Endodontics

procedures

Endodontics is a specialized branch of dentistry that deals with the complex structures found inside the teeth. The Greek word “Endodontics” literally means “inside the tooth” and relates to the tooth pulp, tissues, nerves, and arterioles. Historically, a tooth with a diseased nerve would be removed immediately, but endodontic treatment is now able to save the natural tooth in most cases. Generally, extracting the inner tooth structures, then sealing the resulting gap with a crown restores health and functionality to damaged teeth.

Signs and symptoms of endodontic problems:

Inflammation and tenderness in the gums
Teeth that are sensitive to hot and cold food
Tenderness when chewing and biting
Tooth discoloration
Unexplained pain in the nearby lymph nodes

Reasons for endodontic treatment

Endodontic treatment (or root canal therapy) is performed to save the natural tooth.

Some of the main causes of inner tooth damage include:

Bacterial infections – Oral bacteria is the most common cause of endodontic problems. Bacteria invades the tooth pulp through tiny fissures in the teeth caused by tooth decay or injury. The resulting inflammation and bacterial infection jeopardize the affected tooth and may cause an abscess to form.

Fractures and chips – When a large part of the surface or crown of the tooth has become completely detached, root canal therapy may be required. The removal of the crown portion leaves the pulp exposed, which can be debilitatingly painful and problematic.

Injuries – Injuries to the teeth can be caused by a direct or indirect trauma to the mouth area. Some injuries cause a tooth to become luxated or dislodged from the socket. Root canal therapy is often needed after the dentist has successfully stabilized the injured tooth.

Removals – If a tooth has been knocked clean out of the socket, it is important to rinse it and place it back into the socket as quickly as possible. If this is impossible, place the tooth in dental solution (available at pharmacies) or in milk. These steps will keep the inner mechanisms of the tooth moist and alive while emergency dental treatment is sought. The tooth will be affixed in its socket using a splint, and the dentist will then perform root canal therapy to save the tooth.

Root Canal Therapy

Root canal therapy is recommended when the nerve in the middle of the tooth gets inflamed beyond repair or dies completely. It is called a “root canal” because the nerve extends from the middle of the tooth and connects to the jaw bone through narrow canals in the root. If the infected nerve goes untreated, an abscess will form at the tip of the root in the jawbone.

Root canal therapy is usually successful, and allows you to keep a tooth that would otherwise have to be removed. Modern advances in technology, such as 3D X-rays, make root canals more successful than before.

Signs and symptoms for possible root canal therapy:

An abscess (or pimple) on the gums
Extreme sensitivity to hot and cold
Pain when chewing or pressing on the gums by the tooth
Severe toothache that comes on spontaneously or wakes you up at night
Swelling
Dark spot on X-ray around tip of root

Reasons for root canal therapy:

Bacteria has reached the nerve – can be immediate when a cavity forms, or even years afterwards
Injury or trauma to the tooth that caused the nerve to die

What does root canal therapy involve?

A root canal procedure requires one or more appointments and can be performed by a dentist or endodontist (a root canal specialist).

While the tooth is numb, a rubber dam (a sheet of rubber) will be placed around the tooth to keep it dry and free of saliva. An access opening is made on top of the tooth, and a series of root canal files are placed into the opening, one at a time, removing the infected nerve tissue and bacteria. If tooth decay is present, it will also be removed.

Once the canals are thoroughly cleaned, they will be sealed with specialized root canal filling material.

A crown or a permanent filling will be recommended to protect the tooth afterwards.

After treatment, your tooth may still be sensitive, but this will subside as the inflammation diminishes and the tooth has healed.

You will be given care instructions after each appointment. Good oral hygiene practices and regular dental visits will aid in the life of your root canal treatment.

Root Canal Retreatment

In rare cases, root canal therapy fails to work as expected. The treated tooth might not heal properly, or a patient might experience post-surgical complications that jeopardize the tooth. Root canal retreatment involves the removal of the previous crown and packing material, the disinfecting of the root canals, and the refilling the tooth. In short, root canal retreatment is almost identical to the original procedure, aside from the structural removal. The success rate for a root canal retreatment runs at around 75%.

Why is root canal retreatment required?

Though the prospect of more endodontic surgery might not be pleasant, root canal retreatment is fairly simple.

There are several reasons why root canal therapy unexpectedly fails, including:

Curved or narrow canals not treated during the original procedure
Delay in the placement of filling or crown following the original procedure
New decay to the tooth
New fracture in the treated tooth
Undetected complex canal structures

Cracked Teeth

Cracked and fractured teeth are common dental problems. As people retain their natural teeth longer the likelihood of cracked teeth increases. There are many reasons why teeth may crack, for example, biting on hard objects, trauma, grinding and clenching of teeth. These behaviors place the teeth under extra strain and render them more susceptible to cracking.

Symptoms of a cracked tooth may include:

Unexplained pain when chewing
Sensitivity to hot and cold foods and drinks
Difficulty pinpointing the location of the pain

Treatment depends on the extent of the crack. In cases where the crack is not too deep, a crown is recommended to hold together the tooth. If the crack is deeper, root canal therapy may be necessary. If the crack extends down the root, the tooth may need to be removed entirely.