Root canal treatment vs straight extraction
When we decide whether root canal treatment is better than straight extraction, we assess how important that tooth is for the patient. We assess whether or not the patient is able to keep that tooth clean.
If it’s a less important tooth and the patient is struggling to keep it clean, we’d be concerned about the expense of root canal treatment, and possibly a crown. The sad fact is that the tooth might end up failing anyway. But in general, root canal is a far better option than extraction.
The root canal is the space inside the tooth containing the pulp. The tooth has three broad layers. The enamel is on the outside and that’s the hardest layer. The layer inside that is called dentine. It is still very hard but it’s a little softer than the enamel.
The dentine conducts some sensations back to the innermost layer, which is the pulp of the tooth. The pulp is a soft tissue that conducts feeling. It does not, strictly speak, contain nerves but it creates sensations of hot, cold and pressure
Pulp also contains blood vessels that keep the tooth alive by keeping it moist and hydrated.
Cleaning out that dead tissue
If that tissue is damaged, it dies. The damage is typically caused by bacteria entering the tooth as a result of decay, or from trauma like falling off a bike or whacking your mouth on the edge of a trampoline. On occasion, constant grinding of teeth can also cause the same issue.
Once the tissue dies, it tends to lead to infection and pain, so we need to clean out that dead tissue. This process is what’s known as root canal treatment.
Each root canal is essentially a tube that goes down the middle of each of the roots. The number of roots varies but, generally speaking, as you go from the front to the back of the mouth, there are more root canals in each tooth.
Step by step
We use very small, fine files in those canals to physically clean them out and to enlarge the space enough to flush them out with a disinfectant. If we’re particularly worried about infection, we might also use an antibiotic paste for a period of time. Once the space is as bacteria-free as possible, we seal it off.
For the sealing, the most common material is a rubber compound, then another sealant to fill any micro gaps. The tooth is filled on top of that and if we’re worried about cracking, we might apply a crown or something similar on top of the tooth.
Natural tooth saved
The tooth is dead but as the roots still exist, as well as the ligaments that hold the root into the bone, it will not fall out. Teeth are a lot like icebergs—there’s a lot more underneath the gum than sticking out the top. You won’t have any sensation of hot or cold in that tooth but you’ll still feel a little bit of sensation of pressure, from the ligament around the tooth.
So, root canal treatment saves the natural tooth. In a tooth without a long-standing infection, success rates are high. It is a predictable, long-term treatment. In most cases, root canal treatment is preferable to having the tooth taken out. However, you certainly want to take into account all the surrounding factors before making a decision.