Root Canal Endodontic Treatment
Your teeth and their pulp tissueThe pulp tissue - Your teeth are calcified objects containing a hollow space referred to as the pulp chamber. The pulp chamber contains the nerves, arteries, veins, lymph vessels and connective tissue that nourish the tooth.
Root canals - The nerve and blood vessels enter each tooth at the tip of the root and run through the center of the root to reach the pulp chamber. The number of canals in each tooth can vary according to the type of tooth. Generally, the front teeth have a single root canal while molars often have three or more canals.
A tooth's living tissue plays an important role in the development and formation of teeth. On formation its function is to preserve the tooth's health and vitality by:
- Depositing the organic components of the tooth's mineralised tissues, the dentin and enamel, by supplying nutrients
- Producing new tooth structure to protect the nerve from injury or infection
The goal of root canal endodontic therapyA root canal endodontic therapy is performed when the pulp tissue of the tooth has become infected. In order for your body to heal the infected tissue must be removed and any bacteria present within the pulp chamber or root canals must be eliminated.
How is the pulp infected?The tooth pulp can be infected as a result of:
- Cavity Tooth decay – causing bacteria to spread into the tooth and pulp.
- Cracked tooth - allows for bacteria to infect the dental tooth pulp tissue
- Periodontal or Gum disease – bacteria located in the pocket surrounding a tooth may gain entry into the root canal space where the living tissue resides.
- Tooth Injury – may compromise the blood supply to the pulp tissue.
Complications of an infected abcessed toothIf left untreated an infected tooth may lead to the formation of a tooth abscess at the tip of the root. As the tooth abscess spreads within the bone, the tooth rises slightly out of its socket making it painful when you bite down. Without treatment, this infection can further spread to the surrounding tissues and nerves resulting in:
- Swelling in the face or neck
- Toothache or Tooth Pain
- Jaw pain that can radiate to the ear or temple area
- Difficulty in swallowing
How can root canal endodontic treatment help?Root canal endodontic treatment removes the infected tooth pulp and disinfects the tooth pulp chamber which allows your bodys immune system to begin the healing process. Root canal endodontic treatment allows an individual to retain a tooth in it's natural state.
What are the indications for a root canal endodontic treatment?By Symptoms:
- Persistent toothache or tooth pain
- Sore gum tissue adjacent to a tooth
- Swollen gum tissue
- Darkened or discolored tooth
- Radiographs - a reduction in the density of the bone surrounding the root tip may indicate the presence of an infection in the tooth
- Dental examination - A persistent or recurring bump on your gums
- Due to Exposure of a tooth's nerve during dental work – may occur when the dentist is carrying out other dental work, in which case a root canal treatment may be necessary to prevent the degeneration of the tooth's nerve tissue.
How is root canal endodontic treatment performed?Root canal endodontic treatment may take one or several appointments to complete. It depends upon the extent of infection in the tooth and the number of root canals to be treated.
At the first appointment
- The area to be treated is numbed with an anesthetic
- The dentist or endodontist places a rubber dam over the tooth to prevent the bacteria in saliva from infecting the tooth being treated.
- The pulp chamber of the tooth is accessed by creating an opening into it.
- Radiographs are used to determine the precise length of each root.
- The root canal space is cleaned and shaped with special instruments.
- Copious irrigation is used to dissolve and disinfect the canal space.
- A temporary filling is utilized to seal the tooth.
- The dentist or endodontist numbs the treatment area using a local anesthetic
- The rubber dam is placed over the teeth.
- The temporary filling is removed and dentist ensures that the root canals are dry and free from infection
- The root canals are then filled using gutta percha
- Radiographs are taken to verify the gutta percha has filled the canals completely
- The dentist then restores the tooth utilizing a permanent filling and or crown.
What can you expect following the root canal endodontic procedure?The tooth may feel a little tender for a several days following the procedure. Over the counter Ibuprofen or Aleve may be used as recommended by your dentist or endodontist.
Care guidelines following root canal endodontic treatmentRoutine brushing and flossing are encouraged. Most important is to remember NOT to chew on the tooth that has undergone or is undergoing root canal treatment in order to:
- Prevent the temporary filling from coming out and recontaminating the interior of the tooth
- Prevent tooth form breaking or cracking before it is fully restored
Further dental work for restoring the functionality of the toothTeeth that have undergone root canal treatment may require restorative dental work to insure their ability to tolerate normal chewing and to prevent reinfection by oral bacteria. The common restorations recommended by your dentist will vary according to your dental condition, and may comprise of any of the following:
- A dental post – Posts can be placed in teeth that have large portions of their tooth structure missing. To increase the stability of a tooth, dentists can increase the amount of tooth that extends up to the centre of the dental crown. This can be accomplished by using a dental post which will serve as the anchor for the filling material used to increase the height of the internal core of the tooth.
- A dental crown – Used to restore or repair a broken tooth and improve its appearance. Crowns are made of porcelain or metal and create an excellent seal for the tooth.
Repeating root canal treatmentGenerally, the positive outcomes of a root canal treatment last a lifetime. However, if infection does return the treatment can be repeated. Often at this time a referral to an endodontist, a dental specialist who practices endodontics, is recommended. The most common procedure an endodontist performs are root canals.
Are there any other alternatives to root canal treatment?The only alternative to root canal treatment for an infected tooth is tooth extraction. In general it is better to retain your natural teeth than have them removed.
When does root canal treatment fail?Signs of a failed root canal endodontic treatment:
- Mild to severe tooth pain or toothache
- Slight to more pronounced tenderness or swelling in the gums in the area near the tooth that can either be in a persistent or transient mode following root canal treatment.
- Shape of the tooth's root canals – If they have branches or forks they may be difficult to detect and therefore are overlooked during treatment.
- Unexpected number of root canals – When a tooth has root canals that are tiny they may be overlooked during treatment
- Undetected cracks in the root of the tooth
- Defective or inadequate dental restoration allowing bacteria to seep into the inner core and recontaminate
- Disintegration of the tooth seal with the passage of time causing bacteria to recontaminate the tooth
- Tooth structure that has broken as a result of the treatment and require restorative work for stability
- The treated teeth are not impervious to tooth decay and gum disease, in which case if extra hygiene is not maintained it can result in the loss of the teeth
- Poor response of certain bacteria to the root canal treatment
What are the complications associated with root canal treatment?
- Seperation of a dental instrument or file inside the root canal while cleaning the pulp chamber.
- Infection as a result of incomplete treatment or filling as a result of the root canals being complex or not being detected on the X-ray
- Poor response of certain bacteria to the root canal treatment
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