HOME > General Dentistry > Endodontics

Orthodonitics: Root Canal Treatment

The goal of endodontic (root canal) treatment is to preserve an ailing tooth.
Although root-canal treatment can frequently save a tooth from extraction, damaged or diseased teeth often require extraction. In the picture on the right, the pulp chamber and the root canals are clearly visible as white areas in the x-ray image. Root-canal treatment involves the removal of a tooth셲 pulp and the sealing of the pulp chamber and canal or canals.
The pulp is soft tissue containing blood vessels and nerve tissue. The pulp extends from the pulp chamber in the crown down through the root canal to the tip of the root in the jawbone.
A tooth has only one pulp chamber but may have more than one root. Incisors, or front teeth, have only one root, while molars have three roots. Each root has only one canal. A typical scenario that leads to the need for root-canal therapy starts with a small surface cavity caused by tooth decay.
Early stages of a cavity셲 development are painless and the patient has no idea of a problem existing. An early-stage cavity is usually detected during a routine examination or during a regular cleaning and scaling session. Decay is not reversible, or self-curable; once decay begins, intervention is required. In the case beyond early detection, as decay progresses, the cavity penetrates deeper into the tooth and symptoms begin to appear.
Some early symptoms of decay penetrating deeper and deeper into the tooth are discomfort from hot and cold or, perhaps, some sensitivity or mild pain when chewing. At this point in the progression of tooth decay, the enamel has been penetrated, exposing the softer dentine layer of the tooth.
Cleaning away decayed tooth material and filling the cavity will generally yield a long-lasting cure. When symptoms are ignored by the patient, decay relentlessly destroys a healthy tooth.
As decay continues to progress deeper into the dentine, much of a healthy tooth must be ground away to prepare the tooth for a filling, which becomes problematic later in life as decay begins to form along the margin, or edge, of the filling after five to 10 years. Modern filling materials, including porcelain, ceramic inlays, and composite resin are often used instead of traditional heavy-metal amalgam, because they are safer, more long-lasting, and look more natural than amalgam. Late-stage decay occurs when the decay has eaten away at the hard enamel, then the soft dentine, and finally breaches the pulp chamber, which generally means death to the tooth. When decay penetrates into the pulp, infection, swelling, and severe pain require immediate treatment.
Infected pulp cannot repair itself. Bacteria and their products leak into the pulp and cause the pulp to die. If a root canal procedure is not performed, an abscess (severe infection) can form at the tip of the root and cause considerable pain, as well as damage to the surrounding bone. .
Even if there is no pain, the bone that anchors the tooth in the jaw can be severely damaged by the bacteria.
Successful root canal treatment saves the tooth and helps to retard further bone loss. Without root-canal treatment, the tooth will require extraction, which leads to further bone loss, as we grow older.
In the scenario where a root canal fails and the tooth requires extraction, tooth replacement becomes beneficial to long-term health and is more comfortable.
A bridge or an implant can restore a missing tooth. Although more expensive than a bridge, replacing a lost tooth with an implant is usually the most natural and trouble-free way to restore oral health. Patients should be aware that detecting tooth decay as early as possible, before the onset of symptoms, assures the least amount of damage to a tooth.
Early detection of decay is the most effective way to prevent the cascading of decay from a minor issue to a major cause of many oral maladies.
Catch decay early and have happy teeth.

What to Expect

Here is what you can expect when you have root canal treatment.

Initial visit : Local anesthetic usually is given to maintain patient comfort. The affected tooth is isolated from saliva
with a rubberlike sheet called a dam. An opening is made through the crown of the tooth. The pulp is removed and then
the root or roots are cleaned and shaped.
Medication is injected to sterilize the reshaped pulp chamber and root canal or
canals. A temporary filling is placed in the crown opening to keep out saliva and food particles. Oral antibiotic is
prescribed along with pain medication if an infection is present in the tissues surrounding the affected root or roots.

Next visit : Within a few days, swelling and pain have subsided.
At this point, a decision has to be made as to
whether or not the root or roots are free of infection. If they are not yet free of infection, then another attempt at cleaning
and reshaping the pulp is required. If the pulp chamber and root or roots are clean, completing the root-canal procedure
then proceeds.

To complete the root-canal procedure, the temporary filling is removed and the root canal is permanently sealed: The pulp chamber, including the tip, or apex, and the canals of the roots, is sealed with a cement-like material called MTA, or mineral trioxide.
Another method is to seal the cleaned canal with traditional gutta percha, a latex-like sap of a tropical tree. Gutta percha has been the traditional sealant for the root tip, as well as the canal and the pulp chamber. Mineral trioxide is favored, nowadays, because there is a higher success rate due to its ability to obtain a tighter seal at the root tip than with gutta percha. A successful root canal saves the tooth, but there is a catch, as it were.
A tooth셲 blood supply travels through the root tip and around the pulp chamber. Root canal treatment completely seals the tip, the canal, and the chamber, which eliminates blood supply to the tooth.
Over a period of several years after successful root canal treatment, the affected crown darkens in color and becomes brittle and vulnerable to cracking or breaking. To minimize potential problems associated with crown vulnerability, a new crown of porcelain or ceramic is fitted to the top of the sealed root shortly after root-canal treatment, which permanently restores the strength of the affected tooth. To give added strength to the restored crown, a gold or a plastic post (a needle-like pin) is inserted into the root.
The porcelain or ceramic cap rests on top of the remaining original root or roots. Adding the post strengthens the structural bond that secures the restored crown atop the salvaged root.