Root canal treatment (RCT) is a dental procedure used to treat infection or inflammation inside a tooth.
Inside each tooth is a soft tissue called the dental pulp, which contains nerves and blood vessels. If this becomes badly inflamed, damaged or infected — for example due to deep decay, a crack, trauma or previous dental treatment — root canal treatment may be needed to try to save the tooth.
During RCT, the dentist:
Some teeth may also require a crown or other protective restoration following RCT.
The aim of root canal treatment is to remove infection and, where possible and appropriate, retain the natural tooth rather than extract it.
No.
Root canal systems vary considerably between teeth and between patients.
Some teeth have relatively simple anatomy and can be treated routinely within general dental practice. Others have multiple, narrow, curved, calcified or difficult-to-find canals and can require significantly more advanced treatment.
This is why root canal treatment is assessed according to its clinical complexity, including whether it falls within routine Level 1 care or requires Level 2 or more advanced endodontic care.
The complexity of your treatment can only be determined after your dentist has assessed the individual tooth and appropriate X-rays.
Root canal treatment can sometimes allow an infected or damaged tooth to be retained rather than extracted.
RCT is available under the NHS where it is clinically necessary and appropriate. However, not all root canal treatments are the same and not every RCT falls within the level of complexity routinely provided through general NHS dental care.
Every tooth is assessed individually.
The following information explains how we decide whether RCT can be provided through our routine NHS service and what options are available when treatment is more complex.
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Level 1 care is the level of treatment that would generally be expected to be managed within routine NHS general dental practice.
A Level 1 root canal is generally an uncomplicated case where the canals can reasonably be located, accessed, negotiated, cleaned and filled using the skills and equipment expected within general dental practice.
Examples of features associated with Level 1 complexity can include:
Every tooth is assessed individually.
Being a front tooth, premolar or molar does not automatically determine whether treatment is Level 1 or Level 2. The actual anatomy, condition and technical complexity of the tooth are important.
Level 2 describes more complex endodontic care requiring enhanced skills and experience beyond the routine Level 1 care expected within general dental practice.
A Level 2 case may require a dentist with enhanced endodontic skills and experience and may also require additional equipment or facilities.
Examples of factors that may increase a case to Level 2 complexity include:
The complexity of a case is determined following clinical and radiographic assessment. It is not determined simply by which tooth requires treatment.
No. There is an important distinction between the skills an individual dentist possesses and the level of service commissioned from a dental practice.
A dentist may have undertaken additional postgraduate training and developed enhanced skills in root canal treatment. They may therefore personally be capable of treating cases beyond Level 1 complexity.
However, this does not mean that every advanced procedure that clinician is capable of performing automatically becomes routine Level 1 NHS general dental care.
Level 2 care is specifically recognised as a different level of complexity within NHS dental commissioning.
Where a case is assessed as requiring Level 2 or higher endodontic care, the appropriate treatment pathway will be discussed with you.
If your dentist believes your tooth requires treatment beyond routine Level 1 care, we will explain this to you.
Depending upon the individual circumstances, your options may include:
NHS referral
Where an appropriate NHS Level 2 or specialist endodontic service is available, a referral may be considered.
NHS referral is subject to the acceptance criteria of the receiving service.
A referral does not guarantee that the tooth will be accepted for NHS treatment. Factors such as the tooth's restorability, long-term prognosis, strategic importance, condition of the rest of the mouth and technical complexity may be considered by the receiving service.
Private endodontic treatment
You may also choose to have the tooth assessed and, where appropriate, treated privately by a dentist with enhanced skills and experience in endodontics or by an endodontic specialist.
Private treatment can sometimes provide access to enhanced endodontic treatment, equipment and techniques outside the Level 1 care routinely provided through general NHS dental services.
Extraction
Where appropriate, extraction may also be discussed.
This may be recommended where the tooth has a poor prognosis or cannot predictably be restored, or it may be an alternative where the patient does not wish to pursue referral or private complex endodontic treatment.
Your dentist will explain the risks, benefits and likely outcomes of the appropriate options.
A previously root-treated tooth does not automatically mean that re-treatment is Level 2.
Some relatively straightforward re-treatments can fall within Level 1 complexity.
However, re-treatment can become Level 2 or higher where, for example, existing root fillings are technically difficult to remove, canals are difficult to negotiate, there are posts or other obstructions, anatomy has been altered or other complications are present.
Your dentist will assess the individual tooth and advise you of its complexity and prognosis
NHS dentistry recognises different levels of clinical complexity.
Level 1 care represents treatment expected within routine general dental practice.
Level 2 care requires enhanced skills and experience and may require additional equipment or facilities. NHS England has separate arrangements for the commissioning and accreditation of Level 2 services.
Therefore, a dentist being personally capable of carrying out a complex procedure does not, by itself, mean that the procedure is Level 1 care.
The complexity of the treatment required and the appropriate NHS care pathway must still be considered.
Where a case requires care beyond Level 1 complexity, this should not simply be regarded as your dentist “refusing” to provide treatment.
Your dentist is determining the appropriate level of care required for your particular tooth.
If your case falls within Level 1 and RCT is clinically necessary and appropriate, it can normally be managed within routine NHS general dental care.
If the case is assessed as Level 2 or higher complexity, your dentist will explain why and discuss the appropriate options, which may include an NHS referral where available and where the referral criteria are satisfied.
Private treatment may also be discussed as an option.
NHS endodontic referral services have acceptance criteria.
A referral may not be accepted simply because a patient would prefer root canal treatment rather than extraction.
Depending upon the relevant service, consideration may be given to:
Referral criteria can vary according to the NHS service commissioned within an area.
At Dentistry@BD4, every tooth is assessed individually.
Level 1 RCT
Where RCT is clinically necessary and appropriate and the case is assessed as Level 1 complexity, treatment can normally be provided through routine NHS general dental care.
Level 2 or higher complexity RCT
Where the clinical and technical requirements of the case place it beyond Level 1 care, your dentist will explain this and discuss the appropriate options.
These may include:
Having a dentist within the practice who possesses enhanced endodontic skills does not automatically change a Level 2 case into Level 1 NHS care.
Our aim is to ensure that patients understand the complexity of their treatment, the reasonable options available and the likely prognosis before deciding how they wish to proceed.
This information is intended as general guidance. The complexity and suitability of root canal treatment can only be determined following an individual clinical and radiographic assessment.
