FAQ Root Canal Treatment Complete Knowledge, Covering the Entire Process

What Causes Toothache?

Toothache symptoms mostly arise from dental caries. The pain characteristics depend on the depth of the carious lesion. When the caries is shallow, there may be tooth sensitivity when drinking cold water or eating sweets, lasting for a few seconds. However, if the caries is deep into the dentin, symptoms can range from sensitivity to dull pain lasting for minutes.

In cases where the caries is deep near or penetrates the dental nerve, there may be moderate to severe throbbing toothache, depending on the inflammation and infection status of the dental nerve in the pulp chamber of the affected tooth.

What Symptoms Require Root Canal Treatment?

Toothache symptoms can be simply classified into 2 types:

1. Stimulating pain usually involves mild pain such as sharp pain when drinking cold water or eating sweets, or a dull pain when food debris is stuck between teeth. The pain typically subsides once the stimulus is removed.
2. Spontaneous pain occurs without any stimulus and is usually more severe, characterized by throbbing pain that may radiate around the area. This requires urgent diagnosis and root canal treatment or pain relief medication combined with antibiotics to alleviate the pain first.

What Are the Steps and Duration of Root Canal Treatment?

The number of visits and duration of root canal treatment depend mainly on the inflammation and infection status of the root canal. If inflammation is minimal, single-visit root canal treatment may be sufficient.

Conversely, if there is severe infection, multiple visits may be necessary to eliminate the infection properly. The treatment follows standard procedures to eradicate infection in the root canal as follows:

First Root Canal Treatment

1. Administer local anesthesia to the tooth requiring root canal treatment.
2. Place a rubber dam with clamps and clean the rubber dam surface with 10% Tincture iodine and 75% Alcohol.
3. Remove carious lesions and open access to the root canal using a high-speed drill.
4. Locate the root canal entrance and remove infected dental pulp tissue using small endodontic files.
5. Measure the root canal length during the procedure with an apex locator, possibly supplemented by dental X-rays to confirm the working length.
6. Clean the root canal using small rotary endodontic files powered by a motor.
7. Irrigate the root canal with sodium hypochlorite and EDTA solutions to eliminate any remaining bacteria.
8. Place calcium hydroxide disinfectant inside the root canal and allow it to act for 1-2 weeks.
9. Temporarily seal the root canal entrance with a two-layer temporary filling material.

Second Root Canal Treatment

1. Ask about symptoms of the treated tooth and examine the tooth, surrounding gums, and temporary filling material. Local anesthesia may be administered before proceeding.
2. Place a rubber dam with clamps and clean the rubber dam surface with 10% Tincture iodine and 75% Alcohol, as in the first treatment.
3. Reopen the root canal by removing the temporary filling material.
4. Irrigate the root canal with sodium hypochlorite and EDTA solutions, then dry the canal.
5. If the root canal is dry, clean, and free of pus, fill the root canal with root canal filling material and cement.
6. Temporarily seal the root canal entrance with a two-layer temporary filling material, awaiting further tooth restoration.

What Is the Follow-up Process After Root Canal Treatment?

Teeth that have undergone root canal treatment need proper restoration to prevent fracture of the remaining tooth structure, allow normal chewing function, and maintain aesthetics close to natural teeth. Appropriate restoration should cover the cusps and usually requires placing a post and core build-up, which the dentist will evaluate before starting the restoration.

• Post is a rod made of many fiber strands inserted into the root canal to serve as a support for the core build-up.
• Core is a restorative material that replaces lost tooth structure and serves as a foundation for the crown.

What Are the Consequences of Not Getting a Crown After Root Canal Treatment?

Restoration after root canal treatment is crucial to ensure the treated tooth can function effectively for chewing and maintain natural appearance. Restoration can be done by various methods such as dental crowns or partial crowns (onlays/overlays). Inadequate or absent restoration after root canal treatment can lead to fracture of the remaining natural tooth structure. The extent of fracture depends on several factors, including:

• The thickness of the remaining tooth structure
• The chewing forces applied to the tooth
• The type of food consumed, etc.

If the fracture extends below the gum line, the tooth may no longer be restorable and extraction will be necessary. Therefore, it is recommended to restore the tooth as soon as possible after completing root canal treatment.

Post-Root Canal Treatment Recommendations

1. After treatment, moderate aching pain may last about 2-3 days. It is recommended to take Paracetamol 500 mg, 1-2 tablets immediately after treatment and continue for 2-3 days, 1 tablet every 4-6 hours, or Ibuprofen 400 mg, 1 tablet after meals, possibly continuing for 2-3 days, 1 tablet after breakfast, lunch, and dinner.
2. Avoid eating hard, sticky, or crunchy foods during root canal treatment to reduce the risk of fracturing the remaining tooth structure.
3. You can brush and floss normally.
4. If pain persists for more than 2-3 days, consult your treating dentist for evaluation and pain management.
5. In cases of severe dental nerve infection, antibiotics may be prescribed (Amoxicillin 500 mg, 1 capsule after breakfast, lunch, dinner, and before bed, combined with Metronidazole 400 mg, 1 tablet after breakfast, lunch, and dinner). The dentist will decide on the prescription.
6. After completing root canal treatment and if the treated tooth has no symptoms, schedule restoration as soon as possible.

What Are the Symptoms of a Cracked Tooth and How Is It Treated?

Cracked tooth results from fatigue of the tooth structure due to heavy use in biting or chewing, especially hard, sticky, or crunchy foods, combined with large restorations. Symptoms usually range from sensitivity to cold water to throbbing pain when biting or chewing, especially hard, sticky, or crunchy foods, often lasting for minutes.

Diagnosing a cracked tooth is more complex than diagnosing dental caries because the depth of the crack cannot be seen with the naked eye. 3D dental X-rays along with conventional X-rays are needed to assess associated symptoms.

Cracked Tooth Treatment Depends on the Crack Depth, Divided into 3 Levels:

1. If the crack does not reach the pulp chamber, treatment involves bonding the cracked tooth parts with adhesive and tooth-colored filling material, along with a crown to cover the entire tooth.
2. If the crack reaches the pulp chamber, bonding the cracked parts as in point 1 is necessary, followed by root canal treatment before restoring the tooth with a crown.
3. If the crack extends to the root canal but the root is not fractured, treatment as in point 2 is considered. If the crack progresses to root fracture, extraction and replacement with a prosthetic tooth may be necessary.

Dr. Supasan Thitthaweerat

Endodontics Specialist Dentist

Dental Center, Phyathai 2 Hospital