Root Canal Therapy or Endodontics at Seven Fields, Swindon

An Introduction to Your Root Canal Services in Swindon
Root canal, or endodontics is the branch of dentistry which involves treating the nerve which is found inside the tooth. Your nerve can become damaged as a result of injury, or it can become infected through the bacteria in decay reaching the chamber in which the nerve is located.
If left, you can experience pain, swelling, or loose the tooth, and to prevent this you need the skills of an endodontist.
Massimo Giovarruscio has a root canal clinic in Rome, and is a member of the Italian Endodontic Society. We consider ourselves very luck to have his phenomenal root canal skills in Swindon.
In order to focus his talents, Massimo limits his dentistry to providing only root canal treatments. In addition to providing our root canal for you at Seven Fields, Massimo also provides a referral service for root canal for other Swindon and Wiltshire dentists.

To help you to get the best result, we have all the latest specialist root canal equipment and materials. You will also have a set of new root canal instruments, which are used on your tooth and then discarded. Although the Department of Heath suggests this to decrease the risk of vCJD, this single use has been shown to basically remove the risk of fractured instruments in your tooth. Indeed, with over 1000 canals root treated by Massimo in Swindon, he has yet to leave a fractured instrument in a tooth.

Root Canal Services at Seven Fields Dental Health Centre
With the experience of Massimo’s root canal skills, we can offer the complete range of root canal treatments here in Swindon. You can look at the examples page to see more details or the FAQ or Education pages for more details

Initial Treatment
With root canal treatment we often use instruments approaching the diameter of a human hair, and we have to coax them down a fine canal. Done properly it carries a very high rate of success. If someone has already tried unsuccessfully to clean the canal they can actually make it more difficult. For this reason it is best to get the best result first time.
The dental studies now show that dentists who concentrate solely on root canal do obtain a higher success rate.

Re-Treatment
The assessment of the root canals of a tooth can be an inexact science, and often dentists will find that the tooth was trickier than it first appeared. If teeth have been leaking, or if they were treated many years ago with older techniques they can also need re-treatment.

Instrument Removal
The canals of teeth are very delicate, and can also be curved. This can contribute to instruments breaking. By using the skills acquired during his extensive post-graduate training, Massimo can usually remove these instruments, or alternatively negotiate past them, and save the tooth.

Apicectomy
This is a surgical procedure which we can resort to. As supported by the latest science, we prefer to use conventional techniques when possible. An apicectomy involves a small ‘nick’ in the gum, and the removal of the tip of the tooth, and infection. The tooth is then sealed from the tip.
Of interest, it has now been shown that the best success rates are achieved when it is performed by a trained Endodontist, and that the use of a microscope, and the availability of specialist root canal equipment, such as ultra-sonics also make a significant difference.

MTA Use in Root Canal
There are times, typically when the end of the tooth is very wide open, of the floor of the tooth, or root have been damaged, that we can use a material called MTA to repair damage that would previously have led to the tooth being removed.

Non-Vital Bleaching
Often, during the process of dieing, the teeth can become darkened. In the past these teeth needed to be cut down for a crown, or a veneer. We can use a technique to actually return the tooth to the original colour. Done incorrectly it can damage the root of the tooth, and so while Massimo is happy to use this technique, he typically will only do so when he personally has root treated the tooth.

Root resection
There are times one root of a tooth will not respond to treatment, or the root has already been damaged beyond repair. In these cases, where we have a multi-rooted tooth, we can often simply remove the offending root, and save the tooth. In the correct situation, this process can offer the same prognosis as an implant. We also frequently use this technique in conjunction with our gum or periodontal specialist.

Root Canal Education
Because root canal treatments, or Endodontics is less common than simple fillings, and because it takes place inside the tooth, out of site, it is less well understood. This means that it is one of the treatments in dentistry which has traditionally instilled fear and dread among patients. Many of our patients actually fall asleep as there is very little to disturb them, and our chair was picked for its comfort.

So what does root canal involve?

Assessing and Isolating
Your tooth is assessed, usually done both visually and by dental x-rays, and you are numbed up to ensure comfort. We use a technique called rubber dam, or dental dam, which helps stop water going down the back of your throat, and also helps stop bacteria going down the tooth. Although the rubber dam may seem strange at first, the vast majority of patients prefer it.

This photograph shows the tooth poking through the rubber dam.

This x-ray shows a tooth with a large filling in it. It can often be that the nerve of a tooth either gives troubles immediately after a filling is placed, or several years later, as was the case here.

There is then some work to clean the top of the tooth, and locate the fine canals. For this we use high power magnification, as the canals can initially be just hundredths of a millimeter in diameter.

This shows Massimo working under the high powered magnification provided by a microscope.

Cleaning and Shaping
This stage is very much like the hygienist polishing the outside of your tooth, except it is done on the inside.
The canals themselves are shaped to allow us to remove any debris and bacteria. Another very important aspect is that the canals are rinsed with a bleach to remove any bugs or debris which would otherwise cause problems.
During this process we confirm the length of the tooth. For this we will use a combination of x-rays and a specialist root canal device which helps us to be accurate to within 1/10th of a millimeter.

This shows the tooth, after shaping, and with a trial fitting of the root filling material

Filling the Root Canal System
Once we are happy that the shape of the tooth is good, we can fill the root canal system. We use a rubber based material for this. Using a combination of precision pre-formed materials, heat compaction and more specialist root canal instruments, we fill the canal system, and obtain an x-ray to allow us to both check the final filling and to serve as a base-line for us to monitor.

This shows the same tooth once we have filled it. The arrow shows where the combination techniques even manages to fill what we call an accessory canal. This level of detail helps us achieve the highest success rates possible, currently close to 100%

After the Root Canal
The most common finding afterwards is that there is no difference to a routine filling. Sometimes it might be necessary to take a couple of pain-killers. Sometimes infections can temporarily recur, and we may need to give anti-biotics, but typically this is less than 10% of the time.
It has also been shown that for the back teeth in particular, the long term success can be improved by placing a crown on top of this. Your dentist, either here or Seven Fields or at your own practice, if you have been referred, can advise you about this.

Frequently Asked Questions

Why do I need root canal?
There are several reasons for root canal. The over-riding reason is that the nerve in the centre of the tooth is either giving problems, or as a result of dental treatment needed, it might give problems.

Extensive decay
With tooth decay there is a layer of bacteria which penetrates further than the actual destruction. Once the decay is near the nerve there will be bacteria contaminating the nerve. This causes inflammation, and pressure builds up inside the tooth. This pressure cuts of the blood supply to the nerve, and so the nerve dies. The throbbing sensation often felt is the pressure rising with each heart beat. That is why it can get worse with any exertion. It can also get worse whilst lying down, as the blood pressure to the head is increased.

Broken teeth
If you have an accident, or break a tooth biting into something hard, you can expose the tooth to the mouth. If this is simply a tiny spot, we can try simple fillings, if bigger, it is wise to have the tooth root treated, as it is likely to give problems

Following fillings or crown work
As mentioned above, the nerve can be contaminated by bacteria from decay. Often we can remove the decay but it is too late as the bacteria have penetrated too far. In addition, the removal of the decay will increase the inflammation inside the tooth. The combination of this and any bacteria can push the nerve over its limit.
In a similar manner, any extensive drilling, for example crown preparations, can cause inflammation which can cause the death of the nerve.

Prevention of later problems
If we have to cut teeth back very extensively, we can end up either reaching the nerve, or being exceptionally close to it. In these cases the tooth would almost certainly give problems afterwards, and we might then have to drill through a new crown, leaving it weaker. In these cases we elect to root treat the tooth before the crown.
In a similar vein, if a tooth has consistently been given problems, and it needs crowned, we will root treat it first, as it is easier to get a good result.

As a comparison
You could build a house with uncertain foundations, and then underpin it at a later date, but it is far easier to simply get the foundations correct.

Why do I need to see an Endodontist?
Root canal dentistry is a distinct branch of dentistry, and it requires much specialist root canal equipment, and many unique skills. Some dentists choose to concentrate their skills on one area. Your dentist may have areas of dentistry which he prefers, and may choose to leave certain areas like root canal, to others.
It may also be that your dentist is happy to provide some root canal work, but has the experience to identify the cases which require more advanced techniques.

What symptoms might indicate that I need root canal?
The symptoms of root canal do vary considerably, and if you are in doubt, you should consult your dentist. We do provide emergency appointments for non-registered patients. The symptoms of teeth needing root canal can include;

Sensitivity to hot and cold
If the sensitivity only lasts a few seconds, and is a sharp pain, you will probably just need a filling, but if the pain lasts more than a couple of minutes, the chances are you need root canal work

Pain on biting
Pain on biting can be related to several dental issues, but if there is an abscess under a tooth, biting on the tooth puts pressure on the abscess, causing pain.

Swelling
Swelling around a tooth is most frequently associated with an infection. This infection can be from a root canal related infection, although there are other types of infection

Bitter Taste
Sometimes you can get an infection which connects with you mouth. You can then experience a nasty taste. Some people will notice a little spot that when pressed tastes nasty. Again this can also be related to other infections.

Constant Throbbing Pain
A constant throbbing is characteristic of an infection, which places your nerve under pressure. This is a very typical situation.

No symptoms at all
Sometimes the nerve can die, and give no pain what so ever. This is one of the reasons why dentists take routine x-rays, especially if they are thinking of crowning teeth

 How will the dentist decide if I need root canal?
As mentioned above, there are many symptoms which can relate to root canal issues. Your dentist needs to take a history of your symptoms, examine the tooth, and probably take x-rays. It is then important to see if saving the tooth makes sense. It could be an isolated tooth at the back of your mouth, with curved canals, poor gums, and no tooth opposite. In this situation, having the tooth removed makes more sense. It might however be your front tooth, which has some decay, and can be easily treated, filled and saved.

Does it always work?
Root canal, when carried out by a skilled Endodontist carries a very high success rate, typically around 95% success after ten years. Initial treatments are more successful than re-treatments, and areas without chronic infection are more successful than those with one.

What are my options?
The typical options can be to remove the tooth, and either leave a gap, or replace the tooth with one of the options available. (You can get more detail of this in the Implant section under single tooth).
On occasion, we might look at a tooth, and decide that whilst technically the underlying root canal conditions are poor, the tooth is not giving any problems. In some circumstances we can keep the tooth under observation. 
Is it always the best answer?
Now days there are many different options to root canal treatment. Typically we will look at how broken down the tooth is. An upper pre-molar tooth, (behind you canine or eye tooth), which is broken down to gum level, has two delicate roots, and has a degree of gum disease will have a poor prognosis compared to an implant, and the treatment to restore it might actually cost more. However in many situations, a root treated, restored tooth will carry a similar prognosis to an implant, the treatment will cost less, and it will take less time.

I already have a crown, can I have root canal work?
If you tooth is already crowned, we can often preserve the crown, by drilling through it. It is easier to obtain a good result by removing the crown, and so if the crown will need replaced anyway, we will remove it first.
If it is going to be a technically difficult root canal, to give you the best chances of success, we will often want to remove it. With back teeth we can sometimes remove the crown in a manner which allows us to replace it.
If there is a post down the tooth, we would almost certainly need to remove the crown to allow the removal of the post.

How do I see the Endodontist at Seven Fields
If you have no dentist;
Simply contact us, either by telephone or e-mail, using details either at the bottom of this page (click on e-mail), or using the side bar on the home page (click on Seven Fields on the top of the page). We prefer to arrange a full new patient consultation, but if you are experiences acute problems we can arrange an emergency appointment.

Dentist Referral
If you already have a dentist we do prefer that they refer you to Massimo. This helps us get any pertinent background details.

Self-Referral
If you do have a dentist, but would like us to carry out your root canal, we are delighted to limit the treatment to just the area in question.

I have had root canal with you can I join the practice?
We are delighted to accept new patients, however, if your dentist has referred you, our ethics require us to return you to your dentist. We also find that it is better if you can stay with your usual dentist who has the best long-term knowledge of your teeth.