Knowing What the Pulp Is
In the center of every tooth lies the pulp – a living tissue consisting of blood vessels and nerve fibers – which is encased in dentine and overlaid with enamel (the hard, white layer you see above the gums).
In a normal healthy tooth, the pulp is never seen and its presence is never felt.
However, when there is tooth decay present and left untreated, it will progress deeper and deeper into the dentine and will start to irritate the pulp and cause pulp inflammation. This manifests as great sensitivity or pain to cold and hot foods, and sometimes as an unbearable toothache. If the inflammation of the pulp is severe, it is usually irreversible – this means that even if the decay is cleaned up and a filling placed, your tooth will remain symptomatic and uncomfortable.
Eventually, the pulp will turn necrotic and die, and the sensation of pain will subside since there are no more live nerve fibers left. Some patients will think that their tooth has healed itself, but the truth is, the pulp has now turned putrid and an abscess will start to form at the root ends. Left untreated, this may lead to an infection and more pain.
Other causes of pulp inflammation are trauma, cracked tooth syndrome, severe erosion and severe gum disease.
Read more: Is a Cracked Tooth Treatable?
What is Root Canal Treatment?
In short, Root Canal Treatment (RCT) is the removal of damaged or infected pulp from the tooth. This process is important to eliminate the source of your toothache and to treat any infection caused by a dead pulp, thus preserving your tooth and avoiding an extraction.
As long as your tooth can be restored after the treatment, you can continue using it like a normal tooth for chewing and biting.
How is Root Canal Treatment Done?
Root Canal Treatment is normally completed in 2 separate visits. A single visit is only for selected cases where there is no infection present.
Firstly, your tooth will be numbed with some anaesthetic. An opening is then made to allow direct access into the pulp.
The damaged or infected pulp is then removed from the pulp chamber and root canals. After cleaning the root canals, some medication is placed inside to disinfect the canals. A temporary filling is usually placed in the tooth at the end of this visit.
During the second visit, the temporary filling is removed and the canals reaccessed. Further cleaning may be done, and the canals are then filled with a specialised root canal filling which seals up the canal to prevent reinfection.
The access hole is then filled with a permanent filling (also known as a core), and the root canal treatment is completed.
For teeth with pre-existing large cavities and molars, a crown is necessary for protecting the tooth from fractures and ensuring its longevity. Your dentist will advise you if a crown, as well as a post (for additional retention in severely broken-down teeth), is necessary after you have completed your root canal treatment.
Radiographs (X-Rays) will be taken before, during, and after your root canal to aid diagnosis and treatment.
How Long Can My Root Canal Treated Tooth Last?
Root Canal Treatment has been shown to be very successful, with one study of almost half a million cases demonstrating a survival rate of 98% at 1 year, 92% at 5 years, and 86% at 10 years1.
1: Burry JC, Stover S, Eichmiller F, Bhagavatula P. Outcomes of primary endodontic therapy provided by endodontic specialists compared with other providers. J Endod 2016;42:702–5.
The most common causes of root canal treatment failure would be recurrent decay resulting in leaking restorations and reinfection of the root canal, or vertical root fracture. With the exception of vertical root fracture, root canal retreatment is still possible which will further extend the lifespan of the tooth.
Is Root Canal Treatment Painful?
Although it sounds painful, a Root Canal Treatment is only carried out after local anaesthesia is achieved, which means the affected tooth will be completely numb prior to the start of the treatment.
The process itself is pretty much like having a filling done, minus the painful sensation. Once the numbness wears off, most will feel a lot better, but sometimes a small percentage of patient will feel some pain and discomfort due to the pre-existing inflammation which takes some time to subside. Painkillers are usually prescribed, while antibiotics are only necessary if the tooth has severe or profuse infection which has spread into the adjacent tissues.
Can I Use Medisave for Root Canal Treatment?
Although Root Canal Treatment seems like a complicated dental procedure, it is NOT a surgical procedure, and thus, Medisave cannot be utilised to pay for the treatment fees. However, if you have a CHAS Orange, CHAS Blue, Merdeka Generation or Pioneer Generation card, you will enjoy subsidies to offset the total cost of your completed Root Canal Treatment.
The table below shows the amount of subsidies available for root canal treatment, which will reduce the amount payable for your treatment:
For example, if the Root Canal Treatment for a Canine is $500, the amount payable after CHAS subsidies would be $336 if you hold a CHAS Blue card. Please note that the table above shows the subsidy amount for Root Canal Treatment only. For other dental treatment subsidies, please refer to the full CHAS Dental Subsidy Schedule here.
Why Can’t I Just Extract My Tooth and Replace it with an Implant instead of Doing Root Canal Treatment?
When comparing the outcome of Root Canal Treatment with dental implants, with the current evidence reporting a 90-95% success rate of implants at 10 years versus 86% survival rate of root canal treated teeth at 10 years, many will likely draw the conclusion that a dental implant is superior to root canal treatment. However, such a comparison is not objective as these numbers are derived from different parameters and use a different set of criteria to define a successful treatment. Root canal treatment is subjected to a much stricter criteria to be defined as a success, hence it is unsurprising that it should appear to be less successful than dental implants2.
2: Iqbal MK, Kim S. A review of factors influencing treatment planning decisions of single-tooth implants versus preserving natural teeth with nonsurgical endodontic therapy. J Endod. 2008 May;34(5):519-29. doi: 10.1016/j.joen.2008.01.002. PMID: 18436028.
Root canal treatment essentially extends the lifespan of your tooth and delays the need for an implant until much later. As such, placing an implant can still remain a treatment option should the root canal treatment fails in the future. Of course, if the tooth is very badly broken down, and the restorability as well as the longevity of the tooth is questionable, then perhaps opting for an extraction instead, followed by an implant replacement would be a prudent choice. On the other hand, if your tooth is still in good condition with the exception of a damaged pulp, you can expect to function with it for a significant amount of years after a Root Canal Treatment.