Endodontics, from the Greek endo (inside) and odons (tooth), is a field of dentistry that deals with the tooth pulp and the tissues surrounding the root of a tooth. The pulp (containing nerves, and blood vessels) can become diseased or injured, and is often unable to repair itself; if it dies, endodontic treatment is required.
What Is The Function Of A Tooth’s Nerve Tissue?
Initially a tooth’s nerve tissue plays an important role in the formation and development of the tooth. Then, once the tooth has formed, the function of this tissue becomes one of helping to preserve the tooth’s health and vitality. The nerve tissue keeps the tooth supplied with nutrients and moisture. The nerve tissue also produces new tooth structure (reparative dentin) as is needed so to help to wall off and protect the nerve from injury (such as advancing tooth decay and holes).
A tooth’s nerve tissue does provide a sensory function but this role is probably different from what you expect. Under normal circumstances the nerves inside our teeth provide us with very little information. Yes, when activated by extremes in pressure, temperature, or severe insult (such as a cracked tooth or advancing tooth decay) teeth do respond with a painful sensation. But under normal circumstances the nerves inside our teeth remain relatively “quiet.”
At this point you might be thinking that if you push on your tooth with a finger or close your teeth together you will feel a pressure sensation. Because of this you might assume that that sensation must come from the nerve inside the tooth. Well, in reality, that sensation comes from the nerves found in the ligament that binds the tooth to the jawbone, not from inside the tooth itself. This implies then, from a standpoint of the normal functions we perform with our teeth, that the presence of a live nerve inside a tooth is somewhat academic. If a tooth’s nerve tissue is present and healthy that’s wonderful, but if a tooth has had its nerve tissue removed as a part of root canal treatment then that’s fine too. You will never miss it.
What Is Root Canal Treatment?
Root canal therapy is a sequence of treatment for the pulp of a tooth whose end result is the elimination of infection and protection of the tooth from future infection. The tooth is considered infected when you feel any one of a number of symptoms.
These symptoms are:
- Pain when you eat or drink out things.
- Constant pain like a dull ache. This is usually worse at night. This can be radiating.
- Intermittent pain.
- Pain on biting (because of decay, cracking, etc.)
This is usually caused by either extensive tooth decay, or existing large restorations. Traumatic incidents are also a fact (e.g. tooth breaks due to a blow).
To get your tooth out of pain (i.e. to clean the infection out of it) removal of the pulp tissue, is needed. This is carried out by creating an access hole from the top of the tooth into the nerve (pulp) chamber at the dentists.
The infected pulp is removed from the root canals by a number of different high tech instruments. Once this is done, the dentist fills the cavity with an inert material and seals up the opening.
If enough of the tooth has been damaged, or removed as a result of the treatment, a crown may be required.
Does Root Canal Therapy Hurt?
For most patients, root canal therapy is one of the most feared procedures in all of dentistry; however, at the dentists by asserting that most modern root canal treatment techniques, it is mostly painless.
In the last ten to twenty years, there have been great innovations in the art and science of root canal treatment. At the dentists, root canal therapy has become more automated and can be performed faster, thanks to advances in automated mechanical instrumentation of teeth and more advanced root canal filling methods.
One of these is using a Root tri auto ZX to remove the initial infected tissue instead of the more traditional “scraping techniques” using (hand files).
The dentists also possess newer technologies that allow more efficient, scientific measurements to be taken of the dimensions of the root canal that must be filled. Using electronic root tip gauges (similar to the depth gauges on your fishing boat!) we can accurately measure the length of the roots of your teeth to clean them fully. Using digital radiography we can instantly assess the procedure for accuracy. The Biolase dental laser is also used to clean (disinfect) the canal. This gives superior cleaning control than the traditional-flushing out the canal with a syringe of antiseptic. Studies have shown using lasers to be 10 times more effective. In fact it is so good that most root canal treatment at the dentists can be carried out in 1 appointment! (as opposed to 2-3 appointments).
Of course always the strongest local anaesthetic is used.
However, in some cases, it may be very difficult to achieve full pain control before and during root canal therapy. For example, when you have an abscessed tooth, with a swollen area next to the tooth. The pus in the abscess may contain acids that inactivate any anaesthetic placed around the tooth. In this case, it is best for the dentist to drain the abscess and to let the pus drain out. Releasing the pus, releases pressure built up around the tooth, which is a cause of the pain. The dentist then prescribes a week of antibiotics, which will reduce the infection and pus, making it easier to anaesthetize the tooth for you. The dentist could also open up the tooth and let the pus drain through the tooth, and could leave the tooth open for a few days to help relieve pressure.
Does The Treatment Fail?
Root canal treatments can fail for a number of reasons:
- Any tooth may have more than the expected number of canals, which may be missed while performing the root canal.
- Sometimes the canal may be unusually shaped, making it impossible to fill it completely, so that some infected material is still left in the canal.
- Sometimes the canal filling does not extend deeply enough into the canal, or it does not fill the canal as much as it should.
- Sometimes a tooth root may be perforated while the root canal is being performed, making it difficult to fill the tooth.
- Sometimes a tool can break while it is in the tooth. If the tip of a spiral metal file fails and breaks off during the procedure, it is usually left behind and not extracted. The occurrence of this event is proportional to the narrowness, curvature, length, and number of roots on the tooth being treated.
At the dentists a lot of these complications are greatly reduced because of the technology:
- Magnification so the canals are more likely to be seen.
- Tri auto root zx, making sure the canals are shaped well and at proper.
- Length for accurate filling.
- Digital radiography.
- Using titanium instruments instead of metal, as they are more flexible and less likely to break or perforate canals.
- Using lasers to clean away all the infection.
- Extra training our clinicians get.
What Happens If I Leave Treatment?
An infected tooth if not treated and ignored may endanger other parts of the body. Infection from the tooth can propagate through the face and can cause a major infection called cellulites. This can be life threatening if not treated.
Root canal treatment is too costly. What alternative treatments are there?
Unfortunately the only alternative is to remove the infected tooth. Often teeth requiring root canal treatments are weakened from the large tooth decay cavity and cannot easily be simply extracted. Many require surgical removal. Initially the removal of the tooth may save costs, but in the long term replacing the missing tooth and fixing the surrounding teeth from overuse, is far more costly than root treating it and restoring it with a suitable restoration, usually a crown. The dentists advise against leaving gaps.