In 97-98% of cases, root canal treatment is completely painless. The aim of root canal therapy is to remove infected tissue in the root canals. The infection can be in a living tooth, a dead tooth or a tooth that has been root canaled in the past. The Ultracain DS Forte anaesthesia used in our practice is four times stronger than traditional Lidocaine, allowing us to achieve complete numbness during treatment.
The remaining 2-3% are cases where the patient comes to us in a massive, painful stage of pulpitis, often having already postponed the inevitable treatment for days. In such cases, the infection from deep caries is causing the tooth to become increasingly severe and massive in pain and inflammation. In these exacerbated situations, the massive nature of the inflammation may make the opening of the tooth painful, but this will be short-lived. Double anaesthesia can often eliminate this pain. In some cases, the pain may be so severe that it prevents immediate root canal treatment, in which case root canal treatment can be started after other pre-treatment with medication, when the tooth can be safely accessed.
Once again, it is important to stress that the tooth to be root canaled can be perfectly anaesthetised in 97-98% of cases, so root canal treatment is not painful!
There are several phases of tooth root inflammation:
1. Reversible pulpitis, i.e. reversible periodontitis. Symptoms. Spontaneous pain is rare, with no particular pain for a short night. What to do: see a dentist immediately! In many cases, this type of cavity inflammation can still be reversed and root canal treatment can be avoided. Read more here: Biodentine treatment - tooth preservation
2 Irreversible pulpitis, or irreversible gingivitis. In this case, the tooth hurts spontaneously, not only on stimulation. The pain is so severe that it is often impossible to tell which tooth is hurting. The pain is worse in the evening and the person cannot sleep at night. Typically, painkillers do not work. Action: see a dentist as soon as possible, the tooth should be root canal treated. The first step of treatment, opening the tooth, can be painful even with anaesthetic. It is often necessary to administer a double dose of anaesthetic, or anaesthetic given directly into the tooth at the beginning of the treatment. After the first painful step, however, the tooth is well managed and the pain is easily relieved. As the infection has not yet spread beyond the tip of the root, the chances of successful treatment are very high - 97-98% tooth survival!
3. In these cases, it is no longer the nerve that is inflamed, but the tissue around the tooth. This can take many different forms, from no symptoms at all to inflammation that causes enormous pain. The most common symptom is sudden pain when the tooth is hot or warm, and pain when the tooth is touched or bitten. As if the tooth has become protruded or enlarged. There may also be swelling around the tooth. Action to take: see a dentist as soon as possible. Treatment: root canal treatment. The tooth can be well anaesthetised and pain is not expected during treatment. Depending on how long the infection in the tooth has been present and how far it has spread beyond the root tip of the tooth, success and survival may be reduced.
4. A chronic process with a small, purulent pustule near the tooth, which occasionally discharges a purulent secretion. In this case the chronic infection has been present for some time, the pus finding its way to the gums. It is rarely painful but can become painful if the small opening becomes blocked. What to do: root canal treatment.
Root canal treatment is the last attempt to save a tooth instead of extracting it. So it is not a good solution, but may be a necessary solution instead of tooth removal.
The best solution is to prevent it. Primarily by a thorough oral hygiene protocol at home and dental check-ups every six months or at least once a year, where we can catch incipient decay early enough, which if neglected, can lead to deep decay and its complications.
IMPORTANT! A tooth that is aching can often be saved from root canal treatment if it is done in time! You should not drift and wait, but see an expert dentist as soon as possible! This way there is a chance to avoid root canal treatment, which can save you time, money, energy and even teeth!
When it comes to deciding whether to extract a tooth or have it root canaled, the following points should be considered:
- How deeply are we fighting for the tooth? The dentist is not enough! Two people are fighting for the tooth together, the patient from the inside and the dentist from the outside.
- How much time, money and energy do we want to spend on this tooth? Do we have it in us that root canal treatment is a risky choice, because there is no dentist, no science that can save a tooth 100% by root canal treatment! Can we believe in it, take a risk, be positive about it?
- If we have the inner will and determination to save the tooth, the question is: what state is the tooth in? Is it possible to rebuild the crown after the root canal so that it is perfect both functionally and aesthetically? It is possible to treat the root perfectly, but there is not enough crown area to build a normal tooth that will last for a long time. In this case, tooth extraction may be a better option!
- It's worth asking your dentist's opinion about how the periodontium is, is it diseased too? What are the chances of the tooth.
- If the chances are good and the internal decision is made, the next question is whether to choose a basic or a premium root canal. Modern root canal treatment is now possible with an operating microscope, which can be more successful, but is more expensive and takes longer than one session (a microscopic treatment takes about 1.5-2 hours!).
But even if you opt for a traditional, free-angle root canal, it is still worth choosing a specialist who works according to the modern concept of root canal treatment: root canal treatment in cofferdam isolation and chemo-mechanical treatment with modern disinfectant solutions.
The aim of root canal therapy is to clean out the internal root canals of the tooth, completely removing the tissue, debris and bacteria in them and disinfecting the canal system. During the treatment, the root canal needles must reach the tip of the root to ensure complete disinfection. However, the root tip is already living tissue, periosteum, with many sensitive nerve endings. So the tooth is dead, there is no nerve in it, but there may still be inflammation around the root tip, which can cause pain. In some cases, a chronic, gnarled dead tooth may be completely free of symptoms and then become temporarily painful during the root canal. This temporary pain does not mean that the treatment has failed, it is a normal phenomenon associated with the treatment, it is easily treated with painkillers and usually resolves in a few days.
There may be a supernumerary root canal in the tooth that was not explored during treatment. In such cases, there may be an inflamed part of the root canal that is still inflamed and causing pain. If this is suspected, the diagnosis may be confirmed by 3 D CBCT or a microscopic root canal exploration may be necessary to reveal the supernumerary canal.
Pain that flares up after treatment during the root canal treatment does not mean that the treatment has failed, it can be a normal part of the treatment. It can be treated well with basic painkillers, for example painkillers containing Diclofenac are best in this case, but Algopyrin is also effective. It is not exactly the tooth that hurts, but rather the root canal surrounding the tooth root, which is a very sensitive tissue structure with nerve fibres. On the one hand, the treatment can trigger a long-standing chronic inflammation that has caused little or no complaints, and on the other hand, the treatment, the root canal needles and the rinsing and disinfecting liquid are intended to reach the root apex, where they can temporarily sensitise the tissue around the root apex.
It is important to feel whether or not the pain tends to decrease within a day or two. The former is normal, nothing to worry about. However, if the pain gets worse, it is definitely worth making an extra appointment with your dentist!
Inflammation of the tooth root is most often caused by long-standing, deep caries and less often by other trauma. Caries is essentially an infection in the tooth. If it were on our arm or the tip of our nose, we would eliminate it in seconds, not let it rot away. Unfortunately, in the closed dentition, most people are more permissive, not taking seriously the need to clean every floss as cleanly as the face or armpits. So plaque hiding in the interdental spaces can trigger decay in the tooth. Deep decay can cause bacteria to flow into the pulp, the tissue of the tooth. The first stage of inflammation is pulpitis, or gingivitis. There are two basic forms: reversible and irreversible pulpitis.
In reversible pulpitis, the symptoms are painful (sharp shooting pain on cold or sweet) but last only as long as the stimulus, such as cold, lasts, after which the pain quickly subsides. It is worth visiting the dentist while this condition persists, because in the hands of the right professional, it can be reversed, and with special medication fillings, the tooth can be saved from root canal treatment. See Biodentine treatment, tooth preservation.
Non-reversible pulpitis can only be treated with root canal therapy, but in this case the conditions for root canal therapy and thus the chances of keeping the tooth are very good. The success rate of root canal treatment and the chance of tooth survival is about 98%! True, this is a very painful condition that is difficult to achieve under anaesthesia. However, double anaesthesia with Ultracain DS Forte anaesthetic and an experienced dentist can manage this pain in a good number of cases, so the treatment can also be done painlessly.
In the following conditions the tooth tissue is already dead. So it is not the root that is inflamed, but the tissue surrounding the tooth. Here there are several phases, depending on whether the infection in the tooth is still within the root canal or has already spread beyond the root apex, where complications such as cysts or granulomas are already occurring in the root canal tissue. In such cases, the root canal treatment of the tooth will certainly no longer be painful. However, the success of root canal treatment is decreasing due to the long duration of the infection, since the bacteria have had plenty of time to form a biofilm, a bacterial colony, in the tissues outside the tooth, which is the aim of root canal treatment, but often a difficult task to remove.
After root canal treatment, the symptoms usually subside quickly, but painkillers may still be needed for the first hour or two. In this case, traditional painkillers such as Algoflex forte, Algopyrin or Diclofenac are already effective.
After the root canal treatment, a temporary filling is most often placed in the tooth, so that you cannot chew for a few hours, but you can then use the tooth normally. Biting directly on excessively hard foods is not recommended until the root canal is complete and some kind of protective covering is placed on the crown of the tooth to protect it from cracking.
The point is, notice the decreasing intensity of the pain, whether it persists or recurs, or possibly increases again. It's part of the normal process if it still hurts for a while, but slowly starts to decrease. Root canal treatment is rarely a one-session process, there will probably be no pain after the next session and the treatment can be completed successfully.
However, if the pain persists, does not go away, or perhaps increases again, it is worth visiting the dentist before the next scheduled root canal session. In some cases, antibiotics may be prescribed, or the root canals may need to be re-flushed with disinfectant and sealed with medication.
Complications during root canal treatment are prevented by careful planning, but there may be unforeseen events that reduce the chances of a successful root canal treatment.
How can root canal treatment be carefully planned?
In addition to an oral examination and basic radiographs, careful planning may require the evaluation of a 3-Dimensional CBCT scan. The 3-D scan allows the specialist to better assess the anatomy of the root canal system, so that he or she can be better prepared to treat curvatures, strictures and branching.
Typically, a normal complication is a flare-up of pain after treatment:
Phonix, or flare-ups of pain, can be a normal part of the treatment and does not mean that it has failed. In most cases, it can occur during root canal treatment of chronic, long-standing teeth that have been free of symptoms and complaints. Chronic inflammation that has been blocked until then may flare up acutely as a result of the treatment, causing pain after treatment. The pain passes quickly and is well controlled with normal analgesics
Why are supernumerary root canals a complication?
Supra-numerary root canals are usually thinner and their opening is barely noticeable. The detection of such ducts by free visual inspection occurs in only 15-20% of cases. Microscopic root canal treatment also helps to detect and treat these root canals. It is more common in upper sixth teeth that, despite a thorough root canal treatment, the inflammation on the tooth recurs. In many cases, a 3 D CBCT analysis will help to identify whether infection remaining in the supernumerary canal is causing the inflammation. In such cases, microscopic root canal treatment may be necessary.
What about curved ducts?
Treatment of excessively curved root canals is difficult because there is a maximum flexibility of the root canal needles. Sometimes it is not possible to 'get the bend' right and therefore the root canal cannot be flushed to the root tip. Unfortunately, this usually means unsuccessful root canal treatment. The other complication is the breakage of the rooting needle into the curved canal. Since it is a medical instrument, this is not necessarily a problem, as it can actually act as a root canal. However, this is only the case if the needle breakage occurred during a phase of the treatment when the root canal was already flushed with disinfectant.
Unfavourable complication: fracture or crack of a root canal tooth
Unfortunately, this happens in many cases, as in most cases the root canal tooth is already deeply decayed, i.e. much of the intact tooth material is already lost, and the tooth must be drilled further during the root canal treatment to allow the canals to be explored. In order to avoid root cracking and fracture, root canal treatment should be started with a buccal reduction, which temporarily "takes the tooth out of the bite" for the duration of the treatment. Once the root canal treatment is complete, the cusps are covered with a filling, filling or crown to protect the tooth from fracture. Unfortunately, if the tooth breaks during or after root canal treatment, it is often no longer possible to save the tooth. If the crack is longitudinal, certainly not, if it is transverse, it might.
Pain after root canal treatment can normally accompany the treatment, it does not mean that it has failed. More precisely, it is not the tooth that hurts, since there is no nerve in it, but the root, especially the inflammation of the periosteum containing the sensitive nerve tissue around the root apex. It is most common when treating a chronic tooth that has been inflamed for a long time but has no symptoms. The treatment reaches the previously blocked, chronically inflamed tissues and the inflammation progresses to an acute phase, which is associated with pain. This type of flare-up of pain goes away in a few days and is well controlled with basic painkillers.
If the pain persists for more than 2-3 days after treatment, it is worth visiting the dentist before the next swimming session, as further treatment may be necessary. There may be an unexplored number of supra-root canals, or it may be necessary to re-rinse the root canals with a disinfectant.
No! You should only have a tooth root canal if it is irreversible, i.e. irreversible periodontitis, or if the tooth is already dead. In such cases, there is no other solution, if you want to save the tooth, you have to root treat it. In some cases, however, the tooth pain may be caused by reversible, i.e. irreversible, inflammation of the tooth. This is a type of pain that occurs mainly in response to a stimulus (e.g. cold ice cream or sweets) and rarely or only for a short time. It does not occur at night, but rather during the day.
In this case, if the patient does not choose to drift away but takes action and visits the dentist, root canal treatment can often be avoided. In cases of deep caries, even when the caries has reached the pulp tissue, the pulp tissue can be regenerated if vital pulp therapy is applied in time. Attention! Vital Pulp Strategy and Therapy is a new science, not all practices have the necessary expertise and technical background! It is applied in Budapest Dental Clinic since 2021 and requires a minimum of loupe magnification, and even more microscopic magnification. The treatment is carried out with Biodentine or MTA cements, which are able to heal the sensitive dental nerve tissue. Biodentine treatment for tooth retention
Root canal treatment is often considered worse than tooth extraction, even though it is just as painless as other dental treatments. We use Ultracain DS Forte anaesthetic, which numbs 4 times more than traditional Lidocaine.
While a few years ago only 2-dimensional X-rays were available to examine the roots of teeth, today CBCT technology allows teeth to be examined in 3-dimensions. Many more cases of inflammation, nodules or other problems can be detected, making the diagnosis more accurate.
Success is still not 100%, but the number of teeth saved is increasing! We have no control over the anatomy of the roots. The curved canals have not straightened out, but we have much better instruments, better diagnosis, different treatment and disinfection, so better results.
Infection inside the tooth
Tooth decay causes bacteria to enter the tooth, and if not treated in time, the infection can reach the inside of the tooth and the nerve. The tissues inside the closed space of the tooth quickly become infected, first the inside of the tooth and then, over time, the inflammation spreads beyond the root.
Cyst, or inflammation in the bone
By the time the infection spreads beyond the tooth root and into the bone, the tooth is already dead. Its lining and canals are now filled with bacteria and dead tissue. At this point, the tooth may no longer hurt, but at other times it can become very painful when bitten on.
A new kind of disinfection protocol
Micro CT scans have revealed that even with the best and latest root canal treatment procedures, it is impossible to mechanically treat all surfaces of the root canals that have been excavated, i.e. with root canal needles. Disinfection procedures have therefore been introduced that can disinfect the canals even if the mechanical treatment is imperfect.
More successful root canal treatments
In our clinic, in addition to cofferdam isolation, we disinfect according to strict rules using the latest disinfection protocols, ultrasonic technology and endo-activators, so that root canal treatments are more successful!
Inflammation in the bone
An infection inside the tooth, i.e. bacteria and their toxins that can reach the bone tissue surrounding the tooth without treatment. If our immune system is working well, trying to shut down the process here, a cyst or granuloma forms at the end of the root tip.
Cyst or inflammation in the bone
Although all root tip inflammation is potentially considered a dental nodule, not every cyst or granuloma is definitely a dental nodule, nor does it cause a nodular disease. Nevertheless, their screening and treatment is an important task for the root canal dentist.
With a magnification of 12.5x compared to the free-eye, the operating microscope allows much finer details inside the tooth to be seen. This enables precise root canal treatment that was previously unattainable. Microscopic root canal treatment therefore achieves a much higher success rate in root canal treatment.
Electric root canal scoring, memory metals, lasers, spark-erosion root canal needles, anti-squeeze root canal dilation machines... our practice has all the modern root canal equipment at the disposal of our specialists for more successful root canal treatments.
During the health check, a panoramic X-ray is taken after an oral examination. If a tooth is painful, it is likely to require root canal treatment, in which case a small intraoral X-ray is also taken, as this allows a more detailed diagnosis.
In some cases, further examination of the tooth may be necessary if the two-dimensional image does not give a definite answer. In this case, a high-resolution, sharp, CT scan of the tooth is taken, showing all canals, curvatures and any inflammation in 3 dimensions.
If the prognosis of the tooth cannot be accurately estimated even after these tests, a microscopic examination may be requested. An operating microscope with a magnification of up to 12.5 times can be used to see cracks more accurately and give a more reliable prognosis.
Having the right diagnostic tools helps us to give you a much more reliable prognosis for your tooth. The treatment plan outlines the alternatives, the steps of root canal treatment and the cost of treatment.
In our clinic we use Ultracain DS Forte anaesthetic, which is 4 times more anaesthetic than traditional Lidocaine and the treatment is painless. Our doctors use the latest root canal treatment protocols.
Root canal treatment is the last attempt to save a tooth. Even with the most modern tools, 100% is not achieved, but the success rate is over 90%. A root canal is successful if it is symptom and complaint free 4 years after treatment.