Root Canal Treatment
Endodontics is the branch of dentistry that deals with the pulp of the tooth. The pulp can be found in the centre of the tooth and in the canals inside the root of each tooth. Pulp has nerves, connective tissue, and several blood vessels. Pulp nourishes the tooth when it comes out. At the first time it exits through the gums, pulp will give life to your tooth. When the tooth reached full growth, the pulp can be removed without destroying the tooth because each tooth is also nourished by a blood supply in the gums.
Removing the pulp is an endodontic treatment. It is often referred to as a root canal treatment or a root canal therapy. Most people even refer to the removal of pulp as "having a root canal." Root canal treatment is very common and it has saved about twenty four million teeth every year in the United States alone.
Why do you need root canal treatment?
There are two main reasons for having a root canal treatment. The first reason for having a root canal treatment is infection. An untreated cavity is the most common cause of pulp infection. The tooth decay will erode the enamel of the tooth, then the dentin layer, and then finally it will reach the root canal. This will allow bacteria to infect the pulp. Unfortunately, antibiotics are unable to get to infections inside the teeth. The inflammation caused by the infection will reduce the blood supply of the tooth. This reduced blood supply will also prevent the pulp from healing.
The second reason for a root canal treatment is due to damage in the pulp that can not be fixed. Trauma or a fractured tooth can damage the pulp. Restoration procedures can damage the pulp as well. Several fillings placed on the same tooth can damage the pulp over time. Even common dental procedures like preparing the tooth for a crown can harm the pulp. In these cases, the tooth may need a root canal.
When the pulp is inflamed but not infected, it could heal all on its own. Your dentist may want to see this happen first before performing a root canal. If the pulp continues to be inflamed then it may lead to pain and infection. Infections in the pulp will affect the bone around the tooth and can cause an abscess to form. The goal of root canal treatment is to save the tooth by removing the infected or the damaged pulp. Any infection will be treated and the empty root canals will be filled with a material called gutta percha.
If root canal treatment isn't done then the infected tooth will have to be extracted. As much as possible, you must try to keep your natural teeth. If a tooth is missing then neighbouring teeth will have a tendency to drift out of line. They can also become overstressed from chewing. When you keep your natural teeth, you also avoid other treatments like implants or bridges. Moreover, if you ignore an infected or injured tooth, it can even spread to other parts of your body.
If you have a root canal treatment then your tooth does not necessarily have to be pulled out after a couple of years. Once a tooth is treated, it may last for the rest of your life already.
What are some of the signs and symptoms to watch out for?
If your pulp is infected, you may not be able to feel any pain at first. However, if it is not treated, the infection may cause pain and swelling. In some cases, maybe an abscess will even form. Your tooth may need a root canal treatment if
- it hurts when you bite, touch it, or push it
- it is sensitive to heat
- it is sensitive to cold for more than a couple of seconds
- there is swelling near the tooth
- your tooth is discoloured
- your tooth is broken
In order to determine whether root canal treatment is needed or not, your dentist will place hot or cold substances against your tooth. The purpose is to see if the tooth is more or less sensitive than normal teeth. Your dentist will examine the tissues around the tooth. Your dentist will also tap on the tooth in order to test for symptoms.
You will be given X-rays for the bones around the tooth. The X-ray will show a widening of the ligament that holds the tooth in place or it will show a dark spot at the tip of the root. If any of these are seen in the X-ray then your dentist will recommend a root canal procedure.
Your dentist will need as much information as possible about the tooth. Your dentist can use an electric pulp tester. This hand-held device sends a small electric current through the tooth and it will help your dentist determine if the pulp is still alive. The test does not cause pain or shock. You will simply feel a tingling sensation. This sensation will stop when the tester is removed from the tooth. If you have a cardiac pacemaker or any other electronic life support device then you should inform your dentist. An electric pulp tester must not be used in these cases.
How long does a root canal treatment take?
A root canal treatment can be done in one or more visits and it is dependent on the situation at hand. Uncomplicated root canal treatments can be completed in only one visit. Some teeth are harder to treat because of their position in the mouth. Some teeth have more roots than others. Treating a tooth with more roots takes more time. There are some teeth that have curved root canals which are difficult to find. If your teeth are infected then you will have to visit the dentist several times in order to ensure that the infection is eradicated.
After the root canal treatment, you will need to see a general dentist to have a crown or a filling placed on the tooth. You are more likely to receive a crown if the tooth is discoloured or if it is used for chewing. The purpose of having a crown is to prevent the tooth from breaking later on.
How do you measure the root canals?
First, your dentist or endodontist will numb the area surrounding the tooth. You may also receive sedation in the form of nitrous oxide. Your dentist will also use other means to reduce your anxiety. Before your first appointment, you must ask your dentist what is available.
After sedation, your dentist will make a hole in the top or back of your tooth in order to reach the pulp chamber. Your dentist will remove some of the diseased pulp.
At this point, the root canals can be measured. Dentists will use X-rays or an electric device called an apex locator. Using an X-ray, your dentist will place a file in to the canal and then take an X-ray. Using an apex locator, your dentist will measure the canal based on the reactions and resistance from a small electric current. Sometimes dentists will use both methods.
How do you clean the root canals?
After the canals are measured, your dentist or endodontist will clean it using special tools. The diseased pulp will be removed and the canal will be cleaned with antiseptic. This will help treat and prevent any further infection. All of the canals in the tooth must be cleaned. There are several different canals in a tooth. They can be found at
- the top front teeth have only one canal
- the bottom front teeth have one to two canals
- the premolars have one to two canals
- the molars have three to four canals
The location and the shape of the canals can vary from one tooth to the other. Some of the endodontists will look inside a tooth using a microscope in order to make sure that all of the canals are cleaned. After the canals have been cleaned thoroughly, the roots are filled. A temporary filling is placed over the tooth for the meantime. This is not meant to last. The top of the tooth must be covered with a permanent filling later on.
Most teeth will need a crown. A crown will help restore the tooth's strength and protect it from cracking. If a crown is needed then it should be placed after having the root canal treatment. The pulp that was removed during the root canal treatment is the part that responds to temperature. Your tooth will not be responsive to changes in temperature anymore. There will still be tissues and nerves around the tooth so it may still respond to pressure and touch.
What should you do after the root canal treatment?
Your tooth will be sore for two to three days after the treatment. If the infection or inflammation was really bad before the treatment then the tooth will be more sensitive afterwards. You should avoid chewing on the affected side. You can take over-the-counter painkillers if needed. You can also take a pain reliever that reduces inflammation. Ibuprofen and aspirin are some examples.
What are some of the possible complications from a root canal treatment?
Since the root canal treatment is an invasive treatment, complications can occur. Sometimes when a root canal is opened for treatment, the oxygen in the air will trigger some bacteria to grow. This will cause swelling and pain.
Blood vessels enter the tooth through a small hole beneath the root of the tooth. In some root canal procedures, bacteria are pushed through this hole and into the surrounding tissue. If this happens, the surrounding tissue will become inflamed and may even become infected. This can be treated with painkillers and antibiotics however, the area will be painful until the infection and inflammation are gone.
A root canal treatment can puncture the side of the tooth especially in curved canals or canals that are hard to find. The tools that dentists use are flexible and they can bend as the canal curves. Sometimes, they will bend at the wrong time and make a small hole at the side of the tooth. If saliva can enter this hole then it has to be filled. In some cases, the tooth may even have to be removed. If the hole is far enough under the gum and if saliva can no longer reach it then the hole may close on its own.
Finding the root canals can be a difficult process. If all of the canals aren't found and cleaned, the tooth will stay infected. This can also happen if a canal is not measured properly. Pieces of inflamed pulp can be left near the bottom. In this case, the root canal procedure has to be done again. On some occasions, root canals have branches that are unreachable with the dentist's tools.
The tip of a file can break off inside the tooth and if the tooth is clean, the piece of file can be left there. If the canal is not completely cleaned out, the file piece has to be removed. This can be done from the top of the tooth but in some cases, the file is removed using a surgical procedure called an apicoectomy. A small cut is made in the gum so that the dentist can get at the root of the tooth. The dentist will then shave off the bottom of the root and get into the canal from the bottom. Finally, the file piece is removed.
Will there be any pain during the root canal procedure?
In most cases, there will be no pain in a root canal procedure. Your dentist will use anaesthesia to numb the area around the tooth. If you are feeling any pain during the treatment then you should let your dentist know about it. Some people are actually more afraid of the anaesthesia injection than the root canal procedure itself. Nowadays, the numbing gels are modern injection systems have made the injections practically painless. If the injection hurts then you should let your dentist know about it. Your dentist can change the way the injection is being administered in order to reduce or avoid any pain.