A root canal is done to save an infected tooth. The procedure is virtually painless and Beverly Dental Heights makes the entire procedure comfortable and speedy with the aid of advanced dental technologies and methods.The procedure is needed when the pulp of the tooth gets infected which sometimes also leads to abscess around the tooth due to bacterial infection. A root canal that’s done in an efficient and thorough manner can relieve pain, save the tooth and also prevent the infection from spreading deeper which could have even lead to other health issues.


Root canal computer simulation

Why the tooth pulp gets infected?

Inadequate tooth-care leading to bacterial infestation causes tooth decay and progresses to infect the pulp. An injury to the teeth and gums can also cause damage and infection. Sometimes prior dental treatment involving ‘deep fillings’ that had to be placed closer to the pulp can also attribute to the infection. Not just that, an infected pulp can happen due to aging or often times for no apparent reason.

Signs and Symptoms of tooth needing root canals

An infected pulp normally causes sensitivity and pain. Patients with infected tooth may experience mild to moderate and sometimes severe pain while chewing food and may also experience considerable tenderness and sensitivity with hot and cold beverages. Swelling and dark discoloration of the tooth and neighboring gums is also a common symptom.

Xrays can confirm the need for a root canal and one of the more straightforward case of the tooth needing root canal treatment is radiolucency, which is the presence of a darker area around the apex of the teeth, indicative of changes in the bone as a result of considerable infection within the canals of the tooth. Pimple like lesions at the gums could indicate infection of the canals. Tooth discoloration is also an indication of pulp infection and must be investigated further. Some cases do not show noticeable symptoms but could still progress the infection and decay within the pulp. This is why an annual tooth exam is recommended.

Anatomy of the root canal

root canal anatomy

Root canals are spaces or canals inside the root of the teeth. The root canal system of the tooth consists of a pulp chamber, root canals and accessory canals(branches from root canals). The number of canals in a tooth vary. Incisors (upper teeth) usually have 1 root and 1 canal. Lower molars commonly have 2 roots and 3 canals and the upper molars can have 3 roots and 3 canals and often upto 4 canals and in some rarer cases more. So depending on the type of teeth, the duration and costs can vary.

In cases where the root has multiple canals and has a more complex branching structure, extra care should be taken by the dentist. Such patients present a challenge and the dentist might require multiple sittings to adequately resolve and treat the teeth. If the dentist misses infection in one of the branched root canal, then the patient could continue to experience toothache and will have to get the procedure done again.

The tooth that has infection on more than one canal will require more expertise, additional treatment time and so will also in most cases incur more in treatment costs. Dr Vidya Janardhanan has treated many such complex cases and has a very high patient satisfaction score.

Treatment procedure

The root canals treatment procedure is fairly simple and straightforward and entails minimal pain to the patient. We have laid down a very precise eplanation of the process which should make for a useful read both to the patient and a dental student. If you would rather watch the video of a dentist doing the procedure hands-on, you can watch the video below by clicking on one of the social share buttons. The video is a bit graphic as you would imaging and so for those of you who would prefer reading, we have given the textual explanation with some pictures and figures.


video of toot canal performed by dentist.

Isolating the tooth

The dentist will begin by isolating the teeth with a rubber dam. This is done to isolate the tooth’s canals from bacteria outside and also keeps it dry. Moreover gives the dentist a nice, isolated work-area where she can concentrate on the tooth.
dental rubber dam
The rubber dam is a latex sheet with a hole which will allow the treated teeth to be exposed whilst sealing of the rest of the teeth. This sheet is then clamped to keep it in place within the mouth.

Creating the access cavity

To clean the root canals of the tooth, the dentist has to drill a hole through the tooth’s surface and dentin and reach its pulp chamber. With the back-teeth, the dentist will have to chisel the tooth’s central grinding surface to reach the tooth’s canals and with the front-teeth the opening will be made backside. This hole will allow the dentist to get access to the infection at the canals and will also enable to remove infected bits of teeth.
access cavity root canal

Measuring the canals

The length of the canals vary quite a bit and measuring them accurately is a key component of the treatment which will enable the dentist to treat the canals adequately without leaving it incomplete and also not going beyond the length. The dentist can determine the length by placing a metal file(used to clean) inside the canal and then taking an Xray. This will tell the dentist how far the file is inside the root canal and with a simple calculation can determine how much further the file should go.

Alternatively, the dentist can also use an electronic measuring device. The device has 2 wire leads, one is clipped to the file and the other is gently clipped to patients lip – the device will beep when the file reaches the end of the canal. Teeth can have several canals and each of them will have to be measured if they are infected.

Cleaning the root canal

root canal filesCleaning and shaping a tooth is the whole purpose of the root canal process. Cleaning removes debri, bacteria, infected, dead and live tissue from the canals and the pulp chamber. The shaping of the tooth is done to remove infected bits and also to enable getting an optimal shape to facilitate filling and if needed placing a crown.

Tooth is cleaned with the help of root canal files which are basically tapered metal(1) with rough contour(2) and a holding area(4) and a plastic stopper(3) that can be slid as needed to mark the workable section. The dentist will have files of varying curvature and sizes to fit the differently curved canals.

cleaning and filling root canalThe files are moved along the canal with a twirling motion sych that the abrasive surface of the file scrapes and removes infected tissues from the canal. Often upto 6 different files of varying sizes are used so as to scrape any infected tissue lodged against the walls of the canal.

This cleaning process with files can be done either by hand or with the help of a dental drill. Tooth irrigation is important right through the filing process to facilitate the removal of the scraped debris. Sodium hypochlorite which is also a disinfectant is the preferred choice.

Sealing the canals

Once the canals are cleaned, it is then time to seal it with a filling. A rubber compound called “gutta pecha“ is commonly employed as a permanent sealer. Gutta pecha resembles the files used to clean the canals and have a cone like shape.. Several such cones are used to ensure that the canal is stuffed tight.

Before inserting them into the hollow cleaned canals a paste is applied on them so that the various rubber cones adhere better to each other and form a water tight sealant inside the root canal. The dentist may alternatively use a dental glue-gun device that can warm the rubber compound and introduce it into the canal in the form of a paste.

Filling and Restoration

Once the tooth is clean and free of infection in the canals, the tooth is internally stable, but it still has that access cavity that needs to be closed. Depending on the tooth’s residual stability and strength, the dentist can advice the patient on a crown or a filling.

Filling it with a dental restorative method is usually ok if the access cavity is small and the teeth didn’t already suffer from structural instabilities due to the trauma of the root canal procedure and other inherent infections of the canal, otherwise a crown is the sensible option. A good crown can extend the life and health of the tooth after a root canal.

Chart by Visualizer

The above chart is a visual representation of a study performed by medline that evaluated 1609 patients over a decade and found that crown restorations on teeth with moderate instabilities after root canal exhibited significantly better life. The crown is like a shell protecting the tooth, whereas filling is just plugging the cavity with restorative material and works like cement in layman terms, so – the above result is to be expected. Infact with molars that have fractures and bigger access cavity, the benefits of crown are even more significant.

Will removing root canal tissue affect the teeth negatively?

When we explain the entire process of root canal to the patient, we get this asked sometimes. The root canal involves cleaning the infected pulp and nerve tissue and replacing it with a filling, it essentially removes the nerve(pulp). But this nerve doesn’t originally produce much sensation or purpose and is largely unresponsive. The only time the pulp produces sensitivity and pain is when they are infected. Infact even the sensations that you receive when the healthy teeth bite on something hard is due to the nerve fibers surrounding the gums, not the pulp. So, no – the patient will certainly not miss the nerve tissue.

Is it covered by dental insurance?

Some insurance providers classify it as basic care whilst others classify it as major care. Depending on the classification of the treatment you can avail coverage of 50% (major care listing) or 80% (basic care listing). Often insurance providers restrict coverage for root canal within the first year. Additionally re-treatment within a certain period(around 2 years) may not be covered.

Aftercare and pain

The natural question of every patient after a root canal – one that must be answered by every dentist irrespective of whether the patient asks. We will try and answer this in a detailed but brief manner.

Most of the patients experience little or no pain after a root canal or in between root canal appointments. Some patients will experience temporary soreness in the gums mainly because of the clamps used to hold the rubber dam inside the mouth. This will go away soon. The procedure can rarely cause some residual bacteria to go on overdrive and cause infection, in such an event antibiotics will control it. Your tooth will feel tender and you might experience some pain due to inflammation that happens if the dentist nicks the ends of the canals during the procedure. Again, this is temporary and pain killers can alleviate this ofcourse.

Chart by Visualizer

The above chart shows the results obtained during a case study at a military hospital and was published by King Hussein Medical Center. It is pretty clear that most patients face no discomfort after root canal. At our clinic, we have noticed similar trends with almost all patients reporting being comfortable post-treatment