A Root Canal is one of the most common Dental procedures performed, well over 14 million every year. This simple treatment can save your natural teeth and prevent the need of Dental Implants or Bridges.
Root canal treatment is one of the most common dental procedures that we perform in our office. For most people the idea of a root canal sounds like a painful experience but the procedure is actually painless and can save your natural tooth while preventing the need for the patient to have dental implants or bridges. In order to understand a root canal procedure you must firstly understand the anatomy of the tooth . Under the white enamel there exists a hard layer called dentin. Underneath the dentin is a soft tissue called pulp. This pulp contains blood vessels, nerves and connective tissue which all help the the root of the tooth to grow during development. When a tooth is full developed it can survive without the pulp because it continues to be nourished by the tissues that surround it.
An infection or inflammation of the pulp can be caused by trauma to the tooth, cracks, a possible deep decay or failed dental restorations. Sometimes the dentist can see this visibly due to the swelling and sometimes by the symptoms such as temperature sensitivity or gum and tooth pain. The dentist must perform a non surgical root canal in order to eliminate the diseased pulp. Once the injured pulp is removed and the root canal is thoroughly cleaned and sealed.
The dentist can perform endodontic treatment in one or two visits, sometimes more. This will involve the following steps : Firstly the dentist will examine the patients tooth and perform x-rays and administers local anesthetic. Once the tooth is numb, a protective sheet is placed called a dental dam. This will isolate they tooth and keep it free from saliva during the procedure preventing the canals from becoming reinfected.
The dentist will then make a very small opening in the crown of the tooth. He will use very small instruments to clean the pulp from the root canalks and the pulp chamber. Once this is done the dentist will the root canals with a bio-compatible material known as 'gutta percha' which is a rubber like material derived from a plant. This bio compatible material is used with an adhesive cement and placed in order to completely seal the root canals. The temporary filling is used to close the opening . this is then removed by the dentist once the tooth is restored.
Upon your final visit you must return to the dentist to have a crown or another type of restoration placed onto the tooth in order to protect and restore the tooth to its full function. If there is a lack of sufficient stricture that holds the crown in place then the dentist may place a post inside the tooth in order to stabilize and hold it.
The Root canal treatment ( also known as root canal therapy)
The space inside the tooth is known as the pulp chamber. This is where the root canal system and the pulp exists which is the vital tissue that keeps the tooth alive. Inside the pulp exists the connective tissues, the nerves and the blood vessels.
Root canal treatment is also known as endodontic treatment. This treatment is needed when the pulp becomes inflamed or infected. This can happen for many reasons but could happen due to repeated dental procedures on a tooth or possible traumatic damage such as a crack or a fracture on the root. The presence of gum disease can also cause root canals that become infected and require root canal treatment.
Any one of the above can cause acute inflammation of the pulp which can cuase swelling inside the tooth and a build up of pressure, which can lead to tooth pain and eventually irreversible damage to the patient pulp. Once the pulp inside the tooth dies, the pain dissipates however it can return quickly spreading infection into the jawbone.
Normally whatever is causing the root canal or pulpal disease it will be necessary to perform a root canal procedure in order to save the tooth. In most cases root canals will be dealt with at Dr Ben’s office. In extreme cases you will be referred to an endodontist.
Initially the dentist will remove the decay and the source of infection that has caused the pulp to become infected. Firstly the dentist must determine whether the patients lost tooth structure can be restored. If a tooth fracture has reached the pulp or the cause of the infection is gum disease then it may be more difficult to save the tooth.
During the root canal procedure the following steps will be taken.
The dentist will apply local anesthesia via injections that will numb the tooth that is to be treated and the surrounding tissues. If the pulp is inflamed it could be painful and may take longer to numb. The dentist will wait until it is fully numb before he starts the treatment.
Use of the Dental dam
A dental dam is placed on the infected tooth in order to isolate if from the rest of the mouth. This is composed of a thin sheet of rubber or vinyl and is placed over the affected and adjacent teeth. The tooth that is being treated protrudes through the hole punched into the dental dam and this allows the root canal treatment to be carried out in a sterile environment, where no bacteria from from the mouth or saliva can reinfect the area.
The dentist will drill a small access hole through the surface (biting) of the infected tooth from or behind a front tooth. This will allow him access to the pulp chamber and the root canals for treatment.
The dead pulp tissue that is diseased has to be removed from the tooth using specially designed tools that can clean out the root canals and the pulp chamber. This is not a painful process for the patient. The area is numbed beforehand and connective tissue is either already dead or dying. Once all of the pulp and the nerves are removed the patient can no longer feel pain.
The dentist will use special materials to disinfect the canals and clean them using anti-bacterial solutions.
The dentist will reshape the canals using tiny flexible instruments that will allow them to receive root canal fillings and sealed. The root canals will become washed and cleaned again in order to remove the root canal debris before sealing them.
The dentist will select root canals that will fit exactly into the root canals that he has freshly prepared. The dentist uses the rubber like material called 'gutta percha' that he uses to fill the canal space. As the material is thermoplastic the dentist will heat the material and compress it against the walls of the root canals in order to seal them. He with the use an adhesive cement called a sealer along with the 'gutta percha' in order to fill the canal space. It is important that the dentist reseals the canals in order to prevent them from becoming re-infected with bacteria.
The dentist will then place a temporary or permanent filling in order to seal the access hole that is made to treat the canals. He will then remove the dental dam. If the tooth structure is weak the dentist will place a post inside the tooth in order stabilize it and keep the tooth in position.
Once root canal treatment is completed.
Root canal filling material which is known as ‘gutta percha’ is placed into the canals and the tooth is sealed with a temporary filling that prevents it from contamination. The crown is usually placed over the tooth in order to protect and seal it from contamination.
Once the procedure has been completed an antibiotic may be prescribed in order to treat or prevent and infection. It is important that the patient follows the instructions of the dentist carefully taking the antibiotics at regular intervals. There are minimal after effects to a root canal treatment. This may include slight soreness. This can be alleviated using aspirin or prescription medication.
Once the root canal has been performed your tooth will need a permanent restoration – either a filling or a crown if the structure of the tooth has been damaged and we need to replace tooth structure. This is an important step and many as there is much research to show that root canals are recontaminated with bacteria from the mouth and the infection around the tooth could reoccur.
The root canal system in a patients tooth is akin to the root of a plant going into the ground. The whole system needs to be sealed during a root canal treatment in order for it to be successful long term. Root canals are very small spaces and microscopic instruments are used in order to complete the root canal process. It is important for patients to know that root canals save teeth and do not cause pain but actually relieve it.
When your root canal therapy has been completed, a record of your treatment will be sent to your restorative dentist. You should contact their office for a follow-up restoration within a few weeks of completion at our office. Your restorative dentist will decide on what type of restoration is necessary to protect your tooth. It is rare for endodontic patients to experience complications after routine endodontic treatment or microsurgery. If a problem does occur, however, we are available at all times to respond. To prevent further decay, continue to practice good dental hygiene.
The cost associated with this procedure can vary depending on factors such as the severity of damage to the affected tooth and which tooth is affected. In general, endodontic treatment is much less expensive than tooth removal and replacement with an artificial tooth.
A crown is placed over existing tooth structure when there has been a lot of damage to the structure of the tooth above the gum line. Crowns are extremely durable however that does notmean that the underlying structure of the crown is not susceptible to decay. Many patients think that because they have a crown placed over a previously decayed structure that there is no risk of decay. This is not the case as there almost always tooth structure visible above the gumline. Decay can from from plaque and food particles at the edges of the crown.
Patients must pay particular attention when cleaning and flossing in order to make sure that they remove all plaque from the edges as this could result in decay and the need fro another root canal. The edges of the crown must be cleaned properly where the crown attaches to the tooth. You may need a special tool to keep this area clean so ask Dr Mokhtar or his hygienist what is the best method and tool that you should use.
Eventually like everything else in life, crowns wear out. The usual reason for crowns needing replaced is that the shade of the crown and the adjacent teeth are not the same over time. Also at the edges as the gums recede over time some of the some of the tooth structure can become exposed. The crown over time becomes unsightly and will eventually need replaced. Once decay get sin under the crown it can quickly spread
When the decayed portion under a crown is small it is often very difficult to detect. Sometimes it is necessary to get a second opinion as the x-ray would have to be placed in the exact correct angle in order to see the decay. If the decayed portion is very small then the second dentist giving the opinion must be able to see the x-ray as the slightest change in the positioning of the x-ray head when performing a new x-ray will not show up the decayed area due to the fact that it will be hidden by a metal crown
Depeding on the size of the tooth affected there can be very little tooth structure left underneath the crown before the nerve becomes destroyed by decay. In this instance a new crown will not fix the tooth and a root canal re-treatment will need to be performed and then a new crown will need to be placed. This will be a more difficult process than before as there will decay that has to be removed, damaged tooth structure that will be reduced and be smaller than before and the dentist may have to add a post in order to stabilize and create a foundation for the new crown. The depth of the crown or margins will also need to be deeper in order to cover over the area where the decay was removed after the first crown that was placed is removed. Early detection of the decay around the crown edges is needed in order to actually save a tooth. If it is not possible to save then Dr Mokhtar will recommend an implant or a bridge. It takes a dentist with a high degree of diagnostic skill to find decay around the edges. The earlier it is found the better. The crown will have to be replaced quickly in order to avoid a root canal or even to save the tooth when there is decay under the crown.
The best advice Dr Mokhtar can give to prevent this is brush regularly, floss every day, pay special attention to the crown area and have regular dental check ups.
If you have pain in a tooth or in your jaw or maybe sensitivity to hold and cold temperatures, or tenderness in the gum area of when you chew this could be a sign that there is an infection in the root canal. Also the tooth may have become discolored and you may have swelling in your lymph nodes. In most root canal cases there are few symptoms.
The affected tooth may develop a new trauma or it may have deep decay. The crown you have there already may become more exposed at the edges or the filling there could be cracked. It may be that when the first procedure was done a small amount of saliva got into the tooth and this caused reinfection or the previous surgery did not clean out some of the intricate canal structure. In some cases, the endodontist may discover additional, very narrow or curved canals that could not be treated during the initial procedure due to the fact that they were unseen, and so a second procedure is necessary.
Most patients teeth can be saved and treated effectiveley. In some instances a tooth may not be able to be treated because the canals are not accessible and the root is severely fractured. There also may not be adequate bone supporting the tooth and therefore it cannot be restored. Despite this endodontic technology has become more advanced and teeth that were not bale to be saved a few years ago can now be saved. Dr Mokhtar will always discuss you best options and the final decision will always be yours.