Endodontics is the branch of dentistry that deals with diseases of the tooth’s pulp, which is located in the centre of the tooth and in canals (called root canal) within each tooth root. Pulp, consisting of nerve tissue and blood vessels, nourishes the tooth wen it forms and emerge through the gum. Once the tooth matures, the pulp can be safely removed from the pulp chamber and root canals and the tooth can be maintained. Removing the pulp is called endodontic treatment but is often referred to as root canal treatment.
Root Canal Treatment
Why Would One Need Root Canal Treatment?
Root canal treatment is needed for two main reasons:
- Irreversible damage to the pulp
An untreated carious cavity (decayed/rotten tooth) is the most common cause of pulpal infection. The decay erodes the enamel and dentin of the tooth until it opens into the root canal system, allowing bacteria to infect the pulp. Infections inside teeth do not respond to antibiotic treatment. The inflammation caused by the infection restricts the tooth’s blood supply, so that antibiotics in the bloodstream cannot reach the infection in adequate amounts. The reduced or absent blood supply also limits the pulp’s ability to heal itself.
The pulp can become damaged from trauma, a fracture or extensive restorative work, such as several fillings placed over a period of time. Sometimes, a common dental procedure can cause the pulp to become inflamed. For example, preparing a tooth for a crown sometimes leads to the need for root canal treatment.
In many cases, when the pulp is inflamed, but not infected, it will heal and return to being healthy. The tooth just needs to be monitored to see if it happens before commencing any treatment. Sometimes, though, the pulp remains inflamed, which can cause pain and may lead to infection.
Once the pulp becomes infected, the infection can spread to the bone around the tooth, causing an abscess to form. The goal of the root canal treatment is to save the tooth by removing the infected or damaged pulp, treating any infection, and filling the empty canals with inert material. When required, if root canal treatment is not done, the tooth has to be extracted.
It is better to retain natural teeth if at all possible. If a tooth is missing, neighbouring teeth can drift out of line and can be overstressed. Retaining natural teeth also helps prevent the need for more extensive and expensive treatments, such as implants and bridges.
Having endodontic treatment on the tooth does not mean that it will need to be extracted in a few years. Teeth that have had root canal treatment do eventually become more brittle than other teeth and can break more easily. However, if the tooth adequately protected by crown or full coverage filling, the tooth should last many years.
Signs and Symptoms
If one has an infection of the pulp, no pain may be felt at first. But if left untreated, the infection will cause pain and swelling. In some cases, an abscess will form. Eventually, the tooth may need to be extracted. Some indications that a tooth may need root canal treatment are:
Length of Treatment
Root canal treatment commonly takes two to four appointments, depending on the complexity of treatment and anatomy of the affected tooth. Each appointment may wary from 30 to 90 minutes.
During each appointment, the tooth is first anaesthetised, and then isolated with the sheet of latex (called ‘rubber dam’). This keeps the tooth dry and prevents introducing bacteria into operating field.
Complete treatment consists of the following basic steps:
With successful root canal treatment, the tooth will no longer cause pain. However, because it does not contain an internal nerve, the tooth no longer has sensitivity to hot, cold, or sweet stimuli. These are signs of dental decay, so regular dental check ups with periodic x rays are recommended to avoid further disease in the root filled tooth. The restored tooth could last a lifetime, however, with routine wear, the filling or crown may eventually need to be replaced.
As with most dental invasive dental and medical procedures, complications unfortunately occur. Here are some most common possibilities.
A file (dental instrument used to clean and shape root canals) may break inside the tooth. Usually, it’s possible to leave separated piece in the tooth and finish treatment. But if the cleaning of the canal has not been completed, the file may have to be removed by specialist endodontist. Or the tooth may need to be extracted.
The treated tooth may become darker. It may require further treatment such as whitening the tooth, or fitting a crown or veneer to must darker tooth structure.
Post treatment pain that lasts more than a few days may require further treatment.
A canal may be missed or entire canal may not be fully cleaned out. Locating canals within the tooth can be difficult. If a canal or an offshoot of the canal is not located and cleaned, the tooth can remain infected and the root canal procedure may be repeated.While root canal treatment can save most teeth, it is not successful in every case. Success depends on many factors such as patient’s general health, age, capacity to heal, oral hygiene, and but more importantly the amount and strength of the remaining tooth structure.