When the inside of the tooth is infected or there is irreversible damage to the pulp, a Root Canal Treatment or what dentists call endodontic therapy is indicated. The common cause of pulp infection is dental decay or a cavity . Tooth decay erodes through the enamel and dentin layers of the tooth until it reaches the middle of the tooth, the pulp chamber. When this occurs, bacteria invade the pulp and infects it. Unfortunately, infections inside teeth don't respond to antibiotic treatment. The infection causes inflammation which restricts the blood supply to the pulp so antibiotics in the bloodstream can't reach the infection in adequate amounts and the infection continues.
There are other ways that the pulp can become irreversibly damaged. You can receive a blow to the tooth or teeth, such as in a fall or in an automobile accident. Sometimes a tooth has had decay and been fixed, then gets more decay, is fixed again, etc. and over time the trauma from treatment as well as the periodic decay put the tooth over the edge. A very common scenario is the cracking of part of the tooth or actually having part of the tooth break off. Silver-Mercury fillings tend to expand and crack teeth. This can cause tooth fracture and breakage or cracking. Occasionally the pulp of a tooth that needs a crown will die after the tooth is prepared. Nearly every tooth that requires a crown has had previous damage and bacterial invasion to the pulp. It is no wonder that occasionally the pulp can no longer survive and suffers irreversible damage. In many cases, when the pulp is inflamed, but not infected, it will heal and return to normal. Your dentist may want to monitor the tooth to see if this happens before doing a root canal. Sometimes, though, the pulp remains inflamed, which can cause pain and may lead to infection.
When the pulp of the tooth becomes infected, the infection usually has only one way to go, out the end of the tooth. The infection can spread to the bone around the tooth, which can cause an abscess to form. The pupose of root -canal treatment is to save the tooth by removing the infected or damaged pulp, treating any infection, and filling the now empty spaces (canals) with a special dental material designed to seal the infection out of the tooth. Should the root-canal treatment not be done, the infection persists, affecting not only the tooth and bone surrounding the tooth, but can spread to other areas in the head and neck region. One's overall health and well being can be significantly affected. If the tooth is not treated promptly, it may need to be extracted, and the surrounding infection will still need to be dealt with.
If at all possible, it is far better to retain your own natural teeth. When a tooth is lost, the adjacent teeth can move into the space where the lost tooth was and can be overstressed. Replacing lost natural teeth requires more expensive and extensive treatments, such as implants or bridges. Attention to injured or infected teeth promptly can prevent tooth loss and prevent infection.
Thanks to endodontic treatment, millions of teeth that previously were removed are now able to be saved. The teeth that have had root canal therapy do become more brittle than other teeth and crack or break more easily. Properly restoring or rebuilding the tooth to protect it from breakage allows the tooth to last indefinitely.
Signs And Symptoms of Pulpal (Root Canal) Problems
You could have a pulpal infection and not feel any pain. You may have pain that is significant. Each case is somewhat different. Some signs and symptoms that a tooth may need root canal therapy are:
Caution: *Please inform your dentist if you have a pacemaker or any other electronic life-support device. The dentist will not use the pulp tester if this is the case.
Rebuilding the Tooth After Root Canal Therapy
In most cases, the tooth that has had root canal therapy will require a crown.
To make sure the tooth is strong, your dentist will first rebuild the inside of the tooth (crown build-up or foundation) to strengthen it and to provide internal support for the crown.
With today's materials that actually bond to the remaining tooth structure we can make the tooth as strong or stronger than it was in the past. The build up or foundation will be shaped to best suit the crown that will be made.
For teeth that need further reinforcement, a post may be placed inside the pulp chamber before the build-up or foundation is placed. This is similar to the practice of placing metal (rebar) inside concrete to reinforce and strengthen the concrete for roads or buildings. The crown that is made is cemented onto the foundation and whatever tooth is remaining.
When the Body doesn't respond and additional Treatment is Required
Although no surgical procedure is always successful, in general, the success rate of a root canal therapy is in the 92 to 95 % range. That means there's a small chance you may need a root canal therapy more than once in the same tooth.
Root canal therapy can fail to resolve the problem for many varied reasons. Occasionally, the anatomy of the tooth is abnormal and there is an unusual canal or canals present. Failure of the patient to promptly and properly restore the tooth that has had root canal therapy, can allow the bacteria to return and reinfect the tooth.
When the initial therapy does not resolve the problem. In a small percentage of the cases, initial therapy does not resolve the problem. Either re-treatment or a minor surgical procedure would be indicated.
Although the procedure itself is the same, re-treatment tends to more complicated and takes more time because the dentist must remove all the restorative materials before they can re-treat. That's why re-treatments generally are more expensive than the initial root canal therapy.
Some teeth may also need root tip (periapical) surgery, either instead of or after re-treatment. If the tooth still is infected after retreatment, periapical surgery may be indicated. The surgery requires that a small incision is made in the gum near the tooth. Any infected tissue around the tip of the root is removed so that the body can heal naturally. The tip of the tooth is removed and the remaining tip is sealed to prevent re-infection inside or around the tooth. The periapical procedure is called an apicoectomy. The success rate for this surgery is 80 to 90 percent. If the surgery is not successful in removing the infection and the infection persists, the remaining alternative is to remove the tooth. This generally happens when the patient has had a chronic, long term infection and has not had treatment in the early stages.
Comfortable Root Canal Therapy is the Norm
With the new procedures, root canal
therapy has become more predictable and far more comfortable than in the
past. In normal situations, root-canal procedures
are not uncomfortable. The tooth will be numbed. If it is not, please tell
your dentist. Occasionally the tooth is "hot" (very inflamed) and
a different approach to anesthesia will be required. If this is the case, please
alert your dentist so they can address the situation. In addition to the normal
anesthetic, you may have sedation as well.