How do I know whether I am suitable for root canal treatment?

The most important step in deciding whether root canal treatment (RCT) is appropriate is ensuring there is sufficient tooth structure remaining for the tooth to be strong enough to withstand chewing.

Some patients present with a tooth that is already extremely fragile, cracked/split or severely fractured, making the tooth very likely to break after the RCT is completed.

This is assessed by looking at the tooth, xrays and sometimes the tooth needs to have all previous dental materials (old fillings, crowns etc) and decay removed before a decision can be made.

RCT is successful (clearance of pain and symptoms) in 80-90% of cases, where the root of the tooth is not abscessed or infected.

If there is a long-standing infection at the root tip, RCT is only successful 70-80% of the time.

This is assessed by examining the tooth and gums, testing of the nerve (pulp) and xrays. After RCT, the tooth becomes extremely dry and brittle and is prone to fracture if left with just a large filling.

For back teeth (such as a premolar), a crown is usually needed to prevent the tooth from fracturing in such a way that makes it impossible to repair in the future.

Root canal treatment is NOT successful 100% of the time even if all parts of the procedure go as planned.

Therefore some teeth that have undergone this procedure will require the RCT to be re-done, root end surgery or might require extraction.

THERE IS NO DENTAL OR MEDICAL PROCEDURE THAT CAN BE GUARANTEED 100% SUCCESSFUL ALL OF THE TIME.

There are many factors that determine a successful RCT, including:

• The infection status of the tooth (which is why waiting until the toothache disappears may be a bad idea, because this usually transitions into a chronic infection that may be more resistant)
• The presence of a crown or protection from biting forces (RCT can be deemed a failure if the tooth fractures)
• Host factors (patient's medical history, immunity and oral hygiene).

In certain cases, proceeding with RCT MAY NOT be in your best interests because the tooth may be impossible to repair. In these cases, removal of the tooth and planning for an extraction may be more cost effective.

Even other methods of tooth replacement (bridges, implants or dentures) are susceptible to failure or complications.

My advice would be to choose the treatment option with complications that are acceptable to you and that you can afford the cost of addressing those complications.

This is a discussion that should be done frankly and openly with your dentist to ensure that you receive appropriate treatment and guidance for your particular case.

Root canal treatment has been proven to have a very high success rate.

Sometimes, it is the only way to save the tooth if the nerve is affected. It is always more natural and comfortable to bite and chew with your own tooth, which is why it's a popular treatment. This is compared to extracting and replacing it with other options, such as bridges, implants or dentures.

Having said that, as Dr Jaclyn has mentioned, a lot of times root canal treatment may fail due to non-favourable tooth condition, such as:

• Severe crack or fracture
• Tooth that has been extensively damaged by decay

Your dentist will be able to discuss with you on the viability of root canal treatment after doing a thorough investigation. This includes taking an xray of your tooth.

When it comes to deciding if root canal treatment is suitable for you, you need to factor in:

• Pre-existing medical conditions such as uncontrolled diabetes which would render extraction as a non-viable option
• Longevity (how long do you intend to keep the tooth). As much as root canal treatment can be successful, it is only an adjunct to prolong the lifespan of a tooth. Other factors need to be considered to predict the longevity, after completion of treatment.
• Financial. Post root canal treatment, your tooth is best complemented with a crown to prevent further fracturing of the tooth. So you may have to factor in the cost of root canal treatment, on top of the dental crown for the best results.
• Replacement options. Do you plan to replace the missing tooth if you have it extracted? Do options such as implant, bridge or denture sound like suitable options to you?

Hope it helps with your decision making.