! So why does everyone fear the "root canal"?

In the past, the techniques, instruments and even anesthetics were not even comparable to those of today. Most often, an endodontic treatment is completed in less than an hour! There is no pain during the procedure and any tooth pain prior to the procedure is immediately resolved. If there was infection prior to the procedure, it will quickly resolve following treatment and very rarely will a precautionary course of antibiotcs be required. Most often, patients will comment after the procedure, "That wasn't anything like I had expected. I didn't feel anything" or they are simply amazed when the procedure is completed.

Let's look forward to the new treatments and technologies of the future that will make these procedures even faster and more comfortable and avoid thinking back to the old days when these procedures gained their negative connotations.

Dr. Luke Haslam

Basinview Dental Centre