Unacceptable or inappropriate root canal treatment

Dental claims and dental negligence law is a very specialist area. Our experienced dental negligence lawyers understand the dental terminology and dental procedures that may give rise to dental negligence claims.

We also understand that when dental care and treatment does not give the expected outcome, the possibility that your pain and suffering is due to dental negligence creates an additional level of frustration and anxiety, as well as the added inconvenience and expense of corrective treatment. Our experienced dental negligence lawyers will help you every step of the way to ensure that you receive the compensation due to you.

Please note that the information here is only applicable for adult, permanent teeth. Deciduous (baby) teeth have different treatment needs and procedures.

Why does a tooth need root canal treatment?

A tooth will need root canal treatment when the nerve is irreversibly damaged or when it dies.

The nerve of a tooth may die either as a result of trauma that causes disruption to the blood supply to the nerve (for example, when a tooth is knocked out or dislodged) or irreversibly damaged due to infection and inflammation from tooth decay or gum disease.

When a nerve is dying, the tooth may be very painful. It may become very sensitive to hot and cold, tender to bite on and/or it may continually ache and/or throb.

Although a course of antibiotics may help subdue the tenderness and pain, antibiotics will not help the dying nerve recover. At some point, the tooth will need root canal treatment because the presence of dead nerve tissue is likely to cause an abscess.

Sometimes a nerve will die without any obvious or recognisable symptoms. In these cases, the first indication that the tooth requires root canal treatment may either be a darkening of the tooth or the sudden and unexpected extreme tenderness that accompanies the formation of an abscess.

Even if a tooth is symptom-free, if an x-rays shows an area of infection at the end of a root (this appears as a darkened area within the speckled bone), then the tooth will need root canal treatment to remove the source of the infection.

Can root canal treatment be avoided?

The health of a tooth nerve is usually reflected in the type and severity of any toothache symptoms.

When a tooth nerve begins to be affected by tooth decay and/or gum disease, the tooth is usually sensitive to hot and cold. This sensitivity will initially only occur when eating or drinking hot and cold things. At this stage, if the tooth decay or gum disease is diagnosed and treated, the nerve will fully recover.

However, if the tooth decay or gum disease is not diagnosed and/or treated, the nerve will become more sensitive. The tooth may then start to hurt without any provocation (for example, when just sitting and reading or watching TV). At this stage, if the tooth decay or gum disease is diagnosed and treated, the nerve may still fully recover.

If the toothache symptoms are ignored, or the tooth decay and/or gum disease is still not diagnosed and treated, the continuing attack on the nerve will cause pain and aching that will start without any provocation and will last for a longer time – it may even prevent or disturb your sleep. At this stage, even if the tooth decay and/or gum disease is diagnosed and treated, the nerve may be too badly affected and unable to recover and repair itself. This is when root canal treatment may become unavoidable.

Sometimes, if the dentist removes the tooth decay and places a temporary dressing in the tooth, this may calm the nerve and stop the toothache. However, the tooth should be reviewed in order to check whether the nerve has survived or whether it is slowly dying and the tooth will need root canal treatment.

What happens during root canal treatment?

The whole purpose of root canal treatment is to remove the dead and/or dying nerve tissue and bacteria in the root canal, to clean and shape the internal surfaces of the root canal and to place a root filling inside the entire canal that seals (closes) the canal at the tip of the root.

Root canal treatment is usually started before the nerve completely dies off because of the severe sensitivity and toothache that is experienced.

When opening and working in the root canals of a tooth, it is important to prevent saliva from getting into the canals. This is because there are many bacteria present in the saliva and if these get into the confines of a root canal, they may cause additional infections.

The easiest way of isolating the root canal from the saliva is to place a protective sheet over the tooth so that the tooth sticks through the sheet, but the rest of the mouth is underneath it. These sheets are called ‘rubber dam’. They also protect the airway from the risk of swallowing the small root canal files and instruments and protect the gums from any leakage of the bleach solution, which is used to help clean and wash out the root canals.

After preparing the tooth for root canal treatment, the root canals must be located and measured so that no dead or dying nerve tissue is left at the ends of the roots. This may be done by taking x-rays of the root canals with a known length of file (and adjusting as necessary) or by using an electrical apex locater (the apex is at the tip/end of the root).

The most important part of root canal treatment is to remove all the dead and/or dying nerve tissue and to ensure this, by cleaning and shaping the inside surfaces of all the root canals. This takes time – it cannot be rushed but it is essential to ensure a successful outcome.

When filing and shaping the inside surfaces of the root canals, a very diluted bleach solution is used to help clean and wash out the root canals.

The final stage of root canal treatment is to place a root filling throughout the root canal, most specifically ensuring that it seals (closes) the canal at the tip of the root.

Following the completion of root canal treatment, it is important to take an x-ray to check the root filling. A repeat x-ray should be taken a few months later to check that any area of infection around the tooth roots is healing.

Problems during root canal treatment

A very inflamed nerve may be difficult to anaesthetise (numb) and may require more anaesthetic solution than normally required for a simple filling. Occasionally, a course of antibiotics is required to reduce the level of infection before the anaesthetic solution can be effective.

The molar and premolar teeth have more than one root (they are multi-rooted) and each root will have at least one root canal with nerve tissue. If a multi-rooted tooth requires root canal treatment, all the root canals must undergo root canal treatment. Although this is sometimes difficult to do, failure to treat all the root canals will leave dead/dying nerve tissue in the tooth and so the pain and symptoms will continue.

Sometimes, one of the small root canal files or instruments may break inside the root canal. Whilst this, in itself does not necessarily represent dental negligence, it is important that you are told about the presence of the file and that the dentist takes steps to try and remove it. If this is not possible, then the root canal treatment may still be completed – and may still be successful.

Problems after root canal treatment

If the tooth does not settle (with or without the presence of any fractured file or instrument in the root canal), it may be necessary to consider attempting to re-treat the tooth although a referral to a specialist endodontist for review and any further treatment may be more appropriate.

The death and/or loss of the nerve is accompanied by the loss of the blood supply to the tooth. This may cause the tooth to discolour and also become more brittle (more likely to fracture).

It is therefore sensible to consider placing a crown on a root canal treated tooth in order to hold it together and give it strength. This is particularly important if most of the natural tooth structure has been lost as a result of removing tooth decay.

However, before placing a crown on a root filled tooth, it is sensible to take an x-ray to check that the root canal treatment has been successful and any area infection seen on previous x-rays is showing signs of healing.

Dental negligence claims arising from root canal treatment
The most common claims involving root canal treatment include the following:

  • Delay or failure to recognise the need for root canal treatment
  • Over-reliance/repeated use of antibiotics to control symptoms
  • Failure to isolate the tooth and root canals from the saliva
  • Failure to protect the airway/swallowing root canal files or instruments
  • Inadequate removal of the dead or dying nerve tissue
  • Inadequate cleaning of the root canals
  • Failure to assess the length of the root canals in order to ensure complete removal of the dead/dying nerve
  • Failure to locate, clean and/or fill all root canals in a multi-rooted tooth
  • Failure to inform about the presence of a broken file within a root canal
    Failure to place an adequate root filling
  • Failure to check that the final root filling is adequate
  • Failing to investigate ongoing symptoms in a root treated tooth
  • Failure to refer for specialist review and/or treatment (for example, to attempt removal of a broken file or re-treatment if symptoms continue)

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