Endodontics

All of our dentists undertake endodontic treatment, also known as root canal treatment. Some of our dentists have a special interest in root canal treatment and are able to perform this complex procedure to a very high standard. Dr Hasnat Ali has a special interest in endodontics and provides these services in the Shepherds Bush Practice.  Likewise Tameam Alaubidie provides endodontic treatment in the Notting Hill Practice.  If a root canal treatment fails, it can often be redone. A number of our Dentists are capable to carry out re-root canal treatment and if required, apicectomies.

Root Canal Treatment

At the core of each tooth is a soft mass of tissue called the pulp. In a healthy tooth, the pulp contains living fibres, cells, nerves and a blood supply, extending into the root(s) through the root canal(s).

Decay or injury can destroy the living pulp. Because dead pulp lacks a blood supply, it is more prone to infection, leading to an abscess and toothache.

Root canal treatment (also known as root filling or endodontics) means removing damaged or dead pulp and filling the space left. The remaining tooth can then be repaired.

What will my dentist do?

• An X-ray can show the number and shape of the root canals, and also signs of infection in the surrounding bone. Teeth can have a number of roots and some are easier to fill than others because of their shape.
• To keep root canals dry during treatment the dentist may stretch a sheet of thin rubber around the tooth, on a frame outside the mouth; this is called ‘rubber dam’. Having this fitted makes the treatment safer.
• You will be given a local anaesthetic, and then an opening is made through the top of the tooth, down into the pulp.
• The dentist then uses narrow files to remove the dead pulp from the core of the tooth and from the root canal(s).
• At this point, the dentist may put in a temporary filling and possibly also give you antibiotics if any infection has spread beyond the tooth. If so, you will have to return at a later date, once symptoms have settled, so the dentist can complete the treatment.
• In the next stage, the dentist fills the root canal(s). A filling can then be placed in the remaining cavity in the tooth. Some teeth which have root canal treatment performed will eventually need a crown. 
• Root filled teeth can become darker than other teeth, but bleaching can be used to make them look lighter.

What are the benefits?

• Pulp damage can cause toothache but the pain will usually end very quickly when the root canal is cleaned out.
• Without a root filling, a tooth with a dead pulp would probably have to be taken out in the end. There is also a possibility of infection spreading beyond the tooth itself.

Root-fillings are usually successful and can last many years, but re-treatment is also possible if infection recurs. Occasionally, if inflammation persists at the tip of the root, surgery can be carried out to remove the end of the root. The area is then cleaned and a filling may be placed at the end of the root to seal the root. This is known as an ‘apicectomy’.

Apicectomy

What is it?

Teeth are held in the jaw by their roots. At the core of each tooth is a soft mass of tissue called the dental pulp. In a healthy tooth, the pulp contains living fibres, cells, nerves and a blood supply, extending into the root(s) through the root canal(s). Tooth decay or injury can destroy the living pulp. Dead pulp is more prone to infection, leading to abscess and toothache.

This can usually be dealt with successfully by root canal treatment (also known as root filling and endodontics). Sometimes infection can persist at the end of a tooth root, in the surrounding bone. In this case, a dentist can carry out an apicectomy.

What will my dentist do?

They will:

• Give you a local anaesthetic to numb the mouth around the infected tooth, so that the procedure is painless.
• Make a small cut in the gum, well away from the tooth, so that there won’t be a visible scar afterwards;
• Move a small flap of gum to one side, and make a small “window” in the bone, to uncover the infected area;
• Clean out the infection and cut off the tip, or “apex”, of the root;
• Put a small filling at the end of the root canal to stop any more infection; and
• Stitch the gum back in place.

You may feel some pressure and hear instruments being used, but you should not feel any pain during an apicectomy.

After treatment you will need to keep the area clean.

• For the first day, rinse with warm salt water several times a day, especially after meals. Use half a teaspoon of salt in a glass of warm water, not hotter than is comfortable.
• Brush the teeth normally, but be very careful not to disturb the cut.
• On the next day, continue rinsing and begin to gently brush the teeth next to the cut.

There may be some bruising and swelling for two or three days afterwards. There will also be some slight discomfort – an ice-pack or a frozen pack of peas wrapped in a towel applied to the outside of the face can help. It usually takes about a week for an apicectomy to heal.

Points to remember

• An apicectomy can stop pain and swelling.
• An apicectomy saves a tooth that would otherwise have to be extracted.