Endodontics: when a tooth can still be saved

Why a tooth hurts and what can be done about it

Inside every tooth there is pulp — living tissue with a nerve and blood vessels. When bacteria reach it through deep decay, a cracked tooth or after a blow, it becomes inflamed. The inflammation has nowhere to escape, the pressure inside the tooth rises, and that is the pain that does not go away after a tablet and tends to be worst at night.

Inflamed pulp does not heal by itself — in time it dies. The pain often subsides then and the tooth seems as if the problem were over, although the inflammation has meanwhile been moving towards the root tip and into the bone around it. That is why it is not worth waiting with treatment even when the pain stops.

Endodontic treatment is treatment of the inside of the tooth. We remove the pulp from the root canals, clean them, disinfect them and fill them tightly so that bacteria cannot get back in. The tooth stays in your mouth — it is the alternative to pulling it out.

What to expect at your first visit

If your tooth is hurting badly, do not wait for your next check-up. A consultation with us is free; an emergency examination at the patient's request costs 30 €, and emergency treatment outside surgery hours 50 €.

First we need to know whether the pulp is still alive or already dead — a vitality test at 3 € per tooth will show that. What is happening under the gum and around the root, where nobody can look, is shown by an X-ray of the tooth at 6 €.

If the tooth is badly broken down and there is little left to hold on to, we first build it up before we clean the canals — a pre-endodontic build-up costs 50 €. Without it the tooth cannot be isolated well enough during treatment and saliva would get into the cleaned canal.

How the treatment goes, step by step

The treatment is done under anaesthetic; we charge for the anaesthesia separately — an infiltration anaesthetic costs 15 €.

1. 1 We numb the tooth and isolate it with a rubber dam — a sheet of rubber that separates the tooth from the rest of the mouth, so that saliva cannot get into it while we work.
2. 2 We open the tooth from above and remove the inflamed or dead pulp from it. That tissue is exactly what is causing the pain.
3. 3 We clean the canals along their whole length, right up to the root tip, and disinfect them.
4. 4 We fill the cleaned, dry canals tightly, so that no room is left in them for bacteria.
5. 5 We close the crown part of the tooth with a filling. Whether a crown will also be needed is decided only at the check-up — that is what the last part of this article is about.

It cannot always be done in a single visit. If the inflammation has to be calmed first, we remove the pulp (pulp extirpation, 10 € per canal) and fill the canal temporarily — a temporary filling of a single-rooted tooth costs 15 € — and we complete the definitive treatment at the next appointment.

What the treatment costs

The price is determined above all by how many root canals the tooth has. Front teeth usually have one, teeth at the back two or three — and every canal has to be cleaned and filled separately.

Treating a single-rooted tooth costs 98 € with us, a two-rooted tooth 182 € and a multi-rooted tooth 297 €. Isolation of the working field is added to that — a rubber dam or optragate, 17 € each.

What is added to that depends on the state of the tooth: a vitality test 3 €, an X-ray 6 €, anaesthesia 15 €, and for a badly broken-down tooth a build-up 50 €. Which of these you will need will only be shown by an examination.

When a tooth needs treating a second time

It happens that inflammation reappears after a while in a tooth that has already been treated — for example when an uncleaned spot was left in the canal, or bacteria got back in through a leaking filling. We then open the tooth and repeat the whole treatment. The technical name for this is endodontic retreatment; the re- in retreatment simply means that the tooth is being treated a second time.

There is more work involved, because we first have to get through what is already filling the canal. Removing the original root filling costs 18 €, removing root canal posts 15 €. If a fractured instrument was left in the canal by the previous treatment, taking it out costs 200 €.

The repeat treatment itself costs 132 € with us for a single-rooted tooth, 203 € for a two-rooted one and 357 € for a multi-rooted one. If the canal additionally needs disinfecting with FotoSan, that is 4 € per canal.

When even retreatment is not enough

If the inflammation persists even after retreatment and its source sits at the tip of the root, it can be removed surgically. In a root-end resection the very tip of the root is cut away together with the inflammation around it, and the rest of the tooth stays in place; for a single-rooted tooth this costs 220 € with us. It is the last option before the tooth would have to come out.

Whether your particular tooth can be saved, or whether another solution makes more sense, cannot be said over the phone or from a photograph — only an examination and an X-ray will show that. Coming in to ask costs you nothing: our consultation is free.

What happens to the tooth afterwards

A tooth without pulp loses its supply of nourishment and becomes brittle over time — especially if it had a large filling or a large cavity before treatment. Back teeth, which carry the greatest load when chewing, are therefore often covered with a crown after endodontic treatment: the crown reinforces the tooth all the way round.

Whether this will be necessary in your case depends on how much of your own tooth is left after treatment. The check-up after the procedure will show that — there is no general rule here that would apply to every tooth alike.