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What is Endodontics?
Endodonticsis the science of saving teeth
Why should I save my teeth? Isn’t it
easier to just pull the bad tooth out?
Nothing is as good as your natural tooth!
Saving your natural tooth should always be your first choice when
dental care is needed. Nothing, not even the most advanced bridges and
implants, can truly replace your natural tooth.
- If your dentist recommends extracting your tooth, ask if it can
be saved with an endodontic procedure, also known as root canal
treatment. Endodontic treatment removes the injured pulp (soft inner
tissue) of your tooth and fills and seals the space. Your tooth is
then restored and can function just like any other tooth for the
rest of your life, ensuring comfortable chewing and a natural
appearance.
- If your tooth cannot be saved and some cannot you may consider
replacements such as a bridge or dental implant. Your options may
depend upon the condition of surrounding teeth and bone structure.
- Dental implant procedures can be complex, costly and they often
require several visits and several month’s healing time before the
procedure can be completed.
Why would I need an endodontic procedure?
Endodontic treatment is necessary when the pulp, the soft tissue
inside the root canal, becomes inflamed or infected. The nerve tissue
is vulnerable to damage from deep dental decay, accidental injury,
tooth fracture, or trauma from repeated dental procedures (such as
multiple fillings over time). In addition, an injury to a tooth may
cause pulp damage even if the tooth has no visible chips or cracks. If
pulp inflammation or infection is left untreated, it can cause pain or
lead to an abscess.
If a tooth becomes diseased or injured, bacteria build up inside
the pulp, spreading infection from the natural crown of the tooth to
the root tips in the jawbone. Pus accumulates at the ends of the
roots, forming a painful abscess which can damage the bone supporting
the teeth. Such an infection may produce pain that is severe,
constant, or throbbing, as well as prolonged sensitivity to heat or
cold, swelling and tenderness in the surrounding gums, facial
swelling, and discoloration of the tooth. Sometimes, however, there
are no symptoms
A persistent or recurring blister may be seen on the gums:
Sometimes a tooth with a dead nerve will produce a pimple-like lesion
on the gums. These may come and go. They are literally drains for pus
from an infected tooth, so a person may have a bad taste in the mouth.
A dentist may notice this lesion during examination even though the
patient has not noticed it. A tooth with a lesion like this will
always require endodontic treatment.
Are there any alternatives to root canal
treatment?
If root canal therapy is indicated there is no alternative but an
extraction. Root canal treatment deals with the inner aspects of a
tooth unlike other dental procedures. If such treatment is not
possible then the tooth should be extracted.
A patient should not decide to have a tooth extracted quickly.
Explore all options with dentist
What is the procedure for endodontic
treatment?
Endodontic treatment can be performed in one to several visits and
involves the following steps:
- The first step in the procedure is to take an X-ray to see the
shape of the root canals and determine if there are any signs of
infection in a surrounding bone.The dentist examines and x-rays the
tooth, then administers local anesthetic..Anesthesia may not be
necessary if the dentist finds that the nerve is dead. After the
tooth is numb, the dentist isolates the tooth to keep it clean and
free of saliva during the procedure
- An access hole will then be drilled into the tooth. The pulp
along with bacteria, the decayed nerve tissue and related debris is
removed from the tooth. Very small instruments are used to clean the
pulp from the pulp chamber and root canals and to shape the space
for filling. Disinfecting solutions are used periodically to flush
away the debris.
- Once the tooth is thoroughly cleaned, it is sealed. Some
dentists like to wait a week before sealing the tooth. For instance,
if there is an infection, your dentist may put a medication inside
the tooth to clear it up. Others may choose to seal the tooth the
same day it is cleaned out. If the root canal is not completed on
the same day, a temporary filling is placed in the exterior hole in
the tooth to keep contaminants out between appointments.
- At the next appointment, to fill the interior of the tooth, a
sealer paste and a rubber compound called gutta percha is placed
into the tooth's root canal. To fill the exterior access hole
created at the beginning of treatment, a filling is placed.
The final step will involve further restoration of the tooth.
Because a tooth that needs a root canal often is one that has a large
filling or extensive decay or other weakness, a crown, crown and post
or other restoration often needs to be placed on the tooth to protect
it, prevent it from breaking and restore it to full function. If the
tooth lacks sufficient structure to hold the restoration in place,
your dentist may place a post inside the tooth.Your dentist will
discuss the need for any additional dental work with you.
How does endodontic treatment save the
tooth?
To understand endodontic treatment, it helps to know something
about the anatomy of the tooth. Inside the tooth, under the white
enamel and a hard layer called the dentin, is a soft tissue called the
pulp. The pulp contains blood vessels, nerves, and connective tissue
and creates the surrounding hard tissues of the tooth during
development.
The nerve extends from the crown of the tooth to the tip of the
roots where it connects to the tissues surrounding the root. A tooth's
nerve is not vitally important to a tooth's health and function after
the tooth has emerged through the gums. Its only function is sensory –
to provide the sensation of hot or cold. The presence or absence of a
nerve will not affect the day-to-day functioning of the tooth.
The dentist removes the inflamed or infected pulp, carefully cleans
and shapes the inside of the canal, a channel inside the root, then
fills and seals the space. Afterwards, you will return to your
dentist, who will place a crown or other restoration on the tooth to
protect and restore it to full function. After restoration, the tooth
continues to function like any other tooth.
Will I feel pain during or after the
procedure?
Many endodontic procedures are performed to relieve the pain of
toothaches caused by pulp inflammation or infection.Root canal
treatment can be painless if caught early. Like most problems, the
longer you wait the worse it can be to treat. See your dentist right
away if you feel any pain with chewing, or to hot and cold foods. With
modern techniques and anesthetics, most patients report that they are
comfortable during the procedure. For patients, root canal therapy is
one of the most feared procedures in all of dentistry; contrary to
popular belief, however, modern root canal treatment may be relatively
painless due to effective pain control techniques.Lidocaine is a
commonly used local anesthetic. Pain control medication may be used
either before or after treatment. However, in some cases it may be
very difficult to achieve pain control prior to performing a root
canal. For example, if a patient has an abscessed tooth, with a
swollen area or "fluid-filled gum blister" next to the tooth, the pus
in the abscess may contain acids that inactivate any anesthetic
injected around the tooth. In this case, it is best for the dentist to
drain the abscess by cutting it to let the pus drain out. Releasing
the pus releases pressure built up around the tooth; this pressure
causes much pain. The dentist then prescribes a week of antibiotics
such as penicillin, which will reduce the infection and pus, making it
easier to anesthetize the tooth when the patient returns one week
later. The dentist could also open up the tooth and let the pus drain
through the tooth, and could leave the tooth open for a few days to
help relieve pressure. At this first visit, the dentist must ensure
that the patient is not biting into the tooth, which could also
trigger pain. Sometimes the dentist performs preliminary treatment of
the tooth by removing all of the infected pulp of the tooth and
applying a dressing and temporary filling to the tooth. This is called
a "pulpectomy." The dentist may also remove just the coronal portion
of the dental pulp, which contains 90% of the nerve tissue, and leave
intact the pulp in the canals. This procedure, called a "pulpotomy,"
tends to essentially eliminate all the pain. A "pulpotomy" may be a
relatively definitive treatment for infected primary teeth. The
pulpectomy and pulpotomy procedures eliminate most all pain until the
follow-up visit for finishing the root canal. But if the pain returns,
it means any of three things: the patient is biting into the tooth,
there is still a significant amount of sensitive nerve material left
in the tooth, or there is still more pus building up inside and around
the infected tooth. All of these cause pain. For the first few days
after treatment, your tooth may feel sensitive, especially if there
was pain or infection before the procedure. This discomfort can be
relieved with prescription medications. Follow your dentist’s
instructions carefully.
Will the tooth need any special care or
additional treatment after endodontic treatment?
You should not chew or bite on the treated tooth until you have had
it restored by your dentist. The tooth is susceptible to fracture, so
you should see your dentist for a full restoration as soon as
possible. Otherwise, you need only practice good oral hygiene,
including brushing, flossing, and regular checkups and cleanings.
After receiving a root canal, the tooth should be protected with a
crown that covers the cusps of the tooth. Otherwise, over the years
the tooth will almost certainly fracture, since root canals remove
tooth structure from the tooth and undermine the tooth's structural
integrity. Also, root canal teeth tend to be more brittle than teeth
not treated with a root canal.Most endodontically treated teeth last
as long as other natural teeth. In a few cases, a tooth that has
undergone endodontic treatment does not heal or the pain continues.
Occasionally, the tooth may become painful or diseased months or even
years after successful treatment. Often when this occurs, redoing the
endodontic procedure can save the tooth. The restored tooth could last
a lifetime; however, with routine wear, the filling or crown may
eventually need to be replaced.
What causes an endodontically treated
tooth to need additional treatment?
New trauma, deep decay, or a loose, cracked or broken filling can
cause new infection in your tooth. In some cases, the dentist may
discover additional very narrow or curved canals that could not be
treated during the initial procedure.. Placement of a crown or
cusp-protecting cast gold covering is recommended also because these
have the best ability to seal the root canaled tooth. If the tooth is
not perfectly sealed, the root canal may leak, causing eventual
failure of the root canal.The procedure is often complicated,
depending on circumstances, and may involve multiple visits over a
period of weeks.
Can all teeth be treated endodontically?
Most teeth can be treated. Occasionally, a tooth can't be saved
because the root canals are not accessible, the root is severely
fractured, the tooth doesn't have adequate bone support, or the tooth
cannot be restored. However, advances in endodontics are making it
possible to save teeth that even a few years ago would have been lost.
When endodontic treatment is not effective, endodontic surgery may be
able to save the tooth.
How Successful Are Root Canals?
Root canal treatment is highly successful; the procedure has more than
a 95% success rate. Many teeth fixed with a root canal can last a
lifetime.
Also, because the final step of the root canal procedure is
application of a restoration such as a crown or a filling, it will not
be obvious to onlookers that a root canal was performed.
What are the Risks involved?
There is a possibility that the root canal treatment will not be
successful the first time. If infection and inflammation recur and an
x ray indicates retreatment is feasible, the old filling material is
removed and the canals are thoroughly cleaned out. The dentist will
try to identify and correct problems with the first root canal
treatment before filling and sealing the tooth a second time.
In cases where an x ray indicates that retreatment cannot correct
the problem, endodontic surgery may be performed. In a procedure
called an apicoectomy, or root resectioning, the root end of the tooth
is accessed in the bone, and a small amount is shaved away. The area
is cleaned of diseased tissue and a filling is placed to reseal the
canal.
In some cases, despite root canal treatment and endodontic surgery,
the tooth dies anyway and must be extracted.
What can I do to prevent a root canal?
It's good to see a dentist every six months, because they can
usually catch problems before something like a root canal becomes
necessary. Anytime you feel pain in your tooth or jaw, though, see
your dentist immediately. It's risky to wait until you have the
stabbing pain of a severe toothache. Since some of the reasons why the
nerve of a tooth and its pulp become inflamed and infected are due to
deep decay, repeated dental procedures on a tooth and/or large
fillings, following good oral hygiene practices (brushing twice a day,
flossing at least once a day, and scheduling regular dental visits)
may reduce the need for a root canal procedure. Trauma resulting from
a sports-related injury can be reduced by wearing a mouth guard.
When is Endodontic surgery or Apicectomy
required?
When a root canal filling develops a granuloma, cyst, or some other
infected area at the end of the root, dentists will sometimes endeavor
to save the tooth by performing an operation called apicoectomy.
Despite your dentist's best efforts to clean and seal a tooth, new
infections might emerge. Among the likely reasons for this include:
- More than the normally anticipated number of root canals in a
tooth
- crack in the root of a tooth
- A breakdown of the inner sealing material over time, allowing
bacteria to recontaminate the inner aspects of the tooth
The area of infection seen on x-ray pictures is actually a hole in
the bone of the jaw eaten away by bacteria and toxins. It contains
pus, bacteria and infected tissue Sometimes retreatment can be
successful, other times endodontic surgery must be tried in order to
save the tooth. The most common endodontic surgical procedure is an
apicoectomy or root-end resection. This procedure relieves the
inflammation or infection in the bony area around the end of your
tooth that continues after endodontic treatment.
What is the procedure of endodontic surgery?
In this procedure, the gum tissue is opened, the infected tissue is
removed, and sometimes the very end of the root is removed. A small
filling may be placed to seal the root canal.
The apicoectomy surgery is done using a local anesthetic. An
incision is made in the gum and the dentist invades the infected area
and curettes away the diseased tissue.
Two or three stitches are used to close the wound. These areas
experience some swelling for two or three days but generally heal with
very little discomfort. Usually new bone immediately begins to grow
and fill in the jaw at the end of the root, and after six to 12 months
one can no longer distinguish the location of the infection. In other
words, the area's appearance is now normal.
At times when cysts or other large areas of infection are found,
dentists will elect to do the root canal treatment and apicoectomy at
the same sitting.
How much will the procedure cost as regards
money and time?
The cost of endodontic treatment varies depending on how complex the
problem is and which tooth is affected. Molars are more difficult to
treat, the fee is usually more. Express any concerns or questions you
might have with your dentist and be sure to keep up with regular check
up appointments, because a root canal is an investment that should be
protected. Generally, endodontic treatment and restoration of the
natural tooth are less expensive than the alternative of having the
tooth extracted. An extracted tooth must be replaced with a bridge or
implant to restore chewing function and prevent adjacent teeth from
shifting. These procedures tend to cost more than endodontic treatment
and appropriate restoration. With root canal treatment you save your
natural teeth and money.
The root canal procedure seems lengthy and expensive. Getting rid
of the problem tooth seems an easier thing to do. However once the
tooth is pulled out, it has to be replaced. If the tooth is not
replaced it can create further problems ranging from shifting of
neighboring and opposing teeth, gum problems, reduction in local bone
to jaw joint problems. The cost of the procedure as regards time and
money is minimal considering the expenditure required to replace that
tooth.
Let us take an example
After a lower first molar is removed, the area is allowed to heal
for a month at least and then replacement procedures are undertaken.
The following outcomes are possible depending on the oral health of
the patient
The tooth is not replaced-the second molar behind the missing tooth
and the premolar in front of the missing tooth drift into that space.
If the patient is a child, the drifting of teeth may not allow the new
adult tooth to come in the proper place. The opposing tooth also comes
lower into the space of the missing tooth and often ends up with gum
problems. Soon the patient cannot chew properly from that side and due
to shifted teeth, cleaning becomes a problem.
The tooth is replaced with a removable denture- The removable
partial denture fits on the soft tissue if made in acrylic. If it is
made with metal, the adjacent teeth are prepared to give it support.
This type of denture has to be removed daily to clean it and give the
tissues rest. This denture has to be replaced in a few years time if
the tissues beneath it change.
The tooth is replaced by a fixed bridge- The fixed bridge may seem
like an attractive option at first. However, to make the bridge, the
adjacent teeth are ground so that they can be covered with crowns
which will support the replaced tooth. The cost of the bridge is
therefore that of three crowns compared to only one crown required
after root canal treatment. The life of the bridge is about a decade
with very meticulous maintenance. Gum problems of the supporting teeth
or problems of the surrounding teeth may demand the replacement of the
bridge sooner.
The tooth is replaced with an implant- This is a better option than
the bridge as the neighboring teeth are not touched. However, an
implant entails at least one, sometimes two surgeries. The cost of an
implant is high and the treatment is done over a period of 6 -8
months. Also medical conditions like diabetes will affect the success
of the treatment and also decide whether this is a treatment option at
all.
It is obvious from the above that root canal treatment saves time,
money and most importantly YOUR NATURAL TOOTH.
Some common myths about root canal treatment
Myth #1—Root canal treatment is painful.
Truth—Root canal treatment doesn't cause pain, it relieves it.
Most patients see their dentist when they have a severe toothache. The
toothache can be caused by damaged tissues in the tooth. Root canal
treatment removes this damaged tissue from the tooth, thereby
relieving the pain you feel.
The perception of root canals being painful began decades ago when
root canal treatment was painful. But with the latest technologies and
anesthetics, root canal treatment today is no more uncomfortable than
having a filling placed. In fact, a recent survey showed that patients
who have experienced root canal treatment are six times more likely to
describe it as "painless" than patients who have not had root canal
treatment.
Myth #2—Root canal treatment causes illness.
Truth—Root canal treatment is a safe and effective procedure.
Research studies performed in the 1930s and 1940s and those conducted
in later years showed no relationship between the presence of
endodontically treated teeth and the presence of illness. Instead,
researchers found that people with root canal fillings were no more
likely to be ill than people without them.
The presence of bacteria in teeth and mouth has been an accepted
fact for many years. But presence of bacteria does not constitute
"infection" and is not necessarily a threat to a person's health.3
Bacteria are present in the mouth and teeth at all times, even in
teeth that have never had a cavity or other trauma.
teeth that receive proper endodontic treatment do not cause
illness.
Myth #3—A good alternative to root canal treatment is
extraction (pulling the tooth).
Truth Saving your natural teeth, if possible, is the very best
option.
Nothing can completely replace your natural tooth. An artificial
tooth can sometimes cause you to avoid certain foods. Keeping your own
teeth is important so that you can continue to enjoy the wide variety
of foods necessary to maintain the proper nutrient balance in your
diet.
Endodontic treatment, along with appropriate restoration, is a
cost-effective way to treat teeth with damaged pulp and is usually
less expensive than extraction and placement of a bridge or an
implant.
Endodontic treatment also has a very high success rate. Many root
canal treated teeth last a lifetime.
Placement of a bridge or an implant will require significantly more
time in treatment and may result in further procedures to adjacent
teeth and supporting tissues.
Millions of healthy endodontically treated teeth serve patients all
over the world, years and years after treatment. Those healthy teeth
are helping patients chew efficiently, maintain the natural appearance
of their smiles and enhance their enjoyment of life. Through
endodontic treatment, endodontists and dentists worldwide enable
patients to keep their natural teeth for a lifetime.
Some dental terms explained- Glossary
Abscess
A hole in the tooth or gum tissue filled with pus as the result of
infection. Its swelling exerts pressure on the surrounding tissues,
causing pain.
Apicoectomy
Also called root resectioning. The root tip of a tooth is accessed in
the bone and a small amount is shaved away. The diseased tissue is
removed and a filling is placed to reseal the canal.
Crown
The natural crown of a tooth is that part of the tooth covered by
enamel. Also, a restorative crown is a protective shell that fits over
a tooth.
Endodontic
Pertaining to the inside structures of the tooth, including the dental
pulp and tooth root, and the periapical tissue surrounding the root.
Pulp
The soft innermost layer of a tooth, containing blood vessels and
nerves.
Pulp chamber
The area within the natural crown of the tooth occupied by dental
pulp.
Root canal
The space within a tooth that runs from the pulp chamber to the tip of
the root.
Root canal treatment
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