You have been referred for endodontic treatment by your dentist who has deemed that performing your endodontic treatment requires specialist care. This may be due to medical issues, anticipated difficulties during treatment such as complex root canal anatomy, complex management required or upon your request.

If you are experiencing the following symptoms:

• pain from hot or cold foods
• pain on chewing
• throbbing, aching or shooting pain
• swelling in the area around a tooth or teeth

Endodontic treatment is likely to resolve your symptoms provided they are of tooth-related origin. Sometimes you may have no symptoms at all, which is why regular check up appointments are so important.

If you have suffered a traumatic injury to your tooth/teeth then it is important to see an Endodontist to assess the extent of the injury and any possible damage to the pulp or tooth to plan for any necessary treatment or further follow-up.

Endodontic treatment (root canal treatment) may become necessary when the pulp is inflamed or infected. There can be a variety of causes of pulpal inflammation or infection, the most common being decay (caries). However, other things such as extensive and repeated dental treatment or cracks in the tooth that allow bacteria to get into the pulp can cause pulpal disease. Knocks to the teeth or supporting tissues can also cause damage that may not be obvious but can cause problems. Left untreated, this pulpal inflammation or infection can cause pain or lead to an abscess.

Once the root canal infection and inflammation becomes more established, the pain becomes more deep seated and aching in nature, and may be worsened by chewing. The presence of swelling or a draining “bubble” in the area of the affected tooth may also indicate the development of a root canal infection.

The goal of endodontic treatment is to create an environment inside the tooth to allow the infection to heal and keep the tooth symptom free. We make this environment as sterile as possible by removing bacteria and infected tissue debris to the tip of the root. We then fill this space with an inert root filling material.

Root canal treatment aims to disinfect the root canal system, to allow healing of the surrounding tissues. This is achieved by the Endodontist carefully shaping, cleaning and then filling the root canals of the tooth. Once root canal treatment is completed, you will return to your dentist, for final restoration e.g. a crown to protect and restore it to full function. Once treatment is complete, the tooth is restored to normal function and continues to function like any other tooth. As such, you retain your natural tooth, for which often there is no substitute.

The success of endodontic treatment is very high and the anticipated prognosis for your individual tooth will be discussed with you at consultation with your Endodontist. Guaranteed success is impossible as everyone has different healing responses and some infections respond differently. Research studies have shown however, that the vast majority of endodontic treatments are successful and uneventful. If the Endodontist assesses your situation as unfavourable, this will be discussed with you and you will be advised of alternative options for treatment.

As we want to assess the response of your tooth to treatment, it is important for you to return for a check up even if your tooth is feeling completely comfortable.

Most teeth can be treated endodontically but occasionally, a tooth cannot be salvaged for the following reasons:

• the root canals are not accessible,
• the root is severely fractured,
• the tooth does not have adequate bone support, or
• the tooth cannot be restored.

Recent advances in endodontics are making it possible to save teeth at greater rates than ever before. When endodontic treatment is not effective, endodontic surgery may be able to save the tooth. If neither is recommended, other treatment options will be discussed with you.

A patient referred for a root canal is usually a patient experiencing discomfort and pain from an infected tooth. One of the first purposes of root canal treatment is to relieve pain caused by pulpal inflammation or infection. Using modern techniques, technology, specifically designed instruments and anaesthetics, most patients report they are completely relaxed and comfortable during treatment.

Your tooth may be tender for several days post treatment (and occasionally longer), particularly if you were experiencing pain prior to your treatment. This may be relieved with simple analgesics and your Endodontist will recommend an appropriate personalised pain management strategy for you. A small percentage of cases require antibiotics to be prescribed.

For some time after your endodontic treatment is completed, your tooth may continue to feel slightly different from your other teeth. However, if you experience ongoing pressure, severe pain, or swelling that lasts for more than a few days, please contact your Endodontist.

Infection of the root canal system involves bacterial colonisation and deterioration of pulpal tissue. Antibiotics work only when they can be carried by your bloodstream to the area of infection. When death of the pulpal tissues occurs from infection there is a subsequent lack of blood supply therefore preventing access of the antibiotics to the infected tissue. We need to physically get to the area where the bacteria are and that is what root canal treatment is all about. Endodontic treatment is required to remove infected tissue, bacteria and debris from the root canal system.

Antibiotics may actually mask the symptoms of your root canal infection and in general should not be used unless there is a diffuse swelling, fever or other systemic symptoms (i.e. you are feeling unwell), or if you require preventive antibiotic therapy prior to dental treatment for medical reasons.

Think of the analogy of building a house. Your Endodontist prepares the foundations of your tooth by treating the infected root canal system and fills the space in preparation for your dentist who ‘builds your house’; in this case the restoration of the crown of your tooth. Please discuss with your dentist the type of restoration most suited to your tooth.Will the tooth need any special care or additional treatment after endodontic treatment?

Until the tooth has had a protective restoration placed by your dentist, you should avoid biting on the treated tooth as much as possible. Without the protective restoration, the tooth may be at risk of fracture. Brushing, flossing and good oral hygiene are important and your treated tooth will require the same level of care as your other teeth.

Your Endodontist will need to see you again at a later stage to review your body's healing response to the treatment. Healing of the jaw bone can be slow and it is important to have regular review examinations so that we can take periodic radiographs to assess this healing. It often takes six to twelve months for considerable healing to occur that can be seen radiographically (x-ray).

Where dental injuries have occurred, the affected teeth/tissues may need to be reviewed more frequently so that any further intervention required may be provided in a timely manner.

New decay, trauma, cracks, or loose, cracked or broken fillings can cause re-infection and new disease in the tooth that has previously had root canal treatment. In some cases, there may be persistent infection within the tooth or diseases outside the tooth that are not able to be resolved with endodontic treatment alone. If pain, swelling or general discomfort reappears on the previously treated tooth, please contact your Endodontist for review.

It is always preferable to retain your natural tooth where a positive outcome is anticipated. The only alternative to endodontic treatment is to extract your tooth. If the tooth is not replaced with an artificial tooth, potential problems may arise such as:

• loss of supporting bone around the site of the extracted tooth;
• movement of surrounding teeth (adjacent and opposing) which may affect your "bite" and surrounding gum tissue;
• movements of teeth can predispose you to decay of other teeth;
• potential jaw joint problems;
• potential problems associated with the musculature of the jaw and oral cavity.

Replacement of your missing tooth can involve complex, time consuming and costly treatment.

Due to the great variations in presentation, complexity and treatment needs, it is impossible to accurately predict the cost of treatment prior to consultation. Consultation fees start from $100, plus $50 per radiograph (x-ray). Generally one or more radiographs are required to appropriately assess and diagnose your presenting concern.

Your first consultation appointment not only allows a thorough assessment to be made, but provides an opportunity for your Endodontist to discuss the proposed treatment, including what is involved, the expected number of visits and the estimated costs. We will provide you with an itemised treatment plan to allow you to check with your health fund.

Payment for your initial consultation, treatment or review is required on the day of your visit. For your convenience we offer a HICAPS facility for immediate, on-site processing of your heath fund claim. Our EFTPOS facilities accept VISA and MasterCard and our dental practice also accepts payment in the form of cash or cheque.