If you have had a nasty toothache, you would have heard of this. Root canal treatment is a procedure done under local anaesthetic to remove the irreversible, infected nerve from within the tooth.

Why is it done?

When a tooth is badly decayed or has had a hard knock / trauma, the nerves within the tooth can become inflamed due to the bacteria that creeps in, causing a condition called “irreversible pulpitis” or “pulpal necrosis”. This leaves you with 2 options: 1. Save the tooth by doing a root canal treatment 2. Extract the tooth forever.

How did I even get decay in the first place?

Decay (Caries) to me is a biological response to the lifestyle we have. A combination of diet and oral hygiene habits, your teeth can tell a whole life story.

In Singapore, we live with fluoridated water which theoretically helps to mineralize the enamel (outer layer) of teeth. If the environment is primed for healthy teeth, why do we still get decay?

It is mostly about our diet and oral hygiene. Consuming sugary drinks and foods or sticky foods, can lead to a higher risk of decay due to the acidic oral environment that these sugars create. If the frequency of consumption is high, for example snacking on chocolates, that makes the chance of decay even greater because the acidic levels in our saliva cannot neutralize with a constant supply of fresh acid. Couple that with the lack of flossing, it’s a lethal recipe for an eventual toothache.

As with all things bodily related, there is always a genetic predisposition for some more than others to have softer enamel or “hypoplastic” enamel which basically means that the teeth are weaker and more prone to decay.

The most common areas of decay are in between teeth and also on the grooves of molars. Think about where we ingest our foods and drinks. It would make sense that the little pits and grooves on our molars are more likely to lock in sugars and trap sticky foods because those are the surfaces we use to chew, pressing and packing in whatever we ingest right into the grooves of these teeth. As for decay in between the teeth, that is self-explanatory if flossing is not a part of your everyday routine. Brush as hard as you like, it ain’t going to get the food bits stuck in between your teeth, out. Leave it there long enough and it will not only be a source of unhealthy bacteria irritating your gums, but also a source of acid which will slowly but surely, demineralize the enamel causing holes to form.

How long can a dead tooth last?

Once a root canal treatment is completed and all infected nerves have been eradicated, then yes the tooth is officially dead.

Google will tell you 10 – 15 years. However, a crowned dead tooth can improve those odds and also, good hygiene practices can help to create a sustainable environment for the crown and root canal treated tooth to last a long time.

Not putting a crown over the tooth is not a good idea. Crowning a root canal treated tooth helps the tooth to be protected from unintended biting pressure points that can cause the tooth to crack and split into two. After that happens, an extraction is the only option.

What can I expect during a root canal treatment?

Price range $500 – $1250 depending on front, premolar or molar tooth.

1 – 2 visits on average. Lots of disinfectant liquids, noise, bright light and a green sheet to cover your entire mouth and isolate the tooth. Perhaps a tired jaw but a more pain free tooth by the end of the first visit.

Sometimes a root canal treatment can be done in 1 visit and sometimes it may take 3 – 4 visits. The reason for this range is due to the complexity of the roots within the tooth, and also how many roots there are. For example, a front tooth only has 1 straight canal, while a back molar tooth has 3 – 4 canals and can be curved which would be more challenging to clean right down into the ends of the roots. Bear in mind that an infection takes several months to build up, so don’t expect an infection to last that long to be fixed in 1 sitting.

Visit 1- 2: Cleaning and disinfecting. Local anaesthetic (injection) is given so that the rest of the procedure is numb and painless. The tooth is first opened up using real diamonds, yes, I said real diamonds because diamonds are the hardest material that can cut through hard enamel i.e. the top layer of teeth! Once an access path has been created, special thin files and instruments are used to tunnel through your teeth and create smooth tunnels that allow the trapped bacteria to purge itself, as well as remove the infected tooth tissues at the same time. After the shaping is completed, the tooth is dressing internally within the tunnels with antibiotic medication and left inside the tooth with a temporary filling to disinfect and eliminate any residual bacteria.

Visit 3 – 4: Disinfecting and sealing. Once the tooth has settled down after approximately 2 weeks, the tunnels or rather canals, are cleaned out, then sealed with an inert material called gutta percha. This material is meant to occupy the space where the nerves used to be, to prevent any new bacteria from creeping back in. After which a filling is placed to cover the access point of the tooth, then we plan for a crown another 2 – 4 weeks later once the tooth has completely settled down.

Can I eat after a root canal?

I always encourage patients to be careful with what they eat after a root canal before a crown has been placed as the tooth is still in a vulnerable state. However soft foods should still be playing it safe. If you bite into crabs or have a whole container of nuts, chances of cracking the already compromised tooth are very high and would lead to a complete tooth fracture.

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