GREETINGS to all frequent health care column readers, I am sure many of you may have heard of or even had a root canal treatment done at some stage.In today’s article I will briefly describe the structure of a tooth which is essential in order for one to fully understand and appreciate why and how a root canal treatment is done, I will also describe the indications (why a root canal is done), contraindications (when not to do a root canal treatment), how it is done and what to expect after it has been done.
Inside the tooth, under the white enamel and the hard underlying layer called the dentin, is a soft tissue called the pulp. The pulp contains blood vessels, nerves and connective tissue, and helps to grow the root of your tooth during development. In a fully developed tooth, the tooth can survive without the pulp because the tooth continues to be nourished by the tissues surrounding it.
Definition of Root Canal Treatment
A root canal is a treatment used to repair and save a tooth that is badly decayed or becomes infected. During a root canal procedure, the nerve and pulp are removed and the inside of the tooth is cleaned and sealed. Without treatment, the tissue surrounding the tooth will become infected and abscesses may form as seen in the image above left.
Indications for root canal (when it should be done)
n Irreversibly damaged pulp tissue. A long standing dental infection in the bone that erodes through the side of the bone and causes sudden, serious and painful swelling.
n Injury (trauma): Complicated fracture of the tooth crown, root apex is already developed, darkening of the tooth after an accident.
n Prosthetic reasons: In case of severely worn out teeth, where crowning is being advised by the dentist. Before placing a crown (dental prosthesis) in such a case, that tooth may need the Root Canal Treatment.
n A patient complaining of severe toothache while chewing food or severe pain while taking hot or cold liquid where examination shows presence of severe tooth decay. This can lead to accumulation of blackish material (bacteria) on the tooth.
Contraindications for root canal (when it should not be done)
Lack of time (patient and doctor)
Restless patient (Down’s syndrome, Parkinsonism)
Lack of interest from the patient
Patient prefers other solution (denture, fixed bridge, dental prosthesis)
Extreme root canal anatomy
Vertical fracture of tooth root
Deep root decay
Huge resorption of the root (happens in children primary teeth)
Tooth with no importance (majority of those teeth are the wisdom teeth)
The procedure is done to preserve the infected tooth. This procedure involves removing the damaged or infected pulp, treating any infection and filling the empty canals.It is always done under local anaesthesia (involves numbing a specific part of the body to prevent any feeling of pain).
Root Canal Treatment procedure is started by drilling the enamel part of the tooth, that is topmost portion of the tooth. First the dentist enters the pulp chamber, where the infected pulp is present. The next step is exploration of root canal, removal of the remaining pulp tissue and infected tissue.
After successful removal of the pulp, the root canal is disinfected with the help of medicaments.The disinfection procedure is done by using a plastic pipette or a syringe.
Finally filling (obturation) of root canal is done with an inert filling material called gutta percha.
Post treatment care
It is normal to feel some tenderness in the area for a few days after your root canal treatment as your body undergoes the natural healing process. You may also feel some tenderness in your jaw from keeping it open for an extended period of time. These symptoms are temporary and usually respond very well to over-the-counter pain medications. It is important for you to follow the instructions on how to take these medications.
Your tooth may continue to feel slightly different from your other teeth for some time after your root canal treatment has been completed. However, if you have severe pain or pressure that lasts more than a few days, contact your dentist.
- Do not eat anything until the numbness in your mouth wears off. This will prevent you from biting your cheek or tongue.
- Do not chew or bite on the treated tooth until you have had it restored by your dentist.
- Be sure to brush and floss your teeth as you normally would.
- If the opening in your tooth was restored with a temporary filling material, it is not unusual for a thin layer to wear off in-between appointments. However, if you think the entire filling has come out, contact your dentist.
- Contact your dentist right away if you develop any of the following:
- a visible swelling inside or outside of your mouth;
- an allergic reaction to medication, including rash, itching (nausea is not an allergic reaction)
- a return of original symptoms or
- your bite feels uneven.
The tooth that has had root canal treatment followed by a proper restoration can last as long as your other natural teeth. After the tooth has been restored, you need only practice good oral hygiene, including brushing, flossing, regular checkups and cleanings.
Your dentist may periodically x-ray the tooth to ensure that healing has occurred. Occasionally, a tooth that has undergone root canal treatment does not heal or pain continues. At times, the tooth may become painful or diseased months or even years after successful treatment. Often when this occurs, repeating the root canal treatment can save the tooth.
But like all other diseases, prevention is better than cure.Ensure that you brush your teeth at least twice a day, floss everyday, visit a dentist twice a year (every 6 months) and keep sweet consumption at an all time low level to ensure optimal oral health.
Dentistry is not expensive, neglect is.
Kimberley Eve Nyathi
Final Year BDS
Lviv National Medical University