Endodontic Root Canal Treatment in Hertfordshire
Endodontics is the discipline of dentistry that prevents or treats diseases of a the dental pulp and surrounding tissues. The dental pulp is the soft tissue in the centre of a tooth within which are the tooth’s blood vessels and nerve fibres.
Endodontics, commonly referred to as root canal treatment, involves protecting or removing the pulp from a tooth to prevent or treat disease, in particular infection. An endodontist is a specialist who deals just with this.
The disease itself can be extremely painful and if left untreated can lead to an abscess, an infection affecting the tissues surrounding the tooth roots.
Common reasons for needing endodontic treatment are tooth decay, cracks or fractures of the crown or a leaking filling that has allowed infection in to the area of the pulp.
Endodontic treatment may also be carried out on teeth that have previously been root treated either to treat or prevent infection or to provide a dependable foundation for a new filling or crown, this is commonly referred to as root canal retreatment.
The ultimate goal of endodontic treatment is to save teeth that would otherwise need to be extracted. It is carried out under local anaesthetic just like a regular filling and typically the success rates are extremely high and on a par with treatment alternatives such as extractions followed by an implant.
Teeth that have had undergone endodontic treatment always need to be carefully restored either with a new filling or a crown for a successful long-term outcome – this will be done by your general dentist.
If the pulp in your tooth is not healthy, either because it is inflamed, infected or has died, it needs to be removed, the space cleaned, then filled and finally the tooth can be restored.
Sometimes, if a tooth is very broken down, root canal treatment is required to gain space in order to build the tooth back up again – think of it as the ‘foundation’ for the crown. On occasions, a post may be used to do this.
A post is part of the filling that extends in to the root canal on top of which a crown can be placed.
To get to the root canals, a small hole needs to be made in your tooth, through which the space can be cleaned and filled. This is initially done using instruments that you will have experienced if you have already had a filling and then with fine files which are used to reshape the inside of your tooth. A barrier or rubber dam is placed around the tooth to isolate it from the rest of the mouth. This prevents instruments and materials falling in to your mouth or airway and prevents the contents of your mouth such as saliva and bacteria, which naturally present in your mouth, from entering the tooth.
Your dentist will have suggested you see an endodontist, someone who has received further training in root canal treatments (endodontics). After the initial consultation appointment with your endodontist, the treatment typically takes one or two appointments.
Watch some videos of the treatments here
The specifics of each tooth is different. Your treatment will be discussed and only carried out if you agree (consent). You will be given an itemised treatment plan including costs of all treatment that is required.
Root canal treatment can be very technically demanding (fiddly). To do a thorough job takes time, patience and good technical skills, that’s why the treatment can take so long.
I’ve had it before, does that matter/ I’ve had it before, why do I need it again? Root canal treatment, as a general rule, has the best chance of success when it is done the first time. If you are having it done again, it really depends on why you are having it done. Below are some examples of why you might be having root canal treatment again (root canal retreatment).
Leakage of bacteria from the crown of the tooth such as if the crown or the filling in the tooth has come out.
The previous root canal treatment could be technically improved.
Something was broken in the tooth before and it needs to be removed.
Normally root canal treatment can be carried out through the crown of tooth. If there is a filling or a crown already in the tooth, it is possible that this is leaking which has resulted in the root canal treatment being required. Most of the time therefore, it is better to remove the crown or filling from the tooth, carry out the treatment and have a new one placed. An added advantage of removing the filling or crown is the tooth under the crown or filling can be inspected closely for the presence of cracks or decay and also ensures that we are able to restore (rebuild) the tooth back up again afterwards.
There are a variety of reasons however that when the crown or filling can be left. In such cases, a hole is either made through it (as if it wasn’t there) or surgery is carried out whereby the crown is not touched and access is gained to the root of the tooth by lifting the gum up in a surgical procedure and access the problem that way.
All treatment will be carried out under local anaesthetic so there should be no reason that the treatment should hurt.
Sometimes discomfort may be felt after each appointment. This is because we are generally dealing with already inflamed tissue and by carrying out the treatment, we are stirring things up further. As a general rule, you are more likely to have pain after the appointment if you had pain before the appointment. Rather than causing discomfort, root canal treatment often treats or prevents pain occurring.
If you need something for discomfort afterwards, whatever you take for a headache such as ibuprofen or paracetamol tends to work well. Antibiotics are only very rarely required as we only need to allow time for the body to manage the inflammation.
Rather than thinking of the root canals as tubes within the tooth, think of them more like trees in autumn, without the leaves. There are lots of little branches and ‘hiding places’ for the bacteria within the root. Unlike say a chest infection, where the bacteria are within reach of circulating blood and antibiotics within it, the areas within a tooth where the bacteria are, are not exposed to the circulation.
During times of acute infection, where the bacteria ‘spill out’ in to the tissues beyond the root, antibiotics can have some benefit in the short term, however, the long term solution is to get rid of the source of the infection i.e. the bacteria within the tooth, by carrying out root canal treatment or indeed an extraction.
Your treatment includes at least one follow-up appoint 6-12 months after the initial treatment is complete to ensure the treatment is working. If further appointments are required you will be told all about it.
Further root canal treatment, if required, will be carried out by the endodontist but normally once the root canal treatment is completed, the tooth should be restored as soon as possible and you will be discharged back to your dentist to have this carried out.
If a tooth is knocked it may become pink due to bleeding that occurs within the crown of the tooth. This may only remain for a couple of days in which case, no treatment is required. If this remains for longer or the tooth becomes discoloured grey or black (which can be up to 2 years after the injury), bleaching may be required to restore the tooth to a more ‘normal’ appearance.
If a tooth has been knocked, it may become discoloured a yellow-brown colour. This is because the inside of the tooth may become calcified, affecting the way light flows through the tooth. This can be very difficult to treat and indeed, even if the colour can be regained, the amount of light able to pass through the tooth, may remain affected.
Fees vary depending on location. They will always be made clear to you for each case.
An itemised bill will be provided for you depending on what is required but here’s a guide to give you an idea of costs:
- Consultation (30-minutes, 1 or 2 teeth) – £100
- Consultations trauma or multiple tooth assessment (45-60 mins, 3 or more teeth) – £150-200
- Intravenous sedation (2-hour) – £700
- Incisors, canines (front teeth) and premolars (back teeth) – £700*
- Molars (back teeth) – £800*
- Root canal retreatment additional – £50
- Surgical treatments – £950-1200
- Investigation and management of additional problems e.g. removing crowns, managing broken instruments, removing posts, managing perforations, placing large provisional crowns or restorations – £350
- Panoramic radiograph (OPT) – £50
- Cone beam computed tomography (CBCT) – £150
- Radiologist’s report for imaging 5x5cm CBCT- £70
- Radiologist’s report for imaging 8x5cm CBCT – £90
- Radiologist’s report for imaging 8x8cm CBCT – £115
Consultations followed immediately by treatment are available with prior arrangement
(*Specific fees will be made clear in all cases)