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| Endodonticsis the science of saving teeth
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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 surroundingteeth
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.
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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. |
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 |
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.
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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. |
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. |
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. |
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. |
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. |
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. |
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.
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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 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. |
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. |
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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