Root canal treatment

All teeth have a nerve cavity with one or more root canals. Within the dental profession, this is called the pulp. The pulp consists of nerve tissue and blood vessels. Due to various causes, the pulp can become inflamed and die. This can be due to trauma (a blow to a front tooth), for example, a deep cavity or a deep filling following a deep cavity in the past.

Several symptoms are possible:


The sensation after drinking cold water, for example, lasts longer than +/- 10 seconds: The nerve is not yet dead, but is dying. Root canal treatment is necessary to save the tooth or molar. Removal of the tooth or molar (extraction) is also possible. If left untreated, patients automatically enter the next stage. However, this can cause unnecessary suffering and a lower success rate of root canal treatment.

The tooth or molar is dead. If the nerve has been dead for some time, we can often see this on an x-ray as well. The nerve has died and the once living tissue enters a kind of decay phase (necrosis). Waste products from this necrotic process enter the bone through the root tip(s). An inflammatory reaction occurs at the root tip. When you tap the tooth/molar, it is often sensitive as a result. However, the immune cells can no longer enter the tooth or molar, since there are no longer any blood vessels present. So no matter how hard your immune cells try, they cannot really solve the problem. A certain balance between host and assailant can sometimes be achieved. In cases like this, a dead tooth or molar may have been present for a very long time without being noticed. This does not mean that it is wise to leave it as it is, of course. After all, who wants a chronic inflammation in the jawbone? So in addition, there is always a percentage of immune cells working to keep that inflammation in check. With weaker resistance, we often see that these types of teeth or molars can (again) start to cause complaints. In short, a dead tooth or molar always needs treatment: a root canal treatment or possibly an extraction (removal of tooth/molar).

What does the treatment involve?

  • Depending on the number of root canals present in the tooth/molar, treatment takes 45-120 minutes. In cases of acute pain and abscesses, it is often preferable to carry out the treatments in two sessions.
  • The tooth is isolated using a thin rubber patch (dental dam/rubber dam). This is so that no new bacteria are introduced into the root canal and the rinsing fluid is not accidentally swallowed.
  • A hole is drilled through the top of the tooth toward the nerve cavity.
  • The nerve remnants are removed and the nerve cavities are made slightly larger up to the root tips so that all the canal walls are properly reached. The area is always rinsed with disinfectant fluids between each stage.
  • The clean canals are then dried and filled with gutta-percha: a type of tree rubber. This is combined with cement.
  • The canal entrances are sealed using a leak-proof filling material and then a closing filling made of composite is applied.
  • A final x-ray is taken for later reference.
  • After 6-12 months, another x-ray is taken to see if everything around the root tips is healthy.
  • In case of the presence of a large filling (usually in the molars), a (partial) crown is recommended after this x-ray. Molars with large fillings and root canal treatments are so weakened that we often see them break in the years that follow. This often means the end of a molar. A crown completely encloses the molar, reducing the risk of breaking.