Endodontics – inside (endo) the tooth (dontia). To understand how and why an Endodontic (root canal) treatment is performed, we need to have a basic understanding of the anatomy of the tooth.
Root Canal Treatment
The outermost layer (above the gum-line) is called the enamel. Enamel is the hardest and most mineralized substance in the body.
Under the enamel is the middle layer called dentin. The dentin is about as hard as bone. Beneath the dentin is the innermost layer called the dental pulp. The dental pulp is the soft inner mass of the tooth.
The dental pulp is housed in a canal called root canal.The pulp is needed to nourish the tooth during its growth and development. After a tooth is fully mature, the only function of the pulp is to let us know if it is damaged or infected by transmitting pain.
In a healthy tooth, the pulp is well protected by the outer hard layers of enamel and dentin.
The pulp may develop inflammation or infection due to various reasons such as :-
Dental decay (large deep cavities)
Accumulative effects of placing several fillings over time
Restorative insults to teeth (drilling, heat and dessication)
Traumatic injury (accident)
It is necessary to remove the infected pulp, clean out the root canals and fill that space with a sterile material to prevent further infection. This procedure is called Endodontic therapy or popularly known as root canal treatment.
The goal of root canal therapy is to create an environment within the root canal as sterile as possible by removing all tissue debris and bacteria to the tip of the root. This space must then be filled with an inert material to maintain this clean space.
Steps in Root canal Treatment:
Step 1: The tooth is made numb with the help of a local anesthetic.
Step 2: The decayed portion of the tooth is cleaned out and an access cavity is made on the crown of the tooth to reach the root canals.
Step 3: The root canals are cleaned thoroughly with the help of calibrated instruments. Radiographs are taken periodically to calculate the exact length of the root canals.
Step 4: The root canals are filled with a sterile material to prevent re-infection. The access cavity is sealed with temporary or permanent cement.
The treatment is completed by the general dentist who replaces the temporary filling by a permanent filling or a crown (cap).
All dentists, including your general dentist, receive basic training in endodontic treatment in dental school. The decision to refer cases to a specialist is based on the level of difficulty associated with a given case.
Endodontists are dentists who specialize in root canal treatment (Endodontics). After finishing their basic dental degree, Endodontists spend two to three more years studying Endodontic procedures (root canal treatment) in greater detail. They perform routine as well as difficult and very complex endodontic procedures, including retreatment of previous root canals that have not healed completely, as well as endodontic surgery. Endodontists are also experienced at finding the cause of oral and facial pain that has been difficult to diagnose.
Root canal treatment doesn’t cause pain, on the contrary, it relieves pain in many situations. You will be completely numb during the procedure. Dr.Venkat is well versed in a wide variety of anaesthesia protocols to ensure that you will feel nothing whatsoever during the procedure. You may experience some post treatment discomfort, which is manageable with over-the-counter medication.
Antibiotics cannot cure a root canal infection because the source of infection is inside the tooth where there is no blood supply. Therefore there is no mechanism to deliver the antibiotics. The cure is the complete cleaning and filling of the contaminated root canal space. However, antibiotics are indicated when there is swelling, a temperature, or other systemic signs of infections. Antibiotics may be useful to diminish symptoms such as biting pain before the root canal can be started, and may help prevent some types of post treatment pain involved with having the root canal performed.
The aim is to clean the root canal system thouroughly and this can be achived in one,two or more visits. The estimated number of visits will be discussed during the consultation appointment.
The nature and degree of discomfort experienced after root canal therapy depends upon a number of factors; the original diagnosis, your unique reaction to dental trauma, the amount of pain you had prior to treatment, and the amount of manipulation necessary to treat the tooth. A regimen of anti-inflammatories, analgesics and antibiotics may be required and should be taken as directed. The tooth is expected to be sore when chewing for up to a week after treatment. To help diminish this discomfort, the ‘bite’ on the tooth may be relieved from occlusion and you are asked to avoid the side while eating until it is comfortable again.
Once a tooth has reached a stage where root canal treatment is necessary, the only alternative is extraction (removal) of the tooth.
Saving your natural teeth, if possible, is a better option. Once a tooth is removed, it has to be replaced. In order to give a permanent replacement, one has to either go in for a bridge or an implant. Placement of a bridge or an implant will require significantly more time in treatment, cost and may result in further procedures to adjacent teeth and supporting tissues. Nothing is as good as your natural tooth. If you are not committed to having the tooth properly restored after the root canal procedure and you do not mind the thought of losing a tooth, then endodontic therapy may not be the treatment of choice for you. Sadly, extraction is a short term fix with long term consequences.
We try our best to present the full scope of what you may expect from the treatment, however, in some cases, not everything plays out as expected. It is understood that endodontic treatment is a procedure to retain a tooth which may otherwise require extraction. Although this treatment has a very high degree of clinical success, it is still a biological procedure so it cannot be guaranteed. Occasionally a tooth which has had endodontic treatment may require retreatment, surgery, or even extraction. As previously indicated, once treatment is completed, your tooth will need a final restoration (filling, cap, or crown). Our fee does not include this service.
We find out why the failure has occurred and try to correct it. The successful outcome of a root canal treatment depends on not only the filling of the root canal system, but also the health of the supporting gum and bone, as well as the integrity of the remaining natural tooth structure.
Most teeth can be treated. Occasionally, a tooth can’t be saved because the root canals are not accessible, the root is severely fractured, the tooth doesn’t have adequate bone support, or the tooth cannot be restored. However, advances in endodontics are making it possible to save teeth that even a few years ago would have been lost. When endodontic treatment is not effective, endodontic surgery may be able to save the tooth.
Unless you opt for treatment under sedation you will be able to drive back home. Root canal treatment itself will not cause any drowsiness or loss of coordination.
Retreatment Endodontics
With proper care, most teeth that have had root canal (endodontic) treatment can last as long as other natural teeth.
In some cases, however, a tooth that has received endodontic treatment fails to heal. Occasionally, the tooth becomes painful or diseased months or even years after initial successful treatment.
If your tooth has not healed or has developed new problems, you have another chance. In these cases the root canal treatment has to be repeated to eliminate the infection and we may be able to save your tooth. This procedure is known as Retreatment Endodontics.
All dentists receive basic training in root canal treatment in dental school. However, because retreatment can be more challenging than providing first-time treatment, many dentists refer patients to endodontists.
Endodontists are dentists who specialize in root canal treatment (Endodontics). After finishing their basic dental degree, Endodontists spend two to three more years studying Endodontic procedures (root canal treatment) in greater detail. Because they limit their practices to endodontics, they treat these types of problems every day. Endodontists are experts in performing nonsurgical and surgical retreatment. They use their special training and experience in treating difficult cases, such as teeth with narrow or blocked canals or unusual anatomy. Endodontists may use advanced technology, such as operating microscopes, ultrasonics and digital imaging to perform these special services. For this reason, many dentists choose to refer their patients to endodontists.
As occasionally happens with any dental or medical procedure, a tooth may not heal as expected after initial treatment for a variety of reasons:
Narrow or curved canals were not treated during the initial procedure.
Complicated canal anatomy went undetected in the first procedure.
The placement of the crown or other restoration was delayed following the endodontic treatment.
The restoration did not prevent salivary contamination to the inside of the tooth.
A loose, cracked or broken crown or filling can expose the tooth to new infection.
A tooth sustains a fracture.
New decay can expose the root canal filling material to bacteria, causing a new infection in the tooth.
Step: 1
The first step is to remove the existing crown (cap) or the old filling material on the tooth to gain entry into the root canals.
Step: 2
The previous root canal filling is completely removed to gain access to the root end infection.
Step:3
The canals are cleansed thoroughly to remove all the infection and an intracanal antibacterial medicament is placed.
Step:4
The tooth is monitored for signs that suggest infection control, after which a new root canal filling is placed.
Step:5
The final restoration will be a new crown made by the general dentist after ensuring the tooth is symptom free and shows signs of healing.
Surgical Endodontics
In certain cases, an infection persists at the root tip in spite of conventional root canal treatment. In such cases, it may be necessary to remove the infected root tip surgically to eliminate the disease causing bacteria.
- The tooth and surrounding areas are anesthetized.
- A small opening is made near the tooth by reflecting the gum tissue away from the tooth.
- The infected root tip is removed.
- A small filling is placed at the root tip to seal it.
- The gum tissue will heal upon suturing.
Step 1
Step 2
Step 3
If you have been given an appointment for a root canal treatment, kindly observe the following guidelines to ensure your comfort:
Medication: If medication has been prescribed, please take them as instructed.
Continue all medications for blood pressure, diabetes, thyroid problems and any other conditions as recommended by your physician. If there is a question, please call our office prior to your appointment.
If you have been advised by your physician or dentist to use antibiotic premedication because of mitral valve prolapse (MVP), heart murmur, hip, knee, cardiac or other prosthesis, or if you have rheumatic heart disease, please make sure you are on the appropriate antibiotic on the day of your appointment. If there is a question, please call our office prior to your appointment.
Cancellations: Avoid last minute cancellations. Kindly inform our office 24 hours in advance regarding the cancellation of your appointment.
Food: Avoid treatment on an empty stomach. Have a good meal 2 hours before the procedure. Anesthesia given during the root canal treatment may take about 2 – 3 hours to wear off. You may not be able to eat anything during this period.
Set aside enough time in your schedule for the root canal treatment. We wouldn’t advise you to rush back to your office immediately after a root canal. You don’t have to undergo a root canal everyday, so take it easy!
Root Canal Treatment will be performed using local anesthesia. There are usually no restrictions after the procedure concerning driving or returning to work. The doctor is available should a problem arise after your treatment.
It is normal to feel some tenderness in the area over the next few days 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 transient 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. Remember that narcotic medications, if prescribed, may make you drowsy, and caution should be exercised in operating dangerous machinery or driving a car after taking them.
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 endodontist.
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.
It is not unusual for a thin layer of temporary filling material to wear off in-between appointments. However, if you think the entire filling has come out, contact our office.
Contact us 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, hives or itching (nausea is not an allergic reaction);
- a return of original symptoms; or
- your bite feels uneven.
Do not chew food on the affected side until your general dentist has completed the final restoration on your tooth. You may continue your regular dental hygiene regimen. We will send a report of your completed treatment to your general dentist. If a final restoration is necessary, it should be placed as soon as possible to protect your tooth against fracture and decay. Please telephone your dentist for an appointment.
We don’t always offer 6monthly service, you will be asked to schedule an appointment for a 6-month healing check. This appointment will require only a few minutes and no additional fee will be charged.
