Why do teeth develop dental nerve problems?

It is common for teeth to develop dental nerve problems, this may be because of tooth decay, dental trauma or because a tooth develops a fracture line. Heavily repaired teeth, teeth with crowns especially teeth that support bridgework are all likely to develop dental nerve problems.

What is a root filling?

Root fillings help us save teeth that otherwise need to be removed. It involves cleaning and shaping the space or root canal where the problem dental nerve resides within a tooth. This space is often medicated for 2 weeks. Then at a second visit the root is filled with rubber (Gutta Percha) and this is the root filling. The aim of root fillings are the enable healing and the teeth are often comfortable within 24 hours of the start of treatment.

Is it going to be painful?

It is a myth that having a root filling is a painful dental procedure. They are often a very comfortable procedure with a local anaesthetic (you stay awake).

How successful are root fillings?

This treatment is extremely successful at our clinic which is a referral centre for root fillings and adult restorative dentistry. To put this in perspective at this clinic root fillings for recent dental nerve infections have been 100% successful at 5 years.

Teeth that have had long term infections (6 to 18 months duration) have a 95% success rate at 5 years.

Scientific studies in dental journals give success rates of approximately 75%.

Why did my dentist recommend a referral for a root filling?

Good dentists will recommend referrals for difficult treatment when it is in your best interest as their patient. Root fillings are technically demanding treatment. Many general dentists will do root fillings but will often identifying teeth that are difficult to treat and recommend patients accept a referral to a dentist or endodontist who has undertaken addition dental training and is equipped to treat the more difficult cases successfully. Dr Smyth has accepted referrals since 1999 and has many years of experience carrying out complex dental procedures.

Why can’t my dentist do this?

The chances are your dentist has recommended a referral because they identified that it was a difficult root filling case and that the success rate will therefore be much higher if your tooth is root filled by an experienced operator using specialist equipment including the massive advantage a clinical microscope imparts when finding and cleaning minute root canals which is after all microsurgery.

I have been told I need a root filling so why is another consultation necessary?

Occasionally we read your dentists referral letter and review the x-ray pictures they send to us and we are both in agreement that it is a straight forward case and no formal consultation is necessary – in this situation we will try to go straight to treatment. Dental care at a private clinic is expensive, you do get what you pay for but if we can save patients some money we are happy to do so because we appreciate for most people every little helps!

However by the very nature our clinic most of the patients referred to us have problem teeth at are intermediate/advanced complexity to root fill and Dr Smyth requires an opportunity to meet with you to examine your dentition, carry out tests, discuss your treatment options so you can come to an informed decision about your dental care.

Some patients need a little time after the consultation appointment to reach a decision before they proceed with treatment. We will give you enough information to help you make good decisions about your dental care.  On request we are happy to indicate what we would do if it was us in the dental chair! Dr Smyth’s consultation fee is £125 and this includes any necessary x-ray pictures which makes this excellent value.

Why do you want to look at x-ray pictures of my tooth?

X-ray pictures help identify dental problems such as:

• Infected dental nerves
• Tooth decay (dental caries)
• Gum disease
• Leaking crowns and fillings

They are like a road map of the root canals inside the tooth and help Dr Smyth locate root canals and check that the root filling is perfect before sealing the completed root filling.

How many times will I need to attend?

About two or three times:

• A consultation visit (this may be combined with a treatment visit)
• Usually two treatment visits, very occasionally three

What happens at the first treatment visit?

A local anaesthetic is used to numb teeth prior to treatment. A small rubber sheet (rubber dam) is placed over the tooth. An opening is made through the top of the tooth and the canals inside are carefully cleaned and shaped. A medicinal dressing is sealed into the tooth with a filling material and this continues to clean the root canals between visits. This is the end of treatment visit one and another appointment is scheduled in about 2 weeks time.

….and the second treatment visit?

Once again local anaesthetic, the space inside the tooth is filled with a rubber root filling. We recognise the importance of sealing the tooth immediately after the root filings are completed and you are routinely advised to have molar and premolar teeth built up with a special silver filling called an amalgam dowel.

When a root filling is complete on a molar or premolar tooth the next stage is often to return to your general dentist to have a crown constructed in order to cover and strengthen the tooth and to help it last for a long time.

The advantage of root fillings

There are many benefits of keeping your teeth with root fillings, after all the alternative to having teeth root filled is to have them removed. Keeping teeth helps you:

• Eat healthy foods
• Speak and smile with confidence

Keeping a tooth in your dental arches prevents the adjacent natural teeth from tipping over or over-erupting which can often cause problems in the future.

The disadvantages of root fillings

Root fillings are time consuming and expensive dental procedures, often additional dental work is required to restore the tooth to its original shape. As with any procedure there is a very small risk that the treatment may not work.

What’s your opinion?

In our opinion the benefits of root filling teeth well outweigh the risks.

My tooth has dental nerve problem what are my options?

The general treatment options are as follows:

1. A root filling, followed by a foundation filling and possibly a crown
2. Do nothing and the problem will remain with the risk of pain, infection, swelling, the loss of the tooth and spread of infection, this is unsatisfactory
3. Have the problem tooth removed
4. If a tooth is very badly damaged it may be necessary to investigate the tooth – remove fillings/crowns/tooth decay in order to assess it before attempting a root filling

I have had a root filling in the past and it didn’t work – why?

Root fillings can fail because there is bad bacteria established in the jaw bone outside the root canal region out of reach of the cleaning that takes place during a normal root filling procedure.

How do you re-treat the tooth?

This takes a bit more time because the old root filling material needs to be removed. A solvent is used to soften and remove rubber root fillings. The success rate of these teeth is very slightly lower than teeth that have never been root filled before.

What happens if a root filling is not a success?

In the unlikely event that a root filled tooth did not settle after conventional treatment then the options are to have the tooth removed, or to consider surgical procedures to attempt to repair the root tip e.g. an apicectomy.

I am anxious about dental procedures what should I do?

Many people worry about  dental procedures, a good explanation about what is going to take place often helps set people’s mind at rest. We offer a free simple sedation to patients who are concerned about having dental treatment – it is very good and helps to dramatically reduce your anxiety levels (you stay awake).

Will I be comfortable during treatment?

During treatment you are always in control, if you need to stop the procedure for any reason simply raise your hand and we will stop and make sure you are comfortable. Often there are natural breaks in the procedure so you can sit up, go to the bathroom or simply stand up for a stretch. We have a pillow for your head and a blanket if you get a bit cold in our air-conditioned room.

Why does my tooth need a foundation restoration?

Root filled teeth are a bit like empty cardboard boxes, if you stood on them they would simply collapse. We often recommend silver fillings called amalgam dowels (Nayyar cores), these strengthen teeth and build them up ready for crowns.

After treatment is completed what happens?

Once every case is complete a letter report describing my findings and what treatment was carried out is sent to your dentist with a copy of the x-ray picture of your completed root filling.

I have been told my tooth needs a crown – why?

In many cases back teeth that are root filled benefit from the strength that crowns impart in order to protect them from fracture. Often teeth that need root fillings are badly broken down and a crown will make the tooth the right shape for appearance and function.

Got more questions? If you have any questions please email them to us via our contact form or call Hannah on 0151 423 1601