Treatments Endodontics / R.C.T.

When the nerve of a tooth is affected by decay or infection, there are two choices - Extract it or Save it & the only way to save it is by Root Canal Treatment. In this treatment, the pulp i.e. the living tissue inside the tooth, nerves, bacteria and any decay are removed and the vacant space is filled with biocompatible material - Gutta Percha to restore the tooth to its full function. Root Canal treatment when done properly is highly successful and usually lasts a lifetime, but occasionally a Root Canal treated tooth may have to be retreated due to new infections.

Indications for Root Canal Treatment
Decay has reached the tooth pulp i.e. the living tissue inside the tooth.
Infection or abscess has developed inside the tooth or at the root tip.
Injury or trauma to the tooth including fracture of tooth.

Endodontics is the branch of dentistry that deals with diseases of the tooths pulp. The pulp is found in the center of the tooth and in canals (called Root Canals) inside the root of each tooth. Pulp includes connective tissue, nerves and blood vessels. Pulp nourishes the tooth when it first emerges through the gum. Once the tooth matures, the pulp can be removed without destroying the tooth. That is because each tooth also is nourished by a blood supply in the gums. Removing the pulp is called endodontic treatment, but it is often referred to as Root Canal treatment or Root Canal therapy. Many people refer to pulp removal as "having a Root Canal." Root Canal treatments are quite common. In the United States, they save about 24 million teeth each year.

Root Canal is thus a dental procedure which helps in removing the entire internal parts, mainly pulp chamber of the tooth. It also involves the filling of the prepared empty cavity with a suitable biocompatible material. This procedure is done and advised only when the tooth can not compensate restoring material in a small cavity on the surface. The procedure involves the removal of the nervous elements of the tooth which have been infected or decayed already due to microbial action or any physical pressures. This is the only procedure that can help when the entire pulp and its contents are decayed. This procedure of Root Canal treatment can be done by any general dentist.

Root Canal treatment is needed for two main reasons. The first is infection. An untreated cavity is a common cause of pulp infection. The decay erodes the enamel and dentin of the tooth until it reaches a Root Canal. This allows bacteria to infect the pulp. Antibiotics can not get to infections inside teeth. The inflammation caused by the infection reduces the blood supply to the tooth. The reduced blood supply also keeps the pulp from healing. The second reason for a Root Canal is damage to the pulp that can not be fixed. Trauma or a fractured tooth can damage the pulp. So can a lot of restoration, such as several fillings placed in the same tooth over a period of time. Sometimes, common dental procedures, such as preparing a tooth for a crown, can hurt the pulp. Then the tooth might need a Root Canal. When the pulp is inflamed but not infected, it may heal on its own. Your dentist may want see if this will happen before doing Root Canal treatment. If the pulp remains inflamed, it can be painful and may lead to infection. An infection in the pulp can affect the bone around the tooth. This can cause an abscess to form. The goal of Root Canal treatment is to save the tooth by removing the infected or damaged pulp, treating any infection, and filling the empty Root Canals with a material called gutta percha. If Root Canal treatment is not done, an infected tooth may have to be extracted. It is better to keep your natural teeth if you can. If a tooth is missing, neighboring teeth can drift out of line. They also can be overstressed from chewing. Keeping your natural teeth also helps you to avoid other treatments, such as implants or bridges. Also, if you ignore an infected or injured tooth the infection can spread to other parts of your body. Having Root Canal treatment on a tooth does not mean that the tooth will need to be pulled out in a few years. Once a tooth is treated, it almost always will last the rest of your life.

If you have an infection of the pulp, you may not feel any pain at first. But if it is not treated, the infection will cause pain and swelling. In some cases, an abscess will form. Your tooth might need a Root Canal if:

  • Severe toothache
  • Constant tooth pain during chewing or during contact with any extreme hot or extreme cold temperature material which is otherwise usually tolerated by the mouth.
  • Darkening or discolouration of the tooth
  • Swelling seen in the areas of gums near or around the tooth
  • Hurts when you bite down on it, touch it or push on it
  • Sensitive to heat
  • Sensitive to cold for more than a couple of seconds
  • Fractured or broken
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To determine whether your tooth needs Root Canal treatment, your dentist will often place hot or cold substances against the tooth. The purpose is to see if it is more or less sensitive than a normal tooth. He or she will examine the tissues around the tooth and gently tap on the tooth to test for symptoms. You also will be given X-rays of the bone around the tooth. The X-rays may show a widening of the ligament that holds the tooth in place or a dark spot at the tip of the root. If either of these is present, your dentist probably will recommend a Root Canal procedure. Your dentist may need more information about the tooth. He or she may use an electric pulp tester. This hand-held device sends a small electric current through the tooth. It helps your dentist decide whether the pulp is alive. This test does not cause pain or a shock. You may feel a tingling sensation. It will stop when the tester is removed from the tooth. An electric pulp tester should not be used if you have a cardiac pacemaker or any other electronic life-support device.

Root Canal treatment can be done in one or more visits. It depends on the situation. An uncomplicated Root Canal treatment often can be completed in one visit. Some teeth may be more difficult to treat because of where they are in the mouth. Some teeth have more roots than other teeth. Treating a tooth with many roots takes longer. Some teeth have curved Root Canals that are difficult to find. If you have an infection, you will visit the dentist several times so that he or she can make sure that the infection is gone. There are a few factors which decide the amount of chair time and the number of sittings in a Root Canal:

  • The position of tooth in the mouth, maxillary molars take more time than the mandibular ones.
  • Number of roots present in a tooth and number of Root Canals seen in the roots, as each of the canal is to be emptied and filled with the filling material.
  • The length and thickness of Root Canals.
  • Previous procedures - If the tooth has gone through some treatment earlier, like crown placement, then it takes more time for the entire procedure rather than the normal tooth with some small filling.

Firstly, your dentist will numb the area around the tooth. Your dentist also has other ways to reduce your anxiety. The dentist will make a hole in the top or back of your tooth to get to the pulp chamber. He or she will remove some of the diseased pulp. Then the Root Canals have to be measured. Your dentist needs to know how long the canals are to make sure the entire canal is cleaned. He or she also needs to know how much filling material to put in the cleaned canals. To measure the Root Canals, dentists use X-rays or an electric device called an apex locator. For an X-ray, your dentist will place a file into the canal and then take an X-ray. An apex locator measures a Root Canal based on its resistance to a small electric current. Many dentists use both methods.

After the canals have been measured, your dentist will use special tools to clean out all of the diseased pulp. Then the canal is cleaned with antiseptic. This helps treat and prevent infection. All the canals within a tooth must be cleaned. Teeth have different numbers of canals:

  • The top front teeth have one canal.
  • The bottom front teeth have one or two canals.
  • The premolars have one or two canals.
  • The molars have three or four canals.

The location and shape of the canals can vary quite a bit. Some dentists look inside the tooth with a microscope to make sure all the canals have been cleaned out. Once the canals have been thoroughly cleaned, the roots are filled. A temporary filling is then placed over the tooth. The temporary filling you receive is not meant to last. The top of the tooth should then be covered with a permanent filling or crown. Once the Root Canal treatment is finished, you will need to see your general dentist to have a crown or filling placed on the tooth. You are likely to receive a crown if the tooth is discolored or if it is used for chewing. The purpose of the crown is to prevent the tooth from breaking in the future. In most cases, the tooth will need a crown. A crown will help to restore the tooths strength and protect it from cracking. If a crown is indicated it should be placed soon after having Root Canal treatment. The pulp that was removed during Root Canal treatment is the part that responds to temperature. Your tooth will no longer be sensitive to hot or cold after the Root Canal is treated. There still are tissues and nerves around the tooth, however, so it will respond to pressure and touch.

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Your tooth may be sore for two to three days after the procedure. The worse the infection and inflammation was, the more sensitive the tooth will be after treatment. Avoid chewing on the affected side. You can take pain killers. A pain killer also reduces inflammation & is likely to be most helpful. Examples include Combiflam & Ketanov.

As with most invasive medical or dental procedures, complications can occur. Here are some possibilities:

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.
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.
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. If saliva can get into the hole, it will have to be filled. Sometimes, the tooth has to be removed. If the hole is far enough under the gum that saliva can not reach it, the hole may close on its own.
Finding Root Canals can be difficult. If all of the canals are not found and cleaned out, the tooth can stay infected. This also can happen if a canal is not 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 dentists tools can not reach.
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 Apicoectomy. A small cut is made in the gum so the dentist can get at the root of the tooth. The dentist shaves off the bottom of the root and gets into the canal from the bottom to remove the file piece.

In most cases, you will not have any pain during a Root Canal procedure. Your dentist will numb your tooth and the surrounding area. Let your dentist know if you are feeling any pain during the Root Canal. Some people fear the numbing shots more than the Root Canal treatment itself. Today, numbing gels and modern injection systems have made injections virtually painless. If it does hurt when you are getting an injection, let your dentist know immediately. He or she can change the way the injection is given to avoid causing pain.

Root Canals are done to protect a tooth, the calcified tissues of the tooth. This helps in maintaining the jaw integrity. If the entire tooth is extracted, the space in between the adjacent teeth can lead to shifting around of those teeth if a bridge or implant placement is not done rightly there. So, a Root Canal treatment is advised for the protection of the tooth during an infection.
The thickness of the calcified structure would be considered by the dentist as they are more brittle and can break down. So to maintain and restore a tooth structure, crown placement is usually done.
Any endodontic infection is accompanied with swelling due to inflammation of that region, which occurs after the necrosis or death of the oral tissue. This, if not taken care of, will spread to all the parts of the oral cavity and sometimes would lead to some medical complications in severe cases.
When Root Canal is done, it does not make the tooth entirely dead. Removal of the pulp contents does not make the tooth dead. The reason for this is that the tooth still gets adequate nourishment from the adjacent tissues and from the alveolar bone. So it is not regarded as a dead tooth, and it can be restored and maintains the integrity of the alveolar bone and dental arch when a crown is placed over it.

Patients fear of root canal- It was believed to be one of the most painful procedure in dentistry and every patient who was advised to have root canal done used to fear to go to the dentist. But this is not a problem now, as good anesthetics are available which can fully subside the pain.
It is not time consuming - Earlier caused disturbance in the schedules of the patients as it used to take many visits for the completion of the root canal and this task for them. Now it takes not more than 1 or 2 visits for the completion of the entire procedure.
Pain is not the only symptom - As said above, root canal should be done to prevent an infection, only the pain can not be taken as a factor to consider. If there is no pain in a particular region but there is some swelling with discoloration, the dentist has to properly check for the infection.
Better than extraction -It was believed entirely reverse of this. People used to believe in the fact that getting the tooth removed completely would be better than having root canal done. But maintaining the natural tooth for long can be helpful in proper chewing and strengthening of the tooth. Also the cost for extraction is followed by its next procedure like removable denture or implant, which costs more than a root canal procedure.
Pregnant women - There are suitable anesthetics available for pregnant women and the x-ray required during the root canal treatment is small and focused only in the mouth region, so does not affect the abdominal region. So there is no restriction for pregnant women and they can have the root canal done, but prior to the treatment, the dentist should be kept aware about the fact that the patient is pregnant.

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