What should I bear in mind during root canal treatment?

The most important facts in brief 

• Definition: During a root canal treatment, a dentist removes the tooth nerve and fills the inside of the tooth with a special filling.
• Reasons: In most cases, deep caries that has led to inflammation of the tooth roots makes root canal treatment necessary. Periodontitis, accidents or the insertion of dentures can also be reasons.
• Advantages & disadvantages: With root canal treatment, an infected tooth can be saved and remain in the mouth - but it dies, which can cause damage to health.
• Procedure: First, the dentist drills a hole in the chewing surface and removes the caries, then he widens the root canals with special tools and removes the inflamed tissue. When everything is disinfected and germ-free, he fills the root canal and closes the tooth crown. As a rule, two to three sessions are necessary.
• After treatment: If pain persists after four days, you should visit the dentist again.
• Costs: The statutory health insurance only pays for root canal treatment for teeth that are classified as "worth preserving" and then only pays a subsidy of 300 euros on average.
• Alternatives: If you want to avoid root canal treatment, the tooth usually has to be extracted.

Root canal treatment: What is it?

Root canal treatment (technical term: root canal treatment) belongs to the specialist field of Endodontics, which deals with the inside of the tooth. It can be used when the pulp or root of the tooth is severely inflamed or already dead. The dentist removes the inflamed tooth nerve and fills the open tooth with a sterile material so that the tooth can be preserved and does not have to be extracted. In this way, the function of the tooth is often preserved for many years or even decades. In principle, root canal treatment can be performed on any tooth - both in the lower and upper jaw.

Reasons: When is root canal treatment necessary?

Why a root canal treatment becomes necessary can have various reasons. The most common cause is tooth decay. However, dentists often also perform root canal treatment after accidents in which part of the tooth has broken off to prevent the tooth from becoming infected. Advanced periodontitis or severe teeth grinding can also lead to inflammation of the inside of the tooth. 

Root canal treatment for caries

If a cavity has not been noticed and treated for a long time, it can penetrate through the outer layer of enamel and the dentin deep into the interior of the tooth and inflame the pulp. Here in the centre of the tooth run nerves and blood vessels that connect to the rest of the body via root canals. The inflammation of the pulp enlarges the blood vessels and presses on the nerves. The result: severe toothache. If the inflammation remains untreated, the pulp dies - and so does the whole tooth. 

If the caries-causing bacteria reach the tip of the root, the inflammation can spread to the jawbone and soft tissues and cause the typical "fat cheek" - in technical jargon this is called an abscess. This can even happen when the tooth or the nerve is already dead. In the worst case, the bacteria spread through the blood throughout the entire body - all the way to the heart and brain - and cause serious diseases such as heart valve inflammation. To prevent this, the bacteria are removed in the course of a root canal treatment. 

Symptoms of dental root inflammation

The following symptoms tell you that your tooth roots are inflamed and it's time to go to the dentist:

• Severe toothache
• Sensitivity to hot, cold, sweet and sour foods
• Tooth is sensitive to knocking and pressure
• Swelling with accumulation of pus (abscess)
• Biting pain

However, it is also possible for teeth to die painlessly.

Root canal treatment for dentures

Root canal treatments can also be used when placing dentures - for example, under a crown or under a bridge. If the remaining tooth is ground down so much for crowning that the pulp is partially or completely exposed, it is often removed completely as a precaution to prevent root infection. This is because bacteria could easily invade and quickly work their way to the roots of the tooth. This treatment is to ensure that the denture lasts longer. 

Root canal treatment: Yes or no?

The success rate of root canal treatment is generally very high if the inflammation only affects the tooth nerve and has not yet spread to the bones. Even in the latter case, however, root canal treatment can still be useful. Many teeth can still be preserved despite inflamed bones. However, root canal treatment can also involve some risks. Let's take a closer look at the advantages and disadvantages:

What are the advantages of root canal treatment?

The biggest advantage of root canal treatment is that the natural tooth is preserved and does not have to be extracted. It stands firmly in the jaw.

This has the following advantages:

• Visually no difference to remaining teeth
• No complex and expensive dentures necessary
• Tooth can act as a support for bridges or dentures

Risks & Complications

As root canal treatment is a complicated procedure, there is a certain risk that not everything will go smoothly and the treatment will not be successful. However, this is very rarely the case.

The following complications may occur:

• Renewed infections; insufficient cleaning necessitates renewed treatment (revision)
• Bleeding
• Pain
• Swellings
• Damage to the teeth
• Tooth loss
• Reversible dark tooth discolouration due to metabolic products or iron deposits
• Instruments can break off in the root canal
• Injuries to nerves, bones and muscles

Representatives of biological dentistry also point to negative after-effects on the immune system. After root canal treatment, the tooth is no longer connected to the rest of the body and is therefore biologically dead. Since a completely bacteria-proof closure is considered unrealisable, the remaining organic tissue decomposes and secretes harmful metabolic products (also called "corpse poison"). In this way, highly toxic and potentially carcinogenic substances such as thioether and mercaptan can enter the bloodstream, spread throughout the body and cause various diseases as late effects.  

Procedure: What happens during a root canal treatment?

You can have a root canal done by a dentist or by an endodontist who specialises in root canals. 

Following are the steps of the procedure:

Clarification

Your dentist will inform you about the possible risks and complications of the treatment in a consultation.

Anaesthesia

During root canal treatment, the tooth is usually anaesthetised locally. The root canal treatment itself is therefore usually performed without pain. If pain occurs despite the anaesthetic, you should tell the dentist immediately so that the anaesthetic can be adjusted. If the tooth nerve is already dead, the root canal treatment can also be carried out without anaesthetic, but this is not recommended because pain can still occur.

In addition to local anaesthesia, patients can be put into a twilight sleep. Some practices also offer root canal treatments under general anaesthesia for patients with anxiety. In this case, an anaesthetist controls the depth of the anaesthetic. 

Removal of caries and drilling

During root canal treatment, the dentist usually uses a rubber dam. This is a kind of cloth with a hole made of plastic or rubber that is attached to the tooth with a clamp. The rubber dam ensures that the tooth is separated from the saliva flow during the treatment and remains dry. 

In the first treatment step, the dentist removes the affected caries areas with a drill and gains access to the inflamed tooth nerve. To do this, he drills a centrally accessible hole in the occlusal surface. 

Cleaning the root canal system 

Next, the dentist cleans the root canal system, removing the infected tissue of the dental nerve with small files and very fine instruments. He enlarges the root canals and flushes them repeatedly with a disinfecting solution to kill all bacteria. A laser can also be used to clean the root canals. An electronic length measurement is also helpful.

Closing the root canal

When the inflammation has been completely removed and everything is disinfected, the dentist closes the root canal - usually with an antibacterial rubber-like material called gutta-percha. He then closes the crown of the tooth with a final filling or crown. The latter is custom-made by a dental technician in the dental laboratory. 

However, a root canal treatment is not always completed within one session. If several sessions are necessary because the inflammation is particularly stubborn, the dentist first places a medicinal insert - an ointment to kill the bacteria - inside the tooth and closes the crown with a temporary filling that remains in the tooth until the next appointment. 

X-rays 

Throughout the treatment, the dentist assesses the success using X-rays. The doctor can see how far the inflammation has spread, how long the roots of the teeth are and - finally - whether the filling fits properly. 

How long does a root canal treatment take?

How long the process takes varies from case to case and depends on a number of factors:

• Is this a first root canal treatment or a resection? (Resections take longer).
• How inflamed are the root canals? (The more severe the inflammation, the longer the treatment time).
• Which instruments are used?
• Which tooth is it? (Molar teeth last longer than incisors).
• What is the condition of the root canals? (Straight canals are easier to clean than curved ones). 

In most cases, the entire root canal treatment cannot be carried out in one session. The dentist decides how many sessions are necessary. Two to three sessions of 30 to 60 minutes each are common. 

What do I have to pay attention to after the root canal treatment?

As long as the anaesthetic is still working, you should not eat or drive. Smoking, coffee and black tea are also taboo for the first 24 hours after the treatment. You should also take it easy on the first day and not do any strenuous sport. You should also avoid alcohol for the first three days after the operation, as it has a blood-thinning effect and can delay healing. 

If you have had a temporary filling, you should avoid foods that can loosen your filling. This includes sticky and crunchy foods such as chewing gum, chewy sweets, corn on the cob, raw apples and carrots, but also hard bread.

To avoid swelling and bruising, you can cool the affected area. The duration of healing also varies from person to person. However, thorough and good oral hygiene is crucial.

Pain after root canal treatment: What to do?

Pain may occur after root canal treatment. This is called transitional pain. They are relatively common and normal, but should go away after a maximum of four days. Cooling can provide relief. If the pain is severe, you can also take over-the-counter medicines like paracetamol or ibuprofen. 

However, if the pain does not go away, you should visit your dentist as soon as possible and have the tooth checked. It may be necessary to have another treatment (revision) because the inside of the tooth has become inflamed again. Even years after root canal treatment, inflammation can reoccur and the tooth can hurt again.

Follow-up

About three to twelve months after the root canal treatment, you should go for a follow-up check-up. Your dentist will then take a new X-ray and check that everything has healed well.

What can I do to preserve my tooth after root canal treatment?

To ensure that the treated tooth lasts a long time and to protect the rest of your teeth, you should maintain thorough oral hygiene. 

Here we have summarised the most important pillars of dental care for you:

• Brush your teeth twice a day for about three minutes - in the morning after breakfast and in the evening before going to bed.
• Clean the interdental spaces daily with an interdental brush.
• Use a toothpaste with Fluoride to protect against tooth decay - for example the 'Be you' range from Curaprox  
• Also use a soft toothbrush for normal brushing to protect the gums - for example the CS 5460 from Curaprox.

Costs

A root canal treatment usually costs between 200 and 1,000 euros - depending on how complex it is and what techniques and instruments are used. You will usually receive a cost overview before the treatment.

If the tooth is sealed with a crown following the root canal treatment, this also incurs costs that can vary greatly depending on the type of material.

What does the health insurance pay?

In Germany, the statutory health insurance funds, such as AOK, TK, Barmer and DAK, usually only pay for root canal treatment if the tooth is classified as "worth preserving". Incisors and canines are considered "worthy of preservation" significantly more often than molars.

For molars, the health insurance will only cover the costs if one of the following applies:

• The tooth must not be in a row of teeth with a gap.
• Root canal treatment enables the preservation of dentures.
• Root canal treatment prevents the row of teeth from being shortened on one side.

In addition, the following applies: If the therapy has an "unclear prospect of success", the health insurance company will not pay either. Treatments are considered promising if it is actually foreseeable that the tooth can be preserved by the root canal treatment. This is the case if the root canals can be cleaned and filled up to or near the tip of the root.

If the health insurance company does not consider your tooth worthy of preservation, you have a choice: you can either have the root canal treatment carried out as a private service and pay for it yourself or have the tooth extracted. Of course, this does not apply if you have supplementary dental insurance. In that case, the root canal treatment is usually paid for in full by the insurance company - even for teeth that are not considered worthy of preservation. For privately insured persons, it depends on the respective tariff.

In the case of a revision, i.e. a renewed root canal treatment on a tooth that has already been treated, the costs are somewhat higher due to the increased time required. However, statutory health insurance companies only cover the costs of an unsuccessful root canal treatment in certain cases. According to the guidelines, an apicoectomy is recommended in such cases. This is a surgical procedure in which part of the root tip is removed. 

How much is my own contribution?

Even if the tooth is considered "worth preserving", the health insurance does not pay for the root canal treatment completely. There is a certain fixed allowance, which averages 300 euros for the statutory health insurance funds. Anything over this amount - up to 700 euros - must be paid by the patient. Supplementary dental insurance often covers the entire co-payment.

Special services

Your dentist may offer you special services that make the work easier or improve thoroughness, but they are not covered by the health insurance system. If you use these special services, you will have to pay the costs privately.

This includes the following services:

• Improvement of the disinfecting effect through ultrasound
• Electrometric tooth length measurement 
• Use of a surgical microscope
• Use of laser technology for bacteria reduction

What are the alternatives to root canal treatment?

As an alternative to root canal treatment, the statutory health insurance provides for tooth extraction - i.e. pulling the tooth. If the root canals are difficult to access, an apicoectomy may also be considered as an alternative.

Tooth extraction and implant placement

If you refuse root canal treatment because you don't want a dead tooth in your mouth, the dentist can extract the tooth and replace it with a ceramic implant. Thanks to modern technology, implants are nowadays tooth-coloured and visually inconspicuous. Let your dentist advise you which treatment is better for you.

Root apex resection

As a rule, apicoectomy is only used as a last measure to save the tooth if root treatment has not been successful. However, there are also cases where root canal treatment is technically not possible and the dentist directly suggests an apicoectomy - for example, if the root is too badly damaged, broken or has grown abnormally. Apicoectomies may also be necessary after complications with a conventional root canal treatment, for example if instruments in the root canal break and cannot be removed in any other way. 

Root apex resection is a surgical procedure in which the surgeon removes the root apex. The root tip is not accessed through a hole in the occlusal surface as in root canal treatment, but through the gum and jaw bone: The surgeon first cuts through the gum and periosteum and then removes the jawbone in the area of the root tip using bone cutters until the inflamed tissue is clearly visible. In order to also catch the fine branches of the root canal system, the surgeon usually shortens the root tip by about two to three millimetres. 

Often there is already a root canal filling from a previous root canal treatment. If not, the same procedure as for a root canal treatment now follows: widening of the canals, disinfection and filling. If access from the crown is not possible, the surgeon must work from the root. Then the surgeon carefully cleans the hollowed jawbone, folds back the gum and sutures it. Finally, an X-ray is taken for control. 

Therapeutic anaesthesia 

If the inflammation is not yet far advanced and still reversible, the alternative treatment method of healing anaesthesia can possibly prevent root canal treatment. However, this method is scientifically controversial because it does not work the same for every patient. In addition to anatomical and biochemical differences, the history of the respective tooth also determines the success of the treatment. 

The dentist injects a liquid anaesthetic enriched with nutrients into the affected tooth. This suppresses the pain and helps the tooth fight the inflammation. The treatment consists of up to three sessions, spaced two to three days apart. However, this treatment method is not suitable if the inflammation is already advanced.

Homeopathy

You cannot avoid root canal treatment with homeopathic remedies. Globuli & Co. are only considered as an accompanying measure during dental treatment. However, it has not been scientifically proven that they can relieve pain or inhibit inflammation. Since root infections, if left untreated, can lead to the death of the tooth nerve and can also spread to the jawbone, you should definitely go to the dentist and not rely on homeopathic remedies. If you want to use additional homeopathic remedies, you should talk to your dentist about it.   

FAQ: Frequently asked questions about root canal treatment

The topic of root canal treatment raises many questions. Here you will find answers to some of them: