Root Canal Treatment

When the inner part of your tooth gets infected (and causes pain) essentially there is only two ways to get rid if the infection.  One treatment is to extract the tooth. However, many patients do not want to lose their tooth.  The other treatment is root canal treatment.  This treatment entails the removal of all infection and contents within the tooth, disinfect and clean, internally shape the tooth and fill and seal the inner part of the tooth.  Often, a filling will be have to be placed on the top of the tooth to further seal it from the oral environment.  Once the tooth is treated, the pain will greatly dissipate and your tooth will be healed.  Often, root canal treatment is perceived as a very painful procedure.  That is usually not the case if the tooth is treated in a timely fashion.  If the infected tooth is allowed to fester and the infection spreads throughout the face, it can be very difficult to get adequate local anesthesia.  The extensive infection does not allow the anesthesia to work properly and any treatment will be a challenge.  Sometimes, it is better to start an antibiotic and manage the pain with medication to allow the overall infection to be managed better.

Dental Anatomy

The outside of your tooth is made up of 2 hard substances: the outer, harder layer called enamel and the inner softer layer called dentin. Under the dentin exists the dental pulp. Here are the blood vessels and nerves needed to help form the tooth when it is developing. The dental pulp extends into each individual root sometimes there can be more than one root canal in a root. Once a tooth is fully formed and mature, the dental pulp is not needed anymore. The tooth receives nourishment from the surrounding gum and bone tissue

Why would I need a root canal canal procedure?

There are many reasons why a tooth may need a root canal.  One of the most common reasons is when a cavity in a tooth forms that is very large and deep into the tooth.  When it reaches the dental pulp, the bacteria then can penetrate the soft tissue and can fester.  Often, a patient perceives this as pain but can be exasperated by hot or cold temperatures or sweet foods.  Other reasons for root canal treatment include: repeated traumatic procedures on a tooth (multiple fillings, crown preparations, heavy bite due to work in the area) and direct trauma to the tooth from a direct blow with or without tooth breakage.  All of these can cause inflammation and infection in a pulp and if not addressed could lead to pain and an abscess.

What are the signs and symptoms of a tooth needing a root canal?

Infected teeth can be totally asymptomatic (especially if they are draining into the mouth) or present as a severe toothache.  Some common things to look for include: pain (intermittent or constant), temperature sensitivity that is prolonged, inability to bite down or chew on the tooth, tooth discolouration, swelling in the soft tissue around the tooth (gum or lip) and swelling in the face or neck ( medical emergency).

 

How will a root canal procedure save my tooth?

Once your tooth is adequately anaesthetized with local anaesthetic, the dental pulp will be accessed through the top part of your tooth.  The inflamed and infected tissue will be removed.  The root canals will cleaned and disinfected.  They will be carefully shaped so that they can filled and sealed to the end of the root.  Once healed, the tooth will be restored with a filling and possibly a crown.  Your tooth will be saved and will continue to function as it did previously with no pain or sensitivity. It is very important that you seek treatment once you first notice any symptoms arise.  Allowing your tooth to become severely infected could result in the tooth being unable to be anaesthetized.

Root Canal Procedure

1) First and foremost, an appropriate diagnosis of the problem must be made. Careful examination of the mouth (both extraorally and intraorally), surrounding structures, xrays and patient symptoms will help Dr. Vlahos make the diagnosis.  Once the offending tooth has been identified, local anaesthetic will be administrated.  It is crucial to achieve adequate anaesthesia so the root canal procedure will be relatively uneventful.  A dental  dam (usually made of vinyl) will be placed over the tooth to isolate the tooth from the rest of the mouth and protect the tooth from saliva. Once the treatment has begun, it is very important to try to keep the tooth as sterile as possible.

2) An access opening will be created through the top part of the tooth in order to get at the infected part of the tooth. Once accessed, each individual root canal will be located and accessed.  Typically teeth can have anywhere between 1-5 root canals (but it depends on the kind tooth we are dealing with; front teeth usually one, molars 3-5).  Initially, small files will be inserted into each canal to remove any infection and debris.  Then, the exact length of the root canal will be determined through a device called an apex locator.  Once the exact length is known, each canal will be shaped and clean with rotary instruments to idealize the shape of each canal.  A disinfectant irrigant will be used to further flush out the canals and debris.  The cleaned canals are then dried and ready to be filled.  With adequate local anaesthesia, this and the remaining steps of the procedure should be painless.

3) The root canals are ready to be filled. A biocompatible filling material called gutta percha and a cement is used to seal each individual root canal.  This material is inert and will provide a good seal to prevent any further infection from getting into the root canal system.  Usually, once the canals are sealed, a temporary filling is placed in the access opening until the tooth can be restored permanently.

4) Depending on the degree of your tooth’s structurally integrity either a simple filling or a core filling with a permanent crown will have to placed on your tooth. Root canal teeth tend to be brittle and broken down.  The incidence of tooth fracture can be significantly increased after root canal treatment.  It is also very important to ensure that the tooth has a good seal from the oral environment to prevent bacterial infection again.

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