Some things you may like to know about your root treatment.
What is endodontic (root canal) treatment?
Endodontics is that branch of dentistry concerned with the prevention, diagnosis, and treatment of diseases or injuries to the dental pulp. The pulp, which some people call "the nerve", is the soft tissue inside the tooth that contains the nerves and blood vessels and is responsible for tooth development. Root canal treatment is a safe and effective means of saving teeth that otherwise would be lost. In many countries Endodontics is a registered specialty just like the South African specialties of Orthodontics (braces), Periodontics (gum disease), and Maxillo-facial Surgery. In South Africa we don’t have specialist Endodontists, root treatments being performed in the main by general dentists, and, if more complicated, by specialist Prosthodontists. Some general dentists develop a special interest in this particular aspect of dentistry, and while not being specialist endodontists are prepared to acquire the extra training, and devote the extra time and effort to treat diseases of the dental pulp.
What causes the pulp to die or become diseased?
When a pulp is injured, diseased, and unable to repair itself, it becomes inflamed and eventually dies. The most frequent causes of pulp death are extensive decay, deep fillings, trauma (e.g. severe blow to a tooth), cracks in teeth, and periodontal or gum disease. When a pulp is exposed to bacteria from decay or saliva that leaks into the pulp system, infection can occur inside the tooth and, if left untreated, can cause infection to build up at the tip of the tooth, forming an abscess. Eventually the bone supporting the tooth will be destroyed, and pain and swelling will often accompany the infection. Without endodontic treatment, the tooth will eventually have to be removed.
What are the symptoms of a diseased pulp?
Symptoms may range from momentary to prolonged, mild to severe pain on exposure to hot or cold or on chewing or biting. In some cases the condition may produce no symptoms at all. An X-ray examination may or may not demonstrate the abnormal condition of the tooth. Sometimes in the absence of pain, an X-ray will show evidence of a diseased state in the pulp or tissues surrounding the root .
What is the success rate of root canal therapy?
Endodontics, if performed properly, is one of the few procedures in dentistry that has a predictable prognosis. Studies indicate that root canal treatment is usually 90% to 95% successful. Those in the failure group may still be amenable to re-treatment or surgical treatment to save the tooth, though no treatment's success can be guaranteed. In addition, patients must understand that prognoses vary depending on the specifics of each case and that, without good oral hygiene and a sound restoration after endodontics, there may be an increased chance of failure. Long-term follow-up is advisable to monitor the status of the root treated tooth.
Will the endodontically treated tooth discolour?
If treatment is performed correctly, discolouration seldom occurs. Bleaching with heat or chemical can be used to treat discoloured teeth. Some endodontically treated teeth appear discoloured because they have been restored with tooth-coloured fillings that have become stained or with amalgam fillings that leach silver ions. In these cases the fillings may be replaced or crowns or veneers fitted.
What are the alternatives to root canal treatment?
The only alternative is to extract the tooth, which often leads to shifting and crowding of surrounding teeth and subsequent loss of chewing efficiency. Although extraction may seem the easy way out, it may, depending on the case prove more costly in the end.
Will the tooth need a crown after the treatment?
If there is no previously existing crown, the need for a crown depends on the amount of sound tooth structure remaining after endodontic treatment. Also upon the type of tooth, and the amount of chewing force the tooth will be subjected to. Loss of tooth structure significantly weakens the tooth and renders it more susceptible to fracture; as a result, it may be necessary to protect what is left of the tooth with a strong restoration such as a crown.
What does root canal treatment involve?
Treatment may require one to three appointments, depending on the diagnosis, the number of root s, and the complexity of the case. During these appointments, the diseased or injured pulp tissue is removed, the root canals are cleaned, enlarged, and sealed to prevent recontamination of the root canal system.
The following steps describe the technical aspects of treatment.
- At each visit local anaesthesia is administered and the tooth isolated with rubber dam. Rubber dam prevents contamination from saliva and protects the patient.
- An opening is made through the top of the tooth to gain entrance to the root canal system.
- The pulp tissue is painlessly removed with special instruments called files.
- The exact length of the root canal is determined using an electronic apex locator; periodic radiographs must be taken to verify this measurement.
- The root canal is cleaned, enlarged, and shaped so that it can be filled, or sealed at the final appointment.
- Between appointments, medication is placed in the root canal and sealed in using a temporary filling.
- At the final appointment, the canal is sealed or filled to prevent recurrent contamination. The process of filling the canal is called obturation.
- Permanent restoration of the tooth is accomplished after completion of the root canal treatment.
Will it hurt afterwards?
After a visit for root canal therapy, some patients do experience a degree of discomfort. This discomfort is usually of short duration and normally alleviated by “over the counter” medication such as aspirin, paracetamol, myprodol e.t.c. Depending on the diagnosis, you are more likely to experience pain after your visit if you were already in pain prior to treatment.
There’s something else I need to know ...
If you have any further questions regarding your root canal treatment, or indeed any aspect of your dental treatment please feel free to ask.
Dr. Barry J.D. Forshaw. BDS PDD(ClinDent) HonsBSc(DentSc)(Endodontics)