In cases where a cavity progressed and reached the vital structure of a tooth, the tooth pulp forms an inflammatory process and can become infected with bacteria. This process can also occur after severe trauma to a tooth. The pulpal tissue and nerves need to be removed and cleaned to prevent infection. These canals are then sealed to prevent future pain and infection. 

Endodontic treatment, also known as root canal therapy, involves the treatment of the internal structure of the tooth. Endodontic treatment is often the last treatment option available to save a diseased tooth.

The tooth contains a vital pulp structure in the inside. The pulp has a rich blood supply and contain nerves.

A cavity or decay is the process of tooth destruction caused by bacteria. Streptococcus Mutans is the main decay causing bacteria. The bacteria ferment on surgar in the mouth and secrete a byproduct with a very low ph. The low ph demineralize the tooth structure and result in decay. When the pH of the mouth drop below 5.5 demineralization of teeth occur. A pH of 5.5 is also known as the critical ph.

Decay progress through the enamel and once it is in dentine, it quickly spread towards the pulp of the tooth. Once the bacteria enters the pulp of the tooth the pulp will become inflamed (also known as pulpitis). The bacteria moves down the canals of the tooth containing the nerve and blood vessels. At the end of the root, also known as the apex of the root, abscess formation occurs as the body tries to fight the bacteria.

The only way one can get rid of the infection and inflammation inside a tooth is to do a root canal treatment. During a root canal treatment the inflamed and infected pulp, nerves and bloodvessels are removed.

Root canal therapy is done in two stages.

  • During the first stage we do pain relief and place medicine in the infected pulpal area to help clear the infection and inflammation. A temporary filling is placed and the tooth is allowed to heal for more or less a week. Antibiotics and anti-inflammatory medication may be prescribed if necessary.
  • During the second stage the infected canals are cleaned and shaped under sterile conditions using special instruments called endodontic files. The canals are regularly rinsed with Sodium Hypochlorite, a solution killing bacteria and the bacterial byproducts. EDTA is a solution also used to clean canals, specifically to remove the smear layer. The canals are shaped by the files until they have a certain shape and taper. A gutta percha (gp) point is a rubberish plugger point that fit perfectly into the cleaned canal. The gp point is then treated with a special antibacterial cement and inserted into the canal to seal the canal. A final filling is placed on the sealed canals to make sure the canals stay sterile.

A properly sealed root canal treated tooth should have no pain/symptoms after the treatment has been done. Patients may, however, have slight discomfort for a day or two after the treatment. The infection and inflammation should be a thing of the past.

A badly traumatized tooth may also require endodontic treatment as the pulp often dies and become necrotic after trauma.

It is advised that a root canal treated tooth should be restored with a crown for long term function. Root canal treatment is often the last treatment option available to save a tooth.