Since so many people seem to recoil in horror when they hear some friend or other is having a root canal treatment on their tooth, I thought I’d share my own root canal experiences.
I had cold sensitivity develop in a molar tooth that had previously been filled twice by different dentists, in the 1970s and in the 2000s. X-rays, cold air spray, the probe and tooth sleuth (a plastic thing you bite down on each cusp individually to see if the tooth is cracked) all proved inconclusive.
So I was sent away but told to return immediately, if/when it got worse. Well, it took a few days, but eventually, I realised the weird pressure build-up sensations and spontaneous twinges in my tooth probably fell into the category of ‘getting worse’.
My dentist agreed that we needed to take action. He explained that the nerve was in the process of dying and the best thing to do would be a root canal treatment to save my tooth.
The first appointment
The first appointment involved
- opening the tooth up
- taking out the nerve to stop the toothache
- cleaning out, finding and disinfecting all the canals, and
- placing a medicated temporary dressing.
I gave my verbal consent and my dentist numbed me up so slowly and gently I couldn’t even feel it. After a couple of minutes, I felt outstandingly numb – this was reassuring to me. He charmed me into lying back by his comment that there was not going to be any pain involved whatsoever.
After waiting a while longer, he then tested gently with the explorer and asked if anything felt sharp. My answer was no, so all good to go.
The rubber dam
The next step was ‘putting on the rubber dam’ which was new to me. It can be a bit fiddly but you are already numb by this point. A special clamp is anchored with a frame around your tooth, and then a piece of rubber is stretched over the frame which they then adjust, usually so that only the tooth to be treated is visible in the dentist’s work area.
The rubber dam isolates the tooth being treated from saliva. It also meant that I could swallow easily when I needed to. Moreover, there was no danger of accidentally gulping down the treatment debris such as old filling material and the bleach later used to disinfect the canals. And it protected me in the unlikely event of there being any dropped instruments or files.
An unexpected further benefit of the rubber dam was that it made me feel it was not ‘me personally’ being worked on but rather ‘just my tooth.’
You may also use a soft bite block if you find it comfortable and easier on your jaw joint, but it is not compulsory. He offered me a soft bite block but it didn’t fit well, so I shook my head and he immediately removed it and I did just fine without.
At least 20 minutes had now passed.
Opening up the tooth
Next up was probably the most nerve-wracking moment for an RCT virgin! But I already trusted this guy from previous treatment, so I generously gave him the benefit of the doubt, when he informed me that he was now going to open up the tooth (by drilling into it with the handpiece in case you were still wondering!).
Before doing so, he reiterated that it was not supposed to hurt at all, and if I felt anything untoward, I must signal at once by raising my arm. He further reassured me that it was not a problem to top up the anaesthetic at any point.
So then came the noise and some vibration… after a couple of seconds, he stopped to check that I was indeed totally pain-free, I confirmed, and he gently continued. The level of vibration/pressure sensations was similar to that for a regular filling.
Cleaning the canals
For the next 90 minutes, he stayed totally calm and apparently happily absorbed in intricately working on my tooth. Some people may prefer more of a ‘running commentary’. Just ask if you do!
I couldn’t really see very much at all of what was going on unless I made a real effort to watch. This means if you don’t want to see, you can just relax and close your eyes, or, like me, alternate between staring at the ceiling and peeking at the proceedings. However, at one point, I was so relaxed that I found myself beginning to nod off.
Some of the time, it was noisy with the canals being explored using longish L-shaped pointed attachments to the handpiece. But most of the time, it was quiet with the assistant handing various tiny files to the dentist (he kept asking for particular numbers). He then either attached these files to the root canal system handpiece or more often than not used them by hand to carefully navigate the canals.
Occasionally, he asked me to adjust my head position slightly… just like at the hairdresser’s. There was quiet music playing in the background.
Some people (and I now agree despite having initially been sceptical) have reported that it is a more relaxing experience than a conventional filling, despite taking longer. The difference is, I think, the long periods of quiet, concentrated work.
At various stages, maybe three times per appointment, he took a digital x-ray to confirm progress.
At frequent intervals, I glimpsed a syringe-like nozzle (no needle) which was used to squirt bleach down the canals. The liquid was then suctioned back out.
This alternating process of exploration/shaping and disinfection was repeated endlessly it seems until suddenly the rubber dam was removed and I was all done!
Part 1 all done!
The time had passed surprisingly quickly, and I felt a bit euphoric knowing that the toothache had finally been banished. My jaw felt a bit stiff (understandably), and the local lasted ages longer before it wore off, which was fine by me. The tooth sported a temporary sedative filling and looked slightly open still.
I went away having been assured that the second appointment would be very similar, with more shaping and a substance called gutta-percha being placed as the final filling material, topped off with composite. He also told me that it would be wise to get the tooth crowned eventually, once we were sure the treatment had been a success.
Between appointments (2 weeks) I had slight soreness occasionally, almost as if the tooth/gum were bruised.
The second appointment
At the second appointment, despite the nerve having already been removed, I was numbed up. It really was painstaking work with no stress for me, except for having to keep my mouth open for so long.
The main difference was that he used the ‘plugger’ a lot more, since this was the stage when he gently pushed the gutta-percha cones down to the bottom of the canals – the goal was to have no gaps.
Towards the end, I could sense some heat coming off something inserted in my tooth – I think this was probably serving to melt the gutta-percha?
The last stage was doing the composite filling. He did this very thinly, in lots of separate layers, and used the usual curing light multiple times. Then he checked my bite on a strip of paper.
He advised me to take Nurofen for the jaw joint as soon as I got home. I did so, but I felt no need to take a second dose.
This root canal treatment was successful and I later had the tooth crowned. Teeth that have had root canal treatment are more brittle and a crown provides extra support and strength to the tooth, especially if it is a back tooth. Depending on how the amount of tooth structure that is left, it may also be possible to opt for an onlay or a three-quarter crown.
My endodontist experience
I subsequently had an old root canal, done in the early 1990s by a general dentist, re-treated at an endodontist. An endodontist is a root canal specialist. He also did a great job – again over 2 long appointments. The only real difference between him and my dentist was the use of an endodontic microscope at the first appointment and a general air of confidence as to likely success. He quoted an 85% success rate which apparently is high for a retreatment.
He told me that the only real downside of treatment was if a file were to break off in the lower portion of a tooth root, it might be hard or impossible to retrieve. However, he quickly followed this up by an assurance that it had been years since he’d had such an incident, so I probably shouldn’t lose any sleep over it.
I was also aware of the endodontist measuring the canals from time to time – he wore a special ring on his finger with a ruler scale on it. My dentist had used an electronic device instead.