Endodontics is a branch of dentistry that deals with treating irreversible and reversible conditions of teeth. The most common procedure performed is root canal treatment. Endodontic therapy also consists of root canal re-treatment, endodontic surgery and endodontic cosmetic procedure such as non-vital bleaching of a tooth.
A tooth needing root canal treatment or re-treatment can show a wide range of symptoms and diagnostic findings. Pain, swelling, draining fistula are very common symptoms of inflammation or infection of the surrounding tissues.
Patients usually associate root canal treatment with severe discomfort. Most procedures are painless with proper administration of local anesthesia. Lets discuss endodontic procedures individually.
- Root Canal Treatment
- Root Canal Re-treatment
- Necrotic “dead tooth”
Root Canal Treatment
Why do we need root canal treatment
Root canal treatment is a very common procedure in dentistry. Teeth are not completely solid but have an empty space in the center. The empty space is filled with the pulp tissue. In the center of the tooth are blood vessels, lymphatics, nerve tissue and stem cells, which are there to nourish and protect the tooth from an infection. All the vital tissue comes out of the tooth trough the apical foramen, which is a very small opening around the tip of the root. Tooth decay, gum disease (periodontal disease), or a traumatic injury will lead to the tissue becoming inflamed and or infected. Infected means that the space was invaded or contaminated by a foreign microorganism. While inflammation is caused by our bodies own defenses as a response to injury or an infection. Unlike other areas of our body, the soft tissue within the tooth is totally encased with hard tissue. Because of this the body is unable to deal with any infection effectively. Any long-term inflammation can also lead to decreased blood flow and eventually necrosis or death of the soft tissues. The body cannot effectively repair or remove the damaged tissue, which is why root canal treatment is completed by a dentist. The main objective of root canal treatment is to eliminate inflamed tissue or dead tissue (necrotic tooth), bacteria and its byproduct and any other irritating substances from the root of a tooth. After the tissue is removed, the tooth is cleansed and disinfected and filled with a special filler material and sealer. The filling material placed in a tooth will seal the opening through which the nerve and blood vessels used to enter the tooth. This seal should keep the bugs and other irritants that were left in the canal of a tooth in check, and prevent any future infections around the roots of the affected tooth.
What Are The Causes That Lead To Root Canal Treatment
- Bacterial infection is the most common cause of tooth irritation, which ultimately leads to the need for root canal treatment. Untreated bacterial infection of the tooth can lead to irritation or infection of the pulp (region in the center of the tooth where nerves and blood vessels are present). A large cavity allows bacteria (bugs) to irritate or infect the pulp . The infection elicits an inflammatory response as the body tries to get rid of the offending microbes or other irritants. This causes inflammation (swelling) within the tooth, which leads to pain and decreased blood flow. Decreased blood flow leads to low oxygen levels as well as limited nutrition for the cells in the tooth. Over time this occurrence leads to necrosis or death of the soft tissues present in the tooth. Root canal treatment or an extraction become the only options that will eliminate pain and the infection.
- Localized trauma is another cause of pulp tissue inflammation and soft tissue necrosis. An accident or a traumatic episode leads to either compromised or no blood flow to the tooth. Just like in the instance of the infection the soft tissue of the pulp will be compromised by poor or no blood supply. This ultimately leads to soft tissue necrosis and the need for endodontic treatment or extraction.
Objective of Root Canal Treatment
Root canal treatment procedure is aimed at cleaning the canal of the tooth to eliminate the swollen, diseased tissue or dead tissue. This is completed by making a small access opening on the biting surface of the tooth. The area, which houses the soft tissue is cleansed and enlarged for easier access. After the internal portion of the tooth is cleaned and disinfected, a filler material is placed in the tooth with a special sealant to create a tight seal near the small opening close to the tip of the root. This is performed to seal any bacteria, bacterial byproducts and other bad substances within the tooth. Internal anatomy of each tooth is different and in certain cases all internal areas of the tooth are inaccessible. This is why the seal near the tip of the root is so important. If bacteria or bacterial byproducts make it out of the sealed root, the body will elicit an inflammatory reaction around the root, which can lead to pain and swelling. This is one of the common reasons for the need of root canal re-treatment, or repeated treatment after root canal was already completed.
The whole procedure is done under anesthesia and the tooth is isolated with a rubber dam to prevent further influx of bacteria from the oral cavity into the tooth. In most cases root canal treatment can be completed in a single appointment. In some instances, especially in the presence of a severe infection and swelling, the dentist might clean and disinfect the tooth and place antimicrobial medicine inside the tooth. The medicine will help the infection resolve and disinfect the internal portion of the tooth further.
After root canal treatment is completed, a temporary filling is placed to cover the tooth until the final restoration is completed. In most instances a crown is recommended to protect the remaining tooth structure and create a good seal to prevent leakage of bacteria into the tooth. The crown should be placed on the tooth as soon as possible. This will improve the long-term prognosis of the tooth. In certain instances, especially in teeth with no previous restorations, the upper and lower front teeth can be restored with a filling. Because of the internal anatomy of the front teeth, in most instances the teeth are structurally strong and will hold up well under normal function.
Any postoperative symptoms such as pain, swelling, discomfort on chewing should resolve within 2-4 days. There are always exceptions to the rule. The level of postoperative discomfort can usually be correlated to the severity of infection or inflammation at the time of treatment.
Referral to a Root Canal Specialist (Endodontist)
In certain situations your dentist might elect to refer you to an endodontist, or a dentist that specializes in root canal treatment and surgical treatment of infected teeth and the surrounding areas. Complicated tooth anatomy, difficult access to the tooth or the canals, curved roots, and extra canals that are difficult to locate might pose challenges for a general dentist. By referring you to an endodontist your dentist is looking out for your best interest, making sure that you get the best treatment possible.
As with any specialist visit, the root canal treatment will end up costing you more than it would have if the general practitioner completed it. The cost is higher due to the complexity of the case and the time needed to complete it.