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