Endodontic therapy (Root canal treatment)
For out patients, most difficult to understand, hence scared off procedure is canal therapy. Nevertheless, it is one of the routine procedures, and we would like remove our patients worries by giving the basic outline of this treatment.
In order to understand how root canal treatment works, we need to briefly understand the tooth anatomy.
The part of the tooth that is visible outside is called crown, and the part that is underneath the bone is called root. Like our bones, our teeth are also formed of several layers. The top layer on the visible part above the gums, is called enamel. This is the hardest mineralized material in our body.
Underneath the enamel, the layer called cementum covers also the root surface. Further inside is the structure called dentin, which is almost as strong as a bone. Unlike the enamel, dentin contains nerve ends. Inside the core of dentin is the pulp and pulp chamber.
Pulp contains blood veins, nerve fibers, connecting fiber and various cells. During the process of growth, pulp feeds the tooth. Under the growth completed, pulp only works by inflecting a pain, when the tooth is infected.
When the pulp is inflamed, pulp needs to be removed from by the root canal therapy. This is the only way to keep the tooth in function. If the tooth is completed its growth, it can function successfully without the pulp.
Root canal treatment includes the following steps:
1. Local anesthesia,
2. Cleaning the cavities (if there is) and opening the root canals,
3. Investigating the canal structures and length with an X-ray,
4. Cleaning the root canals, and removing the pulp tissue,
5. Shaping the root canals by using various hand tools and rotating tools,
6. Disinfecting the root canals (killing microorganisms),
7. Filling the root canals with a protective substance*.
*The reason why the root canals are filled is to fill the space originally occupied by pulp tissue, so that it block microorganisms. Thus the tooth can be kept even if dead.
Success of root canal therapy:
A well applied root canal treatment has a success rate about 90-95%. The reason why the treatment fails could be because of the following reasons
Still some pulp tissue remains in (might be due to skipping a root canal, as their number is not always the same)Filling is not properly done and microorganisms leak inDue to perforations during the treatment, or damage in the structureUsually after an unsuccessful root therapy there is pain while chewing.
In case of failure, the root treatment is repeated, i.e. the root filling is removed, cleaned and refilled. Even this does not help, then a surgical method called “root end surgery” is applied. If this also fails there is no other option but to remove the tooth completely.
How does the pulp get infected?
The reason why the pulp is infected is mostly due to some untreated carries. There are bacteria in every mouth, however under normal circumstances these can not reach to pulp, since it is tightly sealed off. As discussed in the dental hygiene section, some of these bacteria produce acids by metabolizing (processing) the food remains that contain carbohydrates (sugar).
The acidity harms enamel and dentin. If the cavities that occur are not treated, then these can advance till the pulp chamber and cause an inflammation there. Tooth can also be inflamed due to a trauma, such as a shock hit on it. The hit can cut the blood connection, and the pulp dies. An interesting situation may occur when there is a big crack on the tooth enamel or dentin that allow blood to run to the pulp, by which the trauma is absorbed. In this case root canal treatment may not be necessary.
Another reason for pulp infection is a surrounding long term periodontal illness (gum disease). Bacteria can reach the canal though the infected gingiva (gum) channels that open to the root surface and infect the pulp. What ever the reason for infection, in the end the pulp dies and may cause a big painful abscess.
How can we understand that a tooth is infected?
When there is a long term sensitivity (pain) for cold and hot food, and there is a severe pain in biting, an infection is very likely.
Also, even if there is no pain, obvious change in the tooth color, and the swelling in the surrounding gum tissue is also a sign of possible infection.
Sometimes, even if there are no other signs, radiographic examinations can also reveal an infection, and the necessity for a root canal therapy.
Necessity of using antibiotics
When the tooth is infected, canal therapy or in severe cases removal of the tooth is necessary. In the mean time the dead tooth forms a good habitat for the bacteria. In some cases your dentist can prescribe you antibiotics to help your body fight with these infections. Nevertheless, under normal circumstances, during a root canal treatment there is no need for any antibiotic use.