ROOT CANAL THERAPY
A root canal
is a treatment used to repair and save a tooth that is badly
decayed or becomes infected.
Root canal procedures
are performed when the nerve of the tooth becomes infected or
the pulp becomes damaged. During a root canal procedure, the
nerve and pulp is removed and the inside of the tooth is cleaned
and sealed.
Root canal procedures
have the reputation of being painful. Actually, most people
report that the procedure itself is no more painful than having
a filling placed. The discomfort experienced in the period leading
up to a seeking of dental care is truly the painful period of
time, not the root canal procedure itself.
What
Is Pulp?
The pulp or pulp chamber
is the soft area within the center of the tooth. The tooth's
nerve lies within root canals, which lie within the roots or
"legs" of the tooth. The root canals travel from the
tip of the tooth's root into the pulp chamber, which also contains
blood vessels and connective tissue that nourish the tooth.
A tooth's nerve is not vitally important to a tooth's health
and function after the tooth has emerged through the gums. Its
only function is sensory – to provide the sensation of hot or
cold. The presence or absence of a nerve will not affect the
day-to-day functioning of the tooth.
Why Does the
Pulp Need to Be Removed?
When
nerve tissue or pulp is damaged, it breaks down and bacteria
begin to multiply within the pulp chamber. The bacteria and
other decayed debris can cause an infection or abscessed tooth.
An abscess is a pus-filled pocket that forms at the end of the
roots of the tooth. An abscess occurs when the infection spreads
all the way past the ends of the roots of the tooth. In addition
to an abscess, an infection in the root canal of a tooth can
cause:
1.
Swelling that may spread to other areas of the face, neck, or
head
2. Bone loss around the tip of the root
3. Drainage problems extending outward from
the root. A hole can occur through the side of the tooth with
drainage into the gums or through the cheek with drainage into
the skin.
What
Damages a Tooth's Nerve and Pulp in the First Place?
Nerve
and pulp can become irritated, inflamed and infected due to
deep decay, repeated dental procedures on a tooth and/or large
fillings, a crack or chip in the tooth, or trauma to the face.
What
Are the Signs that a Root Canal Is Needed?
Signs
to look for include:
1.
Severe toothache pain upon chewing or application of pressure
2. Prolonged sensitivity/pain to heat or cold temperatures (after
the hot or cold has been removed)
3. Discoloration (a darkening) of the tooth
4. Swelling and tenderness in the nearby gums
5. A persistent or recurring pimple on the gums
6. Sometimes no symptoms are present
The Procedure
The
root canal procedure requires one or more office visits and
can be performed by a dentist or endodontist. An endodontist
is a dentist who specializes in the causes, diagnosis, prevention
and treatment of diseases and injuries of the human dental pulp
or the nerve of the tooth. The choice of which type of dentist
to use depends to some degree on the difficulty of the root
canal procedure needed in your particular tooth and the general
dentist's comfort level in working on your tooth. Your dentist
will discuss who might be best suited to perform the work in
your particular case.
The first step in the procedure is to take an x-ray to see the
shape of the root canals and determine if there are any signs
of infection in a surrounding bone. Your dentist or endodontist
will then use local anesthesia to numb the area near the tooth.
Actually, anesthesia may not be necessary, since the nerve is
dead, but most dentists still anesthetize the area to make the
patient more relaxed and at ease.
Next,
to keep the area dry and free of saliva during treatment, your
dentist will place a rubber dam (a sheet of rubber) around the
tooth.
An
access hole will then be drilled into the tooth. The pulp along
with bacteria, the decayed nerve tissue and related debris is
removed from the tooth. The cleaning out process is accomplished
using root canal files. A series of these files of increasing
diameter are each subsequently placed into the access hole and
worked down the full length of the tooth to scrape and scrub
the sides of the root canals. Water or sodium hypochlorite is
used periodically to flush away the debris.
Once
the tooth is thoroughly cleaned, it needs to be sealed. Some
dentists like to wait a week before sealing the tooth. For instance,
if there is an infection, your dentist may put a medication
inside the tooth to clear it up. Others may choose to seal the
tooth the same day it is cleaned out. If the root canal is not
completed on the same day, a temporary filling is placed in
the exterior hole in the tooth to keep contaminants out between
appointments.
At
the next appointment, to fill the interior of the tooth, a sealer
paste and a rubber compound called gutta percha is placed into
the tooth's root canal. To fill the exterior access hole created
at the beginning of treatment, a filling is placed.
The
final step may involve further restoration of the tooth. Because
a tooth that needs a root canal often is one that has a large
filling or extensive decay or other weakness, a crown, crown
and post or other restoration often needs to be placed on the
tooth to protect it, prevent it from breaking and restore it
to full function. Our All Day All Night dentist will discuss
the need for any additional dental work with you.
What
Should One Expect After the Root Canal?
The
root canal procedure should relieve the pain you feel. Until
your root canal procedure is completely finished – that is to
say, the permanent filling is in place and/or the crown is place,
it's wise to minimize chewing on the tooth under repair. This
step will help avoid recontamination of the interior of the
tooth and also may prevent a fragile tooth from breaking before
the tooth can be fully restored. For the first few days following
the completion of treatment, the tooth may feel sensitive due
to natural tissue inflammation, especially if there was pain
or infection before the procedure. This sensitivity or discomfort
usually can be controlled with over-the-counter analgesics such
as ibuprofen (Advil, Motrin) or naproxen (Aleve). Most patients
can return to their normal activities the next day.
As
far as oral health care is concerned, brush and floss as you
regularly would and see your dentist at normally scheduled intervals.
Because the final step of the root canal procedure is application
of a restoration such as a crown or a filling, it will not be
obvious to onlookers that a root canal was performed.
Root
canal treatment is highly successful; the procedure has more
than a 95% success rate. Many teeth fixed with a root canal
can last a lifetime.
Complications
of a Root Canal
Despite
your dentist's best efforts to clean and seal a tooth, new infections
might emerge. Among the likely reasons for this include:
1.
More than the normally anticipated number of root canals in
a tooth (leaving one of them uncleaned)
2. An undetected crack in the root of a tooth
3. A defective or inadequate dental restoration that has allowed
bacteria to get past the restoration into the inner aspects
of the tooth and recontaminate the area
4. A breakdown of the inner sealing material over time, allowing
bacteria to recontaminate the inner aspects of the tooth.
Sometimes retreatment can be successful, other times endodontic
surgery must be tried in order to save the tooth. The most common
endodontic surgical procedure is an apicoectomy or root-end
resection. This procedure relieves the inflammation or infection
in the bony area around the end of your tooth that continues
after endodontic treatment. In this procedure, the gum tissue
is opened, the infected tissue is removed, and sometimes the
very end of the root is removed. A small filling may be placed
to seal the root canal.
Alternatives
to a Root Canal
Saving
your natural teeth is the very best option, if possible. Your
natural teeth allow you to eat a wide variety of foods necessary
to maintain proper nutrition. The root canal procedure is the
treatment of choice.
The
only alternative to a root canal procedure is having the tooth
extracted and replaced with a bridge, implant, or removable
partial denture to restore chewing function and prevent adjacent
teeth from shifting. These alternatives not only are more expensive
than a root canal procedure but require more treatment time
and additional procedures to adjacent teeth and supporting tissues.
Since
some of the reasons why the nerve of a tooth and its pulp become
inflamed and infected are due to deep decay, repeated dental
procedures on a tooth and/or large fillings, following good
oral hygiene practices (brushing twice a day, flossing at least
once a day, and scheduling regular dental visits) may reduce
the need for a root canal procedure. Trauma resulting from a
sports-related injury can be reduced by wearing a mouth guard.
