Root Canal Therapy- Inside Out
In the past, dentists had limited number of options when it came to keeping a patient’s tooth when the living tissue inside it known as pulp become decayed, infected or suffered a trauma injury. However, with the advancement of technology in the dentistry sector, dentists have now become more knowledgeable. They can now help their patient keep the teeth instead of replacing or extracting them. One particular procedure that has come in handy to allow both the patient and dentist to achieve this goal is the root canal therapy. Root canal therapy is a procedure that can help save the tooth even when its nerve is severely decayed or infected. This procedure involves removing of all the decayed material, infected pulp, bacteria and nerves found inside the tooth. Once the dentist or the oral surgeon removes these materials, the resulting space is then filled up and sealed.
Before the introduction of the root canal, the only remedy for a severely decayed or infected tooth was extraction. While extraction of the tooth could benefit the patient solve the problem in the short term, the procedure can lead further and more expensive complications in the long run. Some disadvantages that came with tooth extraction include affecting the shape of a patient’s face; it leads to bone loss in the jawbone among others. Root canal procedure is advantageous in so many ways. For one, it will help the patient relieve extensive pain that comes from the infected tooth. Second, once the procedure is done, the patient can continue and use the replaced tooth just as the natural tooth. Finally, root canal prevents all the complications that are associated with tooth extraction like shifting and drifting of the tooth out of place and other bite problems.
What is Root Canal Therapy?
Root Canal Therapy also referred to as Endodontic Therapy is a sequence of treatment that involves removing the damaged or the dead pulp of a tooth and replacing it with special filing. Filling of the clean and decontaminated canals is normally done with an inert filling such as eugenol-based cement and gutta-percha. Dental pulp is that soft living tissue that is found inside the tiny tube known as root canal, which extends right to the bottom of the tooth’s root. This treatment results in the elimination of infections and protects the affected tooth from further microbial invasion in future. Dental pulp plays an integral role in the growth, development and the overall health of the tooth. Once the dentist diagnoses an infected tooth and recommends tooth canal, if the process is a success, the tooth can function normally without its pulp.
Contents
Root canal therapy procedure is often a complicated one, and depending on various factors, the procedure may involve more than a single visit to the dentist. The whole process may take weeks to be completed. The general sequence of the root canal procedure is as follows:
Diagnostic and Preparation
In the event that the tooth is considered to be extremely threatened due to decay, cracking, infection or any other reason the dentist may advise that the patient receives a root canal therapy. The dentist will first prepare the affected area by administering local anaesthesia through injections so as to numb the tooth that is to receive treatment and the surrounding tissues. In the case that the pulp is intensely inflamed, and hence very painful, it may take some time to get it numb. But the dentist will not start the procedure until he/she makes sure that the area is completely numb. To save the tooth by curing the infection, the dentist will drill the pulp chamber and remove the infected pulp with long needle instruments known as K-files and H-files. Also, in the preparation process, the dentist will place vinyl or thin sheet of rubber over the affected and the adjacent teeth. This allows the treatment to be carried out in a sterile environment that is free from any contamination by the bacteria found in saliva or the rest of the mouth.
Opening the Crown
The next step involves opening of the crown. The dentist or endodontist will make an opening through the biting surface of the teeth using dental drill fitted with a dental burr. This allows access to the root canals and the pulp chamber for treatment.
Removal of the Pulp Tissue
After opening the crown, the dentist will then locate the root canal and remove the pulp. Lower incisors will have two root canals, but anterior teeth will have one root canal. Posterior teeth will have up to four root canal of different sizes. The dentist will use a thin, straight explorer as a probe to locate canal opening with the pulp chamber. It is easier to locate the larger pulp canals, whereas it can be a bit difficult to locate smaller canals. Once the dentist has located the canal, the pulp tissue must then be removed. The thin, flexible, barbed broach is used to remove the pulp tissue if it is still intact. If the pulp tissue has disintegrated, it’s simply removed when the canal is removed and filled. This step is usually not painful as the area is already numb and the tissue that is being removed is either already dead or dying. Once the dentist has removed the pulp along with the nerves contained in it, the tooth itself cannot feel pain anymore.
Cleaning and Shaping
The main objective of cleaning is to remove and eliminate all the contents in the canal that may in one way or another lead to the growth of microorganisms or break down of toxic products into the area. Cleaning is also done to remove irregularities of the canal walls as well as obstructions such as filling materials and calcifications. It is done using disinfectants such as antibacterial solutions and antiseptic. Shaping is done so as to develop a shape that allows the most effective and the simplest 3D filing.
Selection of Root Canal Filling Material
Root canal filling that will exactly fit into the freshly prepared canal is selected. Usually, gutta-percha is the most used material to fill the canal space. Gutta-percha is a thermoplastic material which is heated and compressed against the walls of the root canal to seal it. It is extremely important to seal the canals so as to prevent them from becoming re-infected.
Temporary Filling Material
The dentist will then place a temporary filling material to seal the access hole that was made to treat the canals. This prevents the canals from becoming infected again by bacteria present in the saliva. If the tooth lacks the adequate structure to hold a restoration in place, the dentist may place a post (either very strong plastic or metal) in one of the canals inside the tooth to assist in retaining it. After the whole process, the dentist will prescribe some antibiotics to prevent further infection. Make sure that you carefully follow the dentist’s instructions so as to increase the chances of root canal therapy success. The after effects of the procedure are minimal, and they generally last for a couple of days or a week. It’s very normal to experience some minor discomfort after the procedure, but this can be managed with over the counter drugs like aspirin. However, if you experience any mild after effects, it is vital to see your dentist immediately.
Final Restoration
Your teeth will require a permanent restoration- a crown or a filling. To replace the lost tooth structure, and give complete seal to the top of the tooth. You will need to go back to your general dentist so that he/she can determine the best restoration for you. This step is important since studies have shown that if the filled root canals are re-contaminated with bacteria present in the mouth, the tooth can be infected again.
Just like the root system of a plant, the root canals of a tooth have the main branch and some other smaller branches. For the treatment to prove successful in the long term, the whole system needs to be sealed. Due to the fact that root canals have very small spaces, they need a great deal of care and precision to treat well.
Signs and Symptoms That Could Mean You Need a Root Canal Therapy
Root canal therapy is needed when the soft tissue or the pulp becomes inflamed or infected to the extent that it can’t be restored to become healthy again. The symptoms that indicates one need a root canal therapy vary from individual to individual but the treatment is the same. If you are experiencing the symptoms below, it might be an indication that you need root canal therapy.
– Constant Toothache
A constant toothache is often the first indicator that something is wrong with your tooth. When you cannot be able to do normal activities such as drinking and eating without pain, then you should visit your dentist. He/she will examine the extent of the damage and may reveal that you are suffering from a cavity that has caused your blood vessels and nerves to inflame and become infected. Since antibiotic can not fix the problem, the dentist may suggest that you undergo a root canal therapy.
– Broken Tooth
Another indication that you may require a root canal therapy is a broken tooth exposing the nerves hence causing infections. Leaving a broken tooth untreated may result in further problems. For instance, if the exposed part is not attended to, it may get into your bloodstream and bring multiple health issues. It may also mean that your tooth has to be extracted.
– Sensitivity
Severe sensitivity to heat may also be a warning sign that you may have to undergo root canal therapy. Drinking hot drinks like coffee and tea should not be a problem in normal cases. However, you may not be able to enjoy these beverages in the morning due to sensitivity. The pain can progress to be a severe one. You will need to see your dentist and talk about root canal if you have been experiencing such sensitivity. On the other hand, taking cold food may also be a problem for you. When you take an ice cream, you may find yourself trying to avoid to have contact with the affected teeth due to over sensitivity. For such a problem, the dentist may come to the conclusion that a root canal is necessary for you.
– Swollen Gum
Furthermore, if you notice that the gum around a certain tooth is swollen, this could be a sign that there is a problem below it. A thorough examination of the place may indicate that you need to undergo a root canal therapy.
To always be on the safe side, if you happen to notice any of the symptoms outlined above or just sense that something is not right with your tooth, it is advisable to immediately reach out to your dentist and determine if you need to have a root canal therapy. An Early indication of a problem could bring a significant difference on whether or not you will keep your tooth.
Technology Used In Root Canal Therapy
Root canal therapy has today gone high-tech, making the whole procedure as easy as possible for both the patient and the dentist. Thanks to the recent root canal technology, today teeth can be treated without invasive tooth surgery. Dentists have more resources than ever, with modern dental instruments and advanced techniques to complete root canal therapy. Patients can now have the pain-free procedure completed in just one visit to the dentist. Here are some of the recent advancement in the root canal therapy that makes the whole process much easier.
– Nickel Titanium Files
Previously, dentists used stainless steel files to clean out the root canals. The stainless steel was susceptible to breakage and only removed a limited amount of infection. Today, dentists use nickel titanium to do the same job which is more flexible and cannot easily break.
– Modern Dental Instruments
New high-torque motor handpieces are much faster and stronger than before, thus enabling the dentists to shape the root canal better and have more control over their instruments. Also, ultrasonic instruments are used during the procedure- they produce ultrasonic vibrations to clean the root canal in preparation for the fillings properly.
– Anaesthetics
The use of local anaesthesia makes it easier to numb the whole tooth while receiving the root canal procedure, so patients don’t feel pain during the process. However, for fearful patients, there are more sedation dentistry options that can be used including oral sedation and nitrous oxide.
– X-rays
Endodontists may use x-rays during the procedure to check on the 
status of the tooth. With the advancement of technology, there are now digital x-rays that produce less radiation, and they are developed immediately hence reducing the time you will spend in the dental chair.
– Apex Locators
The main goal for a dentist during the root canal therapy is to clean and fill the canal to the end of the root or the apex. If the dentist is not in a position to find the apex, there are possibilities that some of the infections may be left behind. Apex locators help the dentist to find the root through sound waves and guide him to the very end of the root.
– Microscopes
Microscopes are mostly used during complex dental treatment. Surgical operating microscopes allows the dentist to see deep within the root canal so that he can be able to remove the infections properly. For a better view during the surgery, the dentist may also wear magnifying glasses with fibre optic light.
– Cleaning and Filling the Canal
There are several measures that the dentist takes to prevent infections from returning to the canal. After the removal of the infection, they use medicated rinse to wash away any debris left behind and disinfect the tooth. Gutta-percha is what is commonly use as tooth filling since its antibacterial and non-allergic too.
– Laser Root Canal Therapy
This is the most recent innovation in the root canal technology. Dentists can now thoroughly clean the root canal with laser dentistry without using hand files or drills. The waterlase laser uses high-pressure and a laser system to reduce post-operative pain, melt away infection and reduce the possibilities of any side effects.
How painful is a Root Canal Therapy?
For decades, root canal therapy has a reputation of being painful. The report that comes from most people is that this procedure is more painful than having a filling placed. However, this is not the case. With the advancement of technology, dentists now have numerous measures to mitigate the pain involved. Actually, in most cases, there is no pain or just a little involved. The dentist will always use local anaesthesia, and if the patient is still fearful, he/she may apply other methods to make sure that there is no pain at all.
What Should One Expect After a Root Canal Therapy?
Within the first few days after the therapy, the tooth may feel sensitive because of natural tissue inflammation. This is especially if there was infection or pain before the procedure. However, the discomfort or sensitivity involved can be mitigated using over the counter medications such as naproxen, ibuprofen or aspirin. Most patients can return to their day to day activities the following day after the therapy. It is wise to minimise chewing until your root canal therapy is completed to the end. This is to say that the permanent filling or crown has been placed. This step will help in reducing the chances of the interior of the tooth from getting contaminated again and will also prevent the fragile tooth from breaking before the tooth can be fully restored. Also, carry out normal oral hygiene measures like brushing and flossing on a regular basis. Use antiseptic mouthwash regularly as you can and also visit your dentist at normal scheduled intervals.
How successful is the Root Canal Therapy?
Root canal therapy is a highly successful process. The procedure has more than 95% success rate. Most teeth that have been fixed using root canal last a lifetime. Also, it will not be obvious to other people that you have undergone root canal process since the final step involves placing of a dental crown or filling. It will look just like your natural teeth.
Complications of a Root Canal Therapy
Despite your oral surgeon’s best efforts to clean and completely seal a tooth, new infections might emerge after the process. Among the likely reasons for this includes:
– Instruments Fractures
During the root canal therapy, instruments may break, meaning that a portion of the metal file that was used during the procedure remains inside the tooth. The dentist may choose to leave the file segment behind during the procedure after he/she has already done the cleaning and attempts to remove the segment may result in further problems. There are some measures that the dentist can adopt to minimise this risk like creating a glide path before using a larger taper NiTi files among others.
– Tooth Discoloration
This is a common occurrence after the root canal procedure. Failure to properly clean out the necrotic soft tissue of the pulp may bring about discolouration. Another possible reason is the lack of pulp pressure in dentinal tubules once the pulp has been removed.
– Poor Quality Root Filling
Another possible complication of root canal therapy is when the length of the root canal is not entirely cleaned and filled with root canal filling material. The root canal filling material does not properly extend to the roots. The recommended treatment for this is to either extract the tooth and place a dental implant or redo the whole root canal therapy.
Cost of Root Canal Therapy
The cost of the root canal therapy varies depending on various factors. Some factors include the extent to which the tooth has been affected and the position of the affected tooth. However, the good news is many dental insurance policies cover the cost of root canal therapy meaning that you will not have to bear all the cost on your own.
Root Canal Prevention
Since the main reason patients undergo a root canal procedure is due to severe tooth decay, you can carry out measures that aim to prevent this. Carry out good oral hygiene measures like brushing at least twice a day, flossing at least once a day and visiting the dentist on a regular basis. Trauma that results from sports-related injuries can be reduced by wearing a mouth guard while on the field.
