Q&A With Dr Emma
Hi Dr Emma, I'm currently halfway through a root canal that my dentist is performing on one of my side teeth. It was previously a filled tooth, but it seems that I got an infection under the filling. Could you tell me why the current trend is to do these expensive root canals and not removal of the teeth as it used to be? What does the root canal do and why does it take so many visits? Thanks. Jamie from Ashby, WA.
You've actually asked quite a complex question. To understand root canal therapy, you first need to know a bit about the anatomy of a tooth. Deep in the centre of every living tooth is a structure called the "pulp", which is made up of blood vessels, nerves, and other living cells. The pulp is why you feel the chill of biting into an ice-cream with your front teeth. There are a few things that can cause the pulp to become inflamed, such as decay, excessive wear, or cracks in a tooth. A severely inflamed or infected pulp will usually die, which is when root canal therapy is needed if the tooth is going to be saved.
Root canal therapy involves removing all the inflamed, infected, dead and dying pulp tissue from inside the tooth. The aim is to disinfect the root canals, leaving the inside of the tooth clean and germ-free. There are a few different methods that can be used to try and achieve this. It sounds like your dentist is using a multiple visit technique, which is very common and has a good body evidence to support its use. The dentist can utilise each visit to check the tooth for signs and symptoms of infection or inflammation, monitor the temporary filling, check for healing, and change the dressing paste inside the tooth. Changing the dressing is important to stop the canals from getting reinfected, each time getting closer and closer to the aim of a bug-free tooth.
It's true that in the past the ultimate solution to a toothache was to just pull out the offending peg. We now know that there are long term consequences of having a missing tooth, which is why dentists are so keen to help patients keep their teeth for longer. If a tooth is lost and not replaced:
It can take the enjoyment out of eating. Food getting caught, sore gums and less efficient chewing are all annoying.
A visible gap in your smile can lower self confidence.
Speech may be affected.
There are more serious long term consequences. Over time, the teeth either side can tilt and drift into the space. This can affect your bite, create areas that are difficult to clean, and therefore increase the risk of decay and/or gum disease happening to the teeth that are left behind. One extracted tooth might set you on the path to a lifetime of subsequent problems.
So, while it seems like an inconvenience and an expense at the time, often treating a tooth with root canal therapy turns out to be the best long term solution. Having a missing tooth can be a much bigger inconvenience, and end up costing more in the long run.