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Root Canal (Endodontic) Therapy

   

Introduction

Parts of the tooth

What happens if the pulp gets injured?

What are symptoms of root canal (pulp) injury?

Why do I need root canal therapy?

What does treatment involve?

Is Root Canal Therapy Safe?

What are the risks and complications?

Steps of Root Canal Procedure

Resources


Introduction

If you have a tooth whose internal structures are damaged, you may benefit from root canal therapy. Also called endodontics, root canal therapy can restore your tooth to its state of health by treating the damaged part of your tooth. If you have the choice, it's always best to keep your original teeth.

Parts of the tooth

Your tooth has two basic parts: the crown is the part you see above the gum, and the roots anchor your tooth to your jawbone. Inside the crown and roots is soft tissue (pulp) that helps keep your tooth nourished.

Crown: An outer enamel layer and the dentin inside protect the tooth's underlying structures and prevent bacteria from entering the tooth.

Root: the root canals house the pulp and extend to the underlying bone. The pulp helps nourish the tooth and is made up of tiny blood vessels and nerves. The blood vessels carry nutrients to the tooth, and the nerves give feeling to the tooth. The bone holds the tooth with the help of tiny ligaments attached to the roots. The pulp tissue enters and exits through openings at the root tips.

What happens if the pulp gets injured?

When the pulp is diseased or injured and can't repair itself, it dies. The most common cause of pulp death is a cracked tooth or a deep cavity. Bacteria can invade your tooth through a loose filling, a cavity, or a crack. Your pulp becomes infected as it is attacked by bacteria. Eventually, the bacteria may destroy the pulp. This may lead to the bone getting infected as the bacteria escape through the root openings. The bone breaks down, and your ligament surrounding the root may swell and loosen the tooth.

What are symptoms of root canal (pulp) injury?

The inflammation and infection spread down the root canal, often causing sensitivity to hot or cold foods, throbbing, aching, or pain when you chew. Pain may be prolonged or constant.

Why do I need root canal therapy?

Because the tooth will not heal by itself.  Without treatment, the infection will spread, bone around the tooth will begin to degenerate, and the tooth may fall out. Pain usually worsens until one is forced to seek emergency dental attention. The only alternative is usually extraction of the tooth, which can cause surrounding teeth to shift crookedly, resulting in a bad bite. Though an extraction is cheaper, the space left behind will require an implant or a bridge, which can be more expensive than root canal therapy.

What does treatment involve?

Treatment often involves from one to three visits. During treatment, your general dentist or endodontist (a dentist who specializes in problems of the pulp) removes the diseased pulp. The pulp chamber and root canal(s) of the tooth are then cleaned and sealed. This is all done under local anesthesia. Contrary to popular myth a root canal is causes very little discomfort.

Once it is determined that treatment is successful, the tooth needs either a filling or a crown to protect it from possible future breakage, because root canal filled teeth are brittle. It is estimated 24 million teeth are treated per year with root canal therapy. If the teeth were instead removed, the options of replacing them are usually more costly and less natural. Those options include implants, cemented on bridges, or removable partial dentures.

Is Root Canal Therapy Safe?

Root canal treatment has been practiced for over 70 years, and is a recognized specialty by the American Dental Association. Today, there are a number of new techniques and materials that are much better at completely cleaning out and filling the inside of a tooth.

There are a few Dentists and persons not in the dental profession who voice the opinion that root canals cause many illnesses because bacteria trapped in the root canal can spread infection from the teeth, via the blood stream, to other organs such as the heart, kidneys and brain. Although based on a kernel of truth the notion that root canals cause untreatable infections is simply not true!

It is true that persons with damaged heart valves, particularly due to rheumatic fever, are at increased risk for bacterial infection of the injured valve during invasive surgical procedures including dental work. This is because bacteria may be temporarily introduced into the blood stream during such procedures. These bacteria are generally harmless, small in amount and easily handled by your body's immune system. If you have had untreated rheumatic fever in the past (uncommon in the United States in recent times) certain tissues in your body (including heart valves, kidney and joint cartilage) may be "stickier". This can allow bacteria to adhere to these tissues and possibly break it down more over time. When bacterial infection occurs on a heart valve it is called "Bacterial ENDOCARDITIS".

Persons who have had rheumatic fever or who have heart murmurs from other causes routinely take a brief coarse of antibiotics just prior to invasive dental procedures (not just root canals). This is extremely effective at preventing endocarditis. If you have a heart murmur, artificial heart valve or have had rheumatic fever it is important to tell your dentist before having any dental procedure performed.

What are the risks and complications?

More than 95 percent of root canal treatments are successful. However, sometimes a case needs to be redone due to diseased canal offshoots that went unnoticed or the fracturing of a canal filing instrument used, both of which rarely occur.  Occasionally, a root canal therapy will fail altogether, marked by a return of pain.

Steps of Root Canal Procedure

  • Normal Tooth
  • Infected Tooth- injury involves pulp
  • An opening is made through the crown of the tooth into the pulp chamber.

  • The pulp is then removed with tiny flexible files.
  • The root canal(s) is cleaned and shaped to a form that can be filled.
  • Medications may be put in the pulp chamber and root canal(s) to help get rid of germs and prevent infection.

  • A temporary filling will be placed in the crown opening to protect the tooth between dental visits. Your dentist may leave the tooth open for a few days to drain. You might also be given medicine to help control infection that may have spread beyond the tooth.
  • The temporary filling is removed and the pulp chamber and root canal(s) are cleaned and filled.

  • In the final step, a gold or porcelain crown is usually placed over the tooth. If an endodontist performs the treatment, he or she will recommend that you return to your family dentist for this final step.

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Resources

"Root Canal (Endodontic Treatment)": http://www.ada.org/consumer/endo.html

"Root Canal Therapy" : http://www.drjay.com/rootcana.htm

"Treating Your Tooth To Endodontics" : http://www.aae.org/patient/treating.html

"What is Root Canal Therapy?": http://members.rediff.com/deepakvaswani/rootcanal.htm


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