Root treatment must be performed when a dental nerve – or pulpa in Latin dies and/or becomes infected. As a patient you may have felt pain, or you may have had no symptoms at all.

There are many reasons why a dental nerve might die: deep cavities, extreme heat when drilling and/or the use of chemicals (for example white fillings – called composites). The „dead“ tooth may become dangerous or even life-threatening.

The aim of root treatment is to completely remove the destroyed and sometimes bacteria-infected tissue from the inside of the tooth, so the inflammation cannot continue to spread through the bone, since the tooth is connected to the bone at the tip of the root by many small canals. Since the inside of the tooth can never be 100% clean, the „tooth pocket“ is sealed up so that any bacteria left have no more space to thrive and multiply.

This requires complete cleanliness and sterile working conditions when performing root treatment; the use of a coffer dam is absolutely essential, as this is only way to keep saliva away from the inside of the tooth. Saliva contains many different kinds of bacteria, which would endanger the success of the root treatment. You can see a coffer dam which isolates the tooth from the tongue, the other teeth, saliva and blood.
It is important to use sterile instruments; this picture shows a root treatment box, packed sterile – and opened immediately before treatment. The instruments are neatly sorted.
Usually however, the instruments used are not sterile. They are often stored in simple foam carriers such as the one shown in the picture.

The dentist uses the sterile instruments to clear out the inside of the tooth; special solutions are used at intervals to remove tooth shavings, tooth residue and bacteria.
It is important to treat all canals, as most teeth have numerous canals, three in this picture, one with the instrument in it. A dentist who works carefully always used a magnifier – a magnifying glass or a microscope.

The tooth canal must be treated to the tip of the root, for which the length of the root must be ascertained by means of x-rays or measuring aids – as shown in the picture. Only a tooth which has been treated down to the tip of the root is sustainable over time.
If the tooth smells, or hurts, or bleeds heavily from the inside, it should not be filled for good. In cases like these medication – such as the yellow paste here – is applied and the tooth is sealed up for a few days.
The temporary sealant must keep out saliva – the gray mass here in the picture – it holds for about a week, another session must take place then at the latest, otherwise bacteria from the saliva may enter the tooth, thus reversing the whole procedure.
If the inside of the tooth is clean and there are no other complaints on the part of the patient, then a special material can be used to seal up the inside of the tooth and seal the tooth from above. The sealant takes at least 24 hours to dry – during this time no other treatment should be performed – not even drilling crowns.

On the left you can see a tooth after successful root treatment, the inside of the tooth is homogeneously sealed to the tip of the root – the light streak on the inside of the tooth. A tooth like this can hold for life. On the right you can see an example of unsuccessful root treatment; the front root was not filled, and the back root was only partially filled. Such teeth can cause problems years later – e.g. acute bone inflammation or an abscess. Root tip resection and/or extraction is the result.