Root Canal Treatment

In the centre of every tooth, inside narrow canals that run down to the tip of the root, there is a soft tissue made up of nerves, blood vessels and connective tissue: the pulp, commonly called the nerve of the tooth. Deep decay, a crack, a knock, or repeated procedures on the same tooth can inflame this tissue. Beyond a certain point the inflammation cannot be reversed; the pulp dies, and infection spreads from the root tip into the jawbone.

Root canal treatment removes this tissue, disinfects the canals and fills them so that bacteria cannot settle back in. The aim is to keep the tooth in your mouth instead of extracting it.

Which symptoms point to root canal treatment?

• Pain that lingers for minutes after something hot or cold
• Throbbing pain that starts on its own or wakes you at night
• Pain on biting or when the tooth is touched, or a feeling that the tooth is "too long"
• Swelling of the gum, or a small blister that drains every now and then
• A tooth that darkens or turns grey after a knock

There are not always symptoms. A dead tooth can stay silent for years, and inflammation at the root tip may first be spotted on a routine X-ray. The reverse is also true: a twinge that comes with cold and passes straight away does not on its own call for root canal treatment; it is usually tooth sensitivity. Swelling that spreads across the face, a fever, or difficulty swallowing or breathing, however, is an emergency: see a dentist without delay (the nearest one if you are not in İzmir) or seek emergency care.

How is root canal treatment done, step by step?

1. Diagnosis. X-rays, a cold test and gentle tapping on the tooth show the state of the nerve and of the bone around the root tip.
2. Anaesthetic and isolation. A local anaesthetic is given; you usually feel no pain during the procedure. The tooth is isolated with a rubber dam to protect it from the bacteria in saliva.
3. Finding and measuring the canals. A small access opening is made through the top of the tooth. The canal length is measured with a device that detects the root tip electrically (an apex locator) and with X-rays; the aim is to work right down to the root tip, but not beyond it.
4. Shaping and irrigation. The canals are widened with flexible, motor-driven nickel-titanium files and rinsed generously with disinfecting solutions. It is the rinsing that does most of the work of reducing bacteria.
5. Filling. The canals are filled to the root tip with gutta-percha, a rubber-like material, and a sealer paste, so that they are sealed tight.
6. Final restoration. The access opening is closed and, depending on the state of the tooth, a filling, an onlay or a crown is planned.

Can it be finished in one visit?

Often, yes. Studies show that, in suitable cases, treatment completed in a single visit heals no less well than treatment spread over several. We split it into two or three visits if there is constant discharge from the canal, a marked abscess or swelling, if the canals are very curved, or if the procedure would last longer than you can comfortably keep your mouth open. In the week or two between visits, an antibacterial medicine is placed in the canal and the tooth is closed with a temporary filling. In teeth where the nerve is severely inflamed, lower molars in particular, it can be harder to get the tooth numb; in that case we give additional anaesthetic. If you feel anything, just tell us.

Do I need a crown after root canal treatment?

On back teeth, usually yes. Molars and premolars that need root canal treatment have generally already lost tissue to large decay or old fillings, and they are prone to cracking under chewing forces. An onlay or a zirconia crown that covers the chewing cusps reduces this risk considerably. On front teeth, if little tissue has been lost, a filling is often enough. Do not put off the permanent restoration for too long: if the temporary filling leaks, bacteria get back into the canal and the success of the treatment is put at risk.

"A root canal kills the tooth" and other myths

"It kills the tooth." In a tooth that needs root canal treatment, the nerve is already inflamed or dead. The treatment does not touch the tissues that attach the root to the bone; the tooth stays in place and goes on chewing, it simply no longer feels hot and cold.

"The tooth dries out and shatters like glass." The real reason for brittleness is not drying out but the tissue lost to decay and to the access opening. That is why we recommend a crown on back teeth.

"A root-filled tooth spreads disease around the body." This idea goes back to studies from the early 1900s that were later discredited; there is no valid evidence that root canal treatment causes other diseases. The real risk is leaving an infected tooth untreated.

"If I take antibiotics, it will clear up." A dead nerve has no blood supply, so medicine cannot reach it. Antibiotics may be needed for an infection that is spreading, but they do not clean out the source.

"It makes more sense to have it out and get an implant." If the tooth can be repaired, keeping your own tooth is usually the better option. If the tooth is too broken to save, or there is a vertical crack in the root, extraction followed by an implant is discussed.

What to expect afterwards, and what affects the cost

Once the anaesthetic wears off, some tenderness on biting for a few days is normal and settles with ordinary painkillers. Until the permanent restoration is in place, do not chew anything hard on that side; if swelling develops or the pain keeps getting worse, contact us, or see a dentist near you if you are already back home. Studies show that the great majority of first-time root canal treatments are successful; if a treatment does fail, we explain the options on the root canal retreatment page. The cost depends on how many canals the tooth has, the state of the infection and the restoration needed afterwards. At our clinic in İzmir you receive a written, itemised quote after an X-ray and examination.