For many people, the word root canal treatment is synonymous with pain and fear. However, it truly is not. If done correctly, a root canal treatment is an entirely safe and pain-free procedure. Thousands of root canal treatment procedures are performed by dentists throughout the world each day. According to the American Association of Endodontists, more than 15 million root canal procedures are performed each year. Here’s everything you need to know about root canal treatment.
What is Root Canal Treatment?
Root canal treatment is an endodontic (endo=inside and odont=tooth) procedure which is performed inside the tooth structure. This procedure is performed to remove and rinse out inflamed or non-vital pulp (soft tissue located in the middle of the tooth which consists of nerve and blood vessels) from the interior of the tooth and to replace it with an inert and durable material which prevents re-infection.
Learning about Tooth Anatomy
Our teeth are covered by a hard and mineralized layer known as the enamel. The enamel protects the underlying softer layers of the tooth, the dentine (which still is harder than bone), and pulp, respectively which contain nerve endings and blood vessels that nourish the tooth. The dental pulp fills the space present in the middle of our teeth. The hollow cavity inside the visible part of the tooth (biggest part of the space) is called the pulp chamber, while the space inside the roots are called root canals. Hence, the name root canal treatment.
When the enamel is destroyed, either because of continued poor oral hygiene maintenance or as a result of a direct injury, the underlying dentine and pulp become exposed. When this happens, you might feel a sharp pain whenever you take any hot or cold drinks. This is because the exposed nerve endings send a pain stimulus to the brain whenever the tooth senses a temperature change. This stage is reversible. If you visit your dentist at this stage, he or she will restore the damaged tooth with a filling or a crown, and you are good to go!
However, if you avoid taking that supposedly dreaded visit to the dental office, or the damage (either a cavity or a fracture) is too close to the pulp, then the condition will be much worse. In this situation the pulp tissue becomes irreversibly inflamed. Now, this is a severe and painful situation. Inflammation of the pulp leads to the development of pressure inside the tooth which results in a sharp, spontaneous, lingering and unbearable pain, which does not go away even with pain medication. At this stage, the only option we have to save your tooth from extraction is a root canal treatment.
What are the Symptoms that I Need a Root Canal Treatment (rotfylling)?
If you’re suffering from most of the following problems, then it may be an indication that you need a root canal treatment by root canal specialist or a dentist at tannlege as :
- Pain – Severe and lingering pain in the affected tooth. Specially induced by warmth. Usually, the pain is localized but, in some cases (although rare), it may also be felt in a region away from the impacted tooth. This is known as referred pain.
- Swelling – this is one of the classic signs of inflammation. The affected side of the face also becomes warm and red in appearance. In this instance, the pulp of the tooth may be dead already.
- When the tooth feels elevated –this happens when pus starts to accumulate underneath the root of the tooth caused by death of the pulp due to several infection or other kinds of inflammation or mechanical damage.
- Tenderness when chewing –Usually when the pulp is severely inflamed, after several days the intense pain can change character to chewing tenderness. This suggests that the pulp has necrotized (has died) and you need a root canal treatment. If not treated, there will be flare-ups of intense pain again in the near future.
How is a Root Canal Treatment Performed?
Now, let’s talk about how the dentist performs a root canal treatment. A root canal procedure is usually completed in 2 sittings, depending upon the type of affected tooth and the severity of your condition. However, in some cases, the dentist may also perform this procedure in a single sitting
- Clinical Evaluation – first, the dentist will make a detailed examination of your teeth. They will also look at the x-ray images of suspected teeth to localize the affected tooth and to determine the severity and extent of pulp inflammation. X-ray images also help the dentist in assessing the anatomy of the root canals.
- Preparing the Access Cavity (trepanation) – This is done to gain access to the underlying pulp chamber and root canals. The entrance to the pulp chamber and canals must be very precise. The opening must give the dentist easy straight access to the canals and at the same time be minimalistic. Many dentists damage the tooth too much during this part by widening the access cavity too much. This will weaken the remaining walls of the tooth which in turn reduces life expectancy of the tooth drastically.
- Cleaning and Shaping of Root Canals (negotiating and instrumentation) –In this part the length of all canals is explored, measured and filed/rinsed mechanically by thin files and irrigated chemically by antibacterial chemicals (based on chloride). This step remove dead pulp tissue and bacteria inside the canals. The bacteria, which is sitting on inside surface of the canals, is also removed. A very important part of this step is a thorough chemical rinse of the last 2-3 mm of the canals. This is done most effectively by ultrasonic irrigation systems. This will ensure a much greater rate of success for the root canal treatment.
- Obturation –In this part, which is usually done during the second appointment, the previously instrumented and cleaned canals, will be filled/sealed with inert bio materials. The most durable and bio compatible materials for this purpose are bio-ceramics which are not commonly used because of its high cost.
All teeth are anchored to bone. But the tooth and the bone are not in direct contact. Between the bone and the tooth, there is a connective tissue which functions as the tooth’s shock absorber. This tissue which is called “periodontal ligament” or PDL, will get stiffer and narrower with time after a root canal treatment. Thus, the teeth that are root canal treated lose their bouncy supportive PDL over time. This makes them more prone to fractures. The risk of fracture is already increased in these teeth because of earlier restorations and the root canal procedure in itself. Therefore, it is highly recommended to restore the teeth with a crown after the root canal treatment. This will prolong the life expectancy of such teeth.
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