Teeth can be damaged by dental decay, fractures or other reasons. This exposes the pulp (the soft, inner core of the tooth containing nerves and blood vessels) to bacteria from saliva that may irritate it. Unless treated the problem may increase and symptoms such as pain and swelling can occur as the nerves and blood vessels become progressively more damaged and eventually the pulp space becomes completely infected with bacteria. An inflammatory response to the bacteria occurs resulting in damage to the bone around the root, often appearing as a dark shadow on a dental x ray.  At this stage the tooth is probably very uncomfortable indeed, especially on biting, or with temperature changes.  Often it’s worse on lying down, so it wakes you at night.  You may notice the tooth feels “high” in the mouth, or there may be obvious swelling present.

Once the pulp, or root canal space, is infected, there are only two ways to resolve it: either extract the tooth or carry out root canal treatment (known as Endodontic therapy). Antibiotics cannot resolve the problem as there is no longer a blood supply entering the pulp space to reach the bacteria and deliver the antibiotic.

What does root canal treatment involve?

Under local anaesthetic, the decay or filling is removed from the tooth, and the pulp space beneath is open up to allow the dentist to visualise the canal openings.  Small instruments are used to gradually enlarge the canals, and the bacteria are removed, and the canal space is cleaned internally.

Once the space is clean and dry, a filling is placed right into the full length of the root canals, sealing out bacteria.  A filling is placed over the top, but usually you would need to have a crown placed on the tooth later on, to protect it from breakage.  Root filled teeth are invariably more fragile and brittle than other teeth, and a crown will strengthen and protect the remaining tooth structure underneath.