ROOT CANAL THERAPY
WHAT IS ROOT CANAL THERAPY?
Primarily it is a means of saving a tooth by the removal of the pulp that is found inside every tooth. Pulp is the term for all the tissues inside the canal, i.e. nerves, arteries and veins. After the pulp has been removed the tooth can no longer react to its environment and no longer trouble you. The huge advantage of Root Canal Therapy is that it gives the tooth a second life – the alternative is an extraction. Root Canal Therapy includes the procedure of filling up the now empty canals that remain after removal of the pulp with special sealants and fillers. It is a tricky procedure and sometimes may take numerous appointments to complete.
WHY SHOULD A TOOTH NERVE BE REMOVED?
• Tooth fracture or dental decay has exposed the nerve itself.
• The nerve is hypersensitive due to the exposed root surfaces or a prior dental procedure.
• The nerve has died (a dead nerve will result in the formation of an abscess if it is not removed.)
Any bacteria that accumulate in the close pulp chamber or root system will eventually destroy tissues and lead to the formation of liquid (pus). The pus, together with rising pressure inside this close chamber can lead to intense pain and swelling, that typically represent a tooth abscess. Very often NO PAIN is present during the development of a chronic abscess.
ROOT CANAL THERAPY: THE PROCEDURE
Root Canal Therapy is often done in 2 or more appointments. Curved roots can sometimes complicate the procedure dramatically and makes Root Canal Therapy a very lengthy process.
After very good anesthesia, the tooth is opened up and the inside pulp chamber is cleaned out. From this chamber towards the root tips, 1 to 4 canals are found, that lead to the root tip or apex. A temporary filling is placed to close the opened tooth until the next visit.
After anesthesia the temporary filling is removed and further cleaning and shaping of the canals take place. This could be very time consuming, because each canal (sometimes there are 4) needs to be located and cleaned right down to the root.
The exact length of the canals needs to be determined with the help of x-rays or apex-locator equipment. After a series of rotary instruments have shaped and cleaned the canals, they need to be dried, using a series of paper points. The dried canals get sealed off, by using rubber points.
CAN I EXPECT ANY PAIN OR DISCOMFORT AFTERWARDS?
Following Root Canal Therapy the tooth sometimes feels traumatized and tender. It can also be painful for a few days. This pain does not originate from inside the tooth, but is itself a response from your body’s immune system. Inflammation takes place in the tissue surrounding the root and causes pain. Another factor is that if there was an infection, like an abscess, the tooth is more likely to pain afterwards, because of a stronger reaction from your body’s immune system.
CARE FOR ROOT CANAL THERAPY
After the first appointment when the canals are still open and unfilled
Take anti-inflammatory medication for the first 1-2 days to alleviate excessive inflammation. Your tooth is very weakened, because of the temporary filling.
DON’T bite on hard objects or eat hard crusty or sticky food that can damage your tooth. The temporary filling is very porous and might flake, let your dentist know as soon as the temporary fillings falls out. It needs to be replaced to avoid reinfection. Very little to moderate pain is still possible when biting down until your final visit.
After the final appointment and when treatment is complete expect some pain that can last for about 72-hours. The worse the infection and inflammation were, the more sensitive the tooth will be after treatment. It can be controlled with anti-inflammatory medication. Make sure your final filling / crown is not too high in the bite, because this can cause unnecessary discomfort. Contact your dentist to ease the restoration if necessary. Report back to your dentist after 6 months for follow up X-rays to determine if everything is still in order. Sometimes a painless reinfection can occur.
As with most invasive dental procedures, complications can occur. Here are some possibilities.
1. Sometimes when a root canal is opened for treatment, the oxygen in the air will trigger some bacteria to start growing. This causes swelling and pain.
2. Blood vessels enter the tooth through a small hole at the bottom of the root. Sometimes during a root canal procedure, bacteria are pushed through this hole into surrounding tissue. If this happens, the surrounding tissue will become inflamed and possibly infected. This can be treated with painkillers and sometimes antibiotics. However, it may be painful until it clears up.
3. A root canal treatment can puncture the side of the tooth. This can happen if a canal is curved or hard to find. The tools that the dentist uses are flexible. They bend as a canal curves. Sometimes they bend at the wrong time and make a small hole in the side of the tooth. Sometimes, the tooth has to be removed.
4. Finding root canals can be difficult. If all of the canals aren’t found and cleaned out, the tooth can stay infected. This also can happen if a canal isn’t measured correctly and pieces of infected or inflamed pulp are left near the bottom. In this case, the root canal procedure would have to be done again. Occasionally, root canals have branches that the dentist’s tools can’t reach.
5. The tip of a file may break off inside the tooth. If the canal is clean, your dentist can leave the piece of file in the tooth. But if canal is not completely cleaned out, the file piece may have to be removed. Sometimes this can be done from the top of the tooth. However, in some cases, the file can only be removed through a surgical procedure called an apicectomy. A small cut is made in the gum so the specialist can get at the root of the tooth. Or, the tooth needs to be extracted.