Root Canal Treatment

Services

Contacts

SHIVHARE NIKETAN
H. No. 347/291/1,W. No. 16, OPP UCO BANK,
MALANCHA ROAD,
KHARAGPUR 721301

+91 9475603651

Root Canal Treatment

Root Canal Treatment

Introduction

The pulp is found in the center of the tooth and in canals (called root canals) inside the root of each tooth. Pulp includes connective tissue, nerves and blood vessels. Pulp nourishes the tooth when it first emerges through the gum. Once the tooth matures, the pulp can be removed without destroying the tooth. That's because each tooth also is nourished by a blood supply in the gums.

Removing the pulp is called endodontic treatment, but it is often referred to as root canal treatment or root canal therapy and many people refer to pulp removal as "having a root canal." Root canal treatments are quite common.

Root Canal Treatment Procedure

Why Would You Need Root Canal Treatment?

Root canal treatment is needed for two main reasons. The first is infection since an untreated cavity is a common cause of pulp infection. The decay destroys the enamel and dentin of the tooth until it reaches the pulp. Bacteria then infect the pulp. Antibiotics can't get to infections inside teeth. The inflammation caused by the infection reduces the blood supply to the tooth. The reduced blood supply also keeps the pulp from healing.

The second reason for a root canal is damage to the pulp that can't be fixed. A fracture in a tooth can damage the pulp. So can a less severe blow to the tooth (trauma), even if there's no visible damage. Multiple fillings or other restorations on the same tooth also can damage the pulp.

Sometimes, common dental procedures can hurt the pulp. One example would be if a tooth is cut too close to the pulp while it's being prepared for a crown. Then the tooth might need a root canal.

When the pulp is inflamed but not infected, it may heal on its own. Your dentist may want to see if this will happen before doing root canal treatment. If the pulp remains inflamed, it can be painful and may lead to infection.

An infection in the pulp can affect the bone around the tooth. This can cause an abscess to form. The goal of root canal treatment is to save the tooth by removing the infected or damaged pulp, treating any infection, and filling the empty root canals with a material called gutta percha.

If root canal treatment is not done, an infected tooth may have to be extracted. It is better to keep your natural teeth if you can. If a tooth is missing, neighboring teeth can drift out of line. Keeping your natural teeth also helps you to avoid other treatments, such as implants or bridges. Also, if you ignore an infected or injured tooth the infection can spread to other parts of your body.

Having root canal treatment on a tooth does not mean that the tooth will need to be pulled out in a few years. Once a tooth is treated, and restored with a filling or crown, it often will last the rest of your life.

Signs and Symptoms

If you have an infection of the pulp, you may not feel any pain at first. But if it is not treated, the infection will cause pain and swelling. In some cases, an abscess will form.

Your tooth might need a root canal if:

  • It hurts when you bite down on it, touch it or push on it
  • It is sensitive to heat
  • It is sensitive to cold for more than a couple of seconds
  • There is swelling near the tooth
  • It is discolored (whether it hurts or not)
  • It is broken

To determine whether your tooth needs root canal treatment, your dentist will often place hot or cold substances against the tooth. The purpose is to see if it is more or less sensitive than a normal tooth. He or she will examine the tissues around the tooth and gently tap on the tooth to test for symptoms.

You also will be given X-rays of the tooth and the bone around the tooth. The X-rays may show a widening of the ligament that holds the tooth in place or a dark spot at the tip of the root. If either of these is present, your dentist probably will recommend a root canal procedure.

Your dentist may need more information about the tooth. He or she may use an electric pulp tester. This hand-held device sends a small electric current through the tooth. It helps your dentist decide whether the pulp is alive. This test does not cause pain or a shock. You may feel a tingling sensation. It will stop when the tester is removed from the tooth.

An electric pulp tester should not be used if you have a cardiac pacemaker or any other electronic life-support device.

Length of Treatment

Root canal treatment can be done in one or more visits. It depends on the situation. An uncomplicated root canal treatment often can be completed in one visit. Some teeth may be more difficult to treat because of where they are in the mouth. Some teeth have more roots than other teeth. Treating a tooth with many roots takes longer. Some teeth have curved root canals that are difficult to find. If you have an infection, you will visit the dentist several times so that he or she can make sure that the infection is gone.

Once the root canal treatment is finished, you will need to see your general dentist to have a crown or filling placed on the tooth. You are likely to receive a crown if the tooth is discolored or if it is used for chewing. The purpose of the crown is to prevent the tooth from breaking in the future.

Measuring and Cleaning the Root Canals

Measuring 
First, your dentist or endodontist will numb the area around the tooth. You also may receive sedation, such as nitrous oxide. Your dentist also has other ways to reduce your anxiety. Before your first appointment, ask what is available.

A small protective sheet called a dental dam will be placed over the tooth to keep the area free of saliva. Then the dentist will make a hole in the top or back of your tooth to get to the pulp chamber. He or she will remove some of the diseased pulp.

Then the root canals have to be measured. Your dentist needs to know how long the canals are to make sure the entire canal is cleaned. He or she also needs to know how much filling material to put in the cleaned canals.

To measure the root canals, dentists use X-rays or an electric device called an apex locator. For an X-ray, your dentist will place a file into the canal and then take an X-ray. An apex locator measures a root canal based on its resistance to a small electric current. Many dentists use both methods.

Cleaning 
After the canals have been measured, your dentist or endodontist will use special tools to clean out all of the diseased pulp. Then the canal is cleaned with antiseptic. This helps treat and prevent infection. All the canals within a tooth must be cleaned. Teeth have different numbers of canals:

  • The top front teeth have one canal.
  • The bottom front teeth have one or two canals.
  • The premolars have one or two canals.
  • The molars have three or four canals.

The location and shape of the canals can vary quite a bit. Some endodontists look inside the tooth with a microscope to make sure all the canals have been cleaned out.

Once the canals have been thoroughly cleaned, the roots are filled. A temporary filling is placed over the tooth. The top of the tooth should then be covered with a permanent filling or crown. The temporary filling you receive is not meant to last.

In most cases, the tooth will need a crown. A crown will help to restore the tooth's strength and protect it from cracking. If a crown is indicated it should be placed soon after having root canal treatment.

The pulp that was removed during root canal treatment is the part that responds to temperature. Your tooth will no longer be sensitive to hot or cold after the root canal is treated. There still are tissues and nerves around the tooth, however, so it will respond to pressure and touch.

After Root Canal Treatment

Your tooth may be sore for two to three days after the procedure. The worse the infection and inflammation you had, the more sensitive the tooth will be after treatment. Avoid chewing on the affected side. You can take over-the-counter pain relievers. A pain reliever that also reduces inflammation is likely to be most helpful. Examples include ibuprofen and aspirin.

Possible Complications

As with most invasive medical or dental procedures, complications can occur. Here are some possibilities.

Sometimes when a root canal is opened for treatment, the oxygen in the air will trigger some bacteria to start growing. This causes swelling and pain.

Blood vessels enter the tooth through a small hole at the bottom of the root. Sometimes during a root canal procedure, bacteria are pushed through this hole into surrounding tissue. If this happens, the surrounding tissue will become inflamed and possibly infected. This can be treated with painkillers and sometimes antibiotics. However, it may be painful until it clears up.

A root canal treatment can puncture the side of the tooth. This can happen if a canal is curved or hard to find. The tools that the dentist uses are flexible. They bend as a canal curves. Sometimes they bend at the wrong time and make a small hole in the side of the tooth. If saliva can get into the hole, it will have to be filled. Sometimes, the tooth has to be removed. If the hole is far enough under the gum that saliva can't reach it, the hole may close on its own.

Finding root canals can be difficult. If all of the canals aren't found and cleaned out, the tooth can stay infected. This also can happen if a canal isn't measured correctly and pieces of infected or inflamed pulp are left near the bottom. In this case, the root canal procedure would have to be done again. Occasionally, root canals have branches that the dentist's tools can't reach.

The tip of a file may break off inside the tooth. If the canal is clean, your dentist can leave the piece of file in the tooth. But if canal is not completely cleaned out, the file piece may have to be removed. Sometimes this can be done from the top of the tooth. However, in some cases, the file can only be removed through a surgical procedure called an apicoectomy. A small cut (incision) is made in the gum so the dentist can get at the bottom of the tooth's root. The dentist shaves off the bottom of the root and gets into the canal from the bottom to remove the file piece.

Pain, or the Lack of It

In most cases, you will not have any pain during a root canal procedure. Your dentist will numb your tooth and the surrounding area. Let your dentist know if you are feeling any pain during the root canal. Some people fear the numbing shot more than the root canal treatment itself. Today, numbing gels and modern injection systems have made injections virtually painless. If it does hurt when you are getting an injection, let your dentist know right away. He or she can change the way the injection is given to avoid causing pain.

Myths About Root Canal Treatment

Root canal is usually painful.
When people are told that they need a root canal treatment, they usually think about pain. However, the pain they feel is caused by an infection in the tooth, not by root canal treatment. A root canal is done to eliminate that pain. The root canal procedure itself is painless. A local anesthetic numbs the tooth and the surrounding area. Many people may be afraid to have a root canal because they are anxious about having dental work done. Dentists can provide calming medicines, such as nitrous oxide.

The tooth's nerves are removed, so I won't feel any pain. 
Many people believe that once they have had root canal treatment, they will no longer feel pain in the treated tooth. This, however, is incorrect. The tooth will no longer be sensitive to hot or cold food or beverages. But for a few days after treatment, the area around the tooth can be sensitive. If this happens to you, your dentist can prescribe a medicine to reduce inflammation.

Why bother getting a root canal done when I'm just going to need the tooth taken out eventually? 
It is not correct to assume that the treated tooth will eventually need to be extracted. In fact, most root canal treatments are successful and result in the tooth being saved.

I'm not feeling any pain, so I don't really need a root canal. 
Many teeth that need root canal therapy will not cause pain. But that does not mean the tooth is okay. Your dentist and endodontist have ways to see if the tooth's pulp is damaged or infected. If it is, then you will need root canal therapy, even if the tooth doesn't hurt. If you see something near a damaged tooth that looks like a pimple, see your dentist. The "pimple," called a fistula, is a tunnel of tissue draining pus from an infection. There is no pain because the fistula keeps pressure from building in the tissue. It can come and go. The infection must be treated, and the tooth probably needs root canal therapy. Without treatment, nearby tissues may be damaged.

A root canal means I'm having the roots of my tooth, or my whole tooth, removed. 
The whole point of root canal therapy is to try to save a tooth, not to remove it. Your tooth and roots are not removed. The canals are cleaned and shaped on the inside only. The nerve tissue and pulp are removed along with some of the inside part of the root to ensure all the bacteria have been removed.

After I get the root canal, I won't have to go back to the dentist for a while. 
Once you have received root canal therapy, you will need to make follow-up appointments to have a permanent filling or crown put on the tooth. The temporary filling that is placed after the pulp has been removed will protect the root from infection for only a short time. A permanent filling or crown must be placed to ensure that bacteria don't leak into the canal.

The Second Time Around: Possible Retreatment or Surgery

A root canal can fail for several reasons. If the bacteria were not completely removed from the canals, they can grow and cause pain. Bacteria can also get inside a tooth if a permanent filling was not placed soon enough. Temporary fillings or poorly placed permanent fillings can break down or leak. This allows bacteria back into the canal.

Sometimes the problem is not in the root canal that was filled, but in another canal that the dentist did not find. The bacteria in this unfilled canal will grow and cause pain.

A repeat root canal treatment tends to be more involved and take more time than the first one. Your dentist must remove the crown, post and core, and filling material before doing the second root canal. Some people who need another treatment may have infections that are difficult to destroy. Because they take more time and can be complicated, second root canals also usually cost more.

Sometimes a second root canal can be hard to do. For example, it may be too risky to remove a post and core. The post that is in the tooth may be cemented or set in very tightly. If that is the case, the tooth may be injured in the process. So your dentist may decide to do endodontic surgery instead.

This surgery allows the dentist to get inside a tooth's root from the bottom of the tooth, rather than the top. Your dentist will not touch the crown of the tooth. The retreatment of the root canal will occur through the bottom of the root.

Endodontic surgery is done in the dentist's office. An endodontist, general dentist or oral surgeon can perform this procedure. First, you will receive a shot to numb the area. Then your dentist will make a small cut (incision) in the gum near the base of the tooth. He or she will clean out the infected tissue around the tip (apex) of the root and shave off the tip. This procedure is called an apicoectomy. The endodontist will clean the inside of the canal from the root end, and then put a filling in the end of the root. The incision is then stitched.

Endodontic surgery is successful about 85% of the time. If the surgery does not get rid of the infection, the tooth will have to be extracted.

Restoring the Tooth After Root Canal

For small cavities in front teeth, your dentist may place a tooth-colored filling after a root canal. Usually, though, your tooth will need a crown. The crown is created in a dental laboratory. It is made of porcelain, metal or a combination of the two.

First, your dentist will have to build up a foundation to strengthen the tooth and support the crown. This buildup is called a core. To help hold the core in place, your dentist may have to use a post. A post is a metal rod.

There are two ways to put a post and core in a tooth. The post can be pre-made and used with a core material that is built up around it. Or the post and core can be custom-made in one piece to fit your tooth.

This second type is used when a significant amount of the tooth is lost. The custom-made post will take two dental visits. During the first visit, your dentist prepares the tooth and takes an impression so the post and core can be made. During the second visit, your dentist cements the post and core to the tooth. Finally, a crown is made and cemented onto the tooth, post and core.