How the inflammation develops

If caries spreads unchecked for long enough, it eventually reaches the inside of the tooth. Every root has one or more canals containing the pulp, a living tissue of blood and lymph vessels and nerves. Invading bacteria make the pulp inflamed and swollen; this irritates the nerve and usually causes considerable pain.

Within hours or days the inflammation can spread down into the jaw – causing the familiar swollen cheek – and to neighbouring teeth. If you have throbbing or pulsing pain in the jaw or head, or pain when chewing, please come and see us quickly.

When is it needed?

The most common reason is inflammation reaching the inside of the tooth (pulpitis). Once the tissue is infected with bacteria, root canal treatment is usually the only way to keep the tooth. Even dead teeth can often still be saved. With acute inflammation, antibiotic treatment may be needed first.

Inflammation of the pulp (pulpitis)
A fractured tooth
Before fitting a restoration
An incomplete old root filling
Inflammation at the root tip
Infected fillings, crowns or inlays that have let bacteria reach the pulp

How treatment works

The aim is to remove the infected pulp with its vessels and nerves and free the tooth of bacteria. How long this takes depends on the extent of the inflammation, the number and shape of the roots and the position of the tooth.

X-ray: shows the number of roots and how far the inflammation has progressed
Anaesthesia: the tooth is numbed locally; if it is already dead, treatment is occasionally possible without
Rubber dam: a latex or silicone sheet isolates the tooth so that no saliva or bacteria get in and no instruments or rinses are swallowed
Access: through a small opening in the chewing surface to the root canals
Measurement: measuring needles or electronic probes determine the length of the canals
Preparation: special instruments widen the fine canals and remove inflamed tissue and bacteria
Disinfection: various rinsing solutions kill the germs
Root filling: the canals are sealed with special material and the opening closed with a tight composite filling, stabilised with a post if necessary
Crown: usually the final step, for stability and a tight seal

Pain and possible complications

Thanks to modern local anaesthetics, root canal treatment is no longer painful. Occasionally, heavily infected tissue prevents the anaesthetic from working; we then prescribe an antibiotic first and treat afterwards. Mild pain once the anaesthetic wears off can be eased with painkillers and usually disappears within a few days.

Like any treatment, this one can have complications:

Discomfort in the tooth during or after treatment, which usually subsides on its own
Incomplete cleaning of curved or highly branched canals – a re-treatment or an apicoectomy may then be needed
Broken instruments in very narrow or curved roots, removed with special instruments or surgically
Perforation of the tooth wall with unsuitable technique or overly large, rigid instruments
Overfilling of the canal, which can irritate the maxillary sinus in the upper jaw or the nerves in the lower jaw; the body often clears small excesses itself, larger ones are removed surgically

Root canal, apicoectomy or extraction?

Root canal treatment is the less invasive standard treatment: it resolves the inflammation from the inside. If bacteria remain, however, inflammation can recur. An apicoectomy is a surgical procedure: the gum and jawbone are opened, the inflamed root tip is removed and the canal sealed against bacteria. It removes the affected tissue quickly and effectively, but healing can take longer. We offer both conventional and microsurgical apicoectomy.

Both procedures can be combined on the same tooth – for example if a first root canal treatment was unsuccessful or curved roots and branched canals leave areas out of reach. Whether a tooth is treated or extracted and replaced with an implant depends on the anatomy of the jaw, access to the canals and previous treatments. We are committed to treating natural teeth that are worth keeping and to avoiding complex, expensive solutions such as bridges or implants.

Our team

Our team, led by Dr. Nina van Sprundel, specialises in root canal treatment and uses modern technology for gentle, comfortable care. Dr. van Sprundel has published on post-endodontic disease and the importance of digital volume tomography. Through regular further training we stay up to date, and we take time for your individual needs.