Root canal therapy

A root canal treatment is indicated when the dental pulp is affected by various diseases or injuries. The pulp contains blood vessels and nerves, so infection and / or inflammation will usually cause extreme pain. If not properly treated in time, the infection will spread to the neighboring tissue, contaminating the bone around the root, causing bone defects and in some cases, even tooth loss. Inversely, the sooner the root canal treatment is done, the greater the chance to keep the tooth on the arch.

Endodontics is a distinct dentistry branch that specializes with this type of therapy.

What might cause pulp infection or inflammation?

• a deep cavity (carious tooth decay) that has reached or even penetrated the pulp;
• a tooth fracture or fissure that has reached or penetrated the pulp;
• various traumatic factors like: defective bite loading, severe bruxism (grinding of the teeth), aggressive orthodontic treatments or other serious injuries to the tooth;
• advanced periodontal disease;
• deep erosion through certain chemical agents.

These are all factors that, when present, will allow bacteria to enter the pulp and start the responding inflammatory process. Because teeth are hard-tissue organs, the pulp has no room to expand, so a great amount of pressure occurs around the nerve. This is the most significant cause of the extreme pain classically associated with dental problems.

Without a proper root canal treatment, the infection will most likely spread to the surrounding tissues that hold the tooth inside the bone and even to the bone itself, so any damage to this area will weaken its support. This means the tooth might have to be removed and replaced with either a dental bridge or a dental implant. If the bone defect that remains after the extraction is too large, then bone augmentation will be indicated before implantation.

Many dentists like to say, however, that “the best implant is a natural tooth”, so getting a correctly performed root canal treatment will entail saving your tooth from extraction.

Here are some of the main advantages of this procedure:

• the infection is stopped and bacteria are eliminated from the blood stream;
• pain will be alleviated or even eliminated after the procedure, sometimes almost immediately;
• keeping the tooth helps maintain the natural structure of the bone and the soft tissues of the face keep their support;
• the cost of a root canal treatment is more accessible than that of a dental implant.

In some cases, when pulp disease has had a long evolution in time or the tooth has suffered from necrosis, severe pain might not occur. This does not mean that need for treatment is excluded or that the chance of complications is reduced.

Putting off the root canal treatment because of anxiety associated with the procedure will (paradoxically) complicate the outcome and, in some cases, an aggravated inflammation may even modify the response to local anesthetic effect.

If you experience tooth ache or have big cavities or fillings, do not hesitate to make an appointment as soon as possible. The best way to prevent all of these problems is to practice good oral hygiene and schedule regular check-ups.   

What happens during a root canal treatment?

• The area is numbed with local anesthesia.
• To isolate it from the rest of the mouth, we will place a rubbery flexible sheet around the affected tooth. This sheet prevents saliva from contaminating the working area and it is called a rubber dam.
• Access to the pulp cavity is obtained by making an opening with dental burs.
• The entire content of the pulp cavity and the root canals is removed, using specially designed filing instruments and an endo-motor. An endo-motor is a calibrated apparatus that activates the files we use for shaping canals, creating a glide path to the end of the root.
• In between cleaning and shaping with endodontic files, specific disinfection agents are used to wash out the infected dentin.
• In cases with severe infection, the root canal filling is postponed. Instead, a Calcium-based-medicine will be placed inside the pulp chamber and root canals for a few days to treat it. If the infection has reached beyond the end of the root and formed a granuloma or a cyst inside the bone, we might prescribe antibiotics.
• When the infection is eradicated, the root canals are filled with a sealing material and rubber-like tips.
• The tooth structure is restored with either a core build-up (with or without endodontically retained glass fiber posts), an esthetic filling or covered with a dental crown, depending on the grade of destruction.
• In the first few days after the root canal treatment, you might experience local discomfort or even some pain. Simple over-the-counter anti-inflammatory drugs will counteract this.
• Follow the doctor’s instructions concerning medication and dental hygiene and let them know if you have any symptoms.

After getting a root canal treatment

A tooth can last in the mouth for many years even if it has undergone root canal therapy. Just like any other tooth, it may become decayed or damaged and the tissue surrounding it may still get gum disease. The risk of detecting issues too late is greater as the pain that usually signals a problem is eliminated once the nerve is removed. So even putting off your professional teeth cleaning might significantly aggravate any dental issues. A proper treatment and restoration, a good oral hygiene and regular check-ups are all equally involved in the successful outcome of this procedure.