Endodontics (Root Canal Treatment RCT)
What is Endodontic or Root Canal treatment?
- Treatment of the nerve space or root canal of the tooth.
- Endodontic treatment and Root Canal treatment usually refer to the same thing.
- 'Endo' means internal, therefore inside and 'odont' is a tooth.
The structure of teeth
The outside of the tooth is covered with enamel. The next layer is the dentine. Inside the dentine is a space with nerves and blood vessels. The root canal is the space in the root of the tooth which contains the pulp (blood vessels and nerves). The pulp of the tooth supplies nourishment and sensation to the tooth. The pulp tissue gives the tooth the ability to heal minor damage to the dentine - particularly in response to a low grade irritation or damage e.g. slow dental decay. The pulp protects the tooth giving it greater resistance to decay. The pulp gives the tooth the ability to feel hot and cold sensation.
Why do RCT (Root canal treatment)?
When the pulp in the tooth is destroyed or "dies" the pulp chamber or root canal becomes empty or full of "dead" (necrotic) body fluids then bacteria can enter this space. The body's defense mechanisms can not remove the bacteria so an infection forms.
Common causes of pulp damage:
- Decay occurring close to the pulp - unfortunately this is not always deep cavities. The anatomy of some teeth result in the pulp being close to the surface of the tooth.
- Trauma (accidents). Moderate trauma may cause injury to the pulp that the body will be able to repair. Sometimes the pulp in the tooth 'dies' years after trauma and the mechanisms and reasons are not always well understood.
- Effect of having large restorations or fillings over a period of time
- Irritation over an extended time
Some people have pulp damage without any symptoms. They have no pain. A dentist may discover a 'dead' tooth via radiographs (x-rays) showing bone destruction or in finding a very loose tooth or finding pus formation or a hole in the bone near a tooth that releases pus slowly (draining sinus). Attention should be paid to removing the infection and healing the bone. Long term dental infections have been linked to heart attacks and strokes.
Pain and the root canal
Tooth pain that may result in the need for endodontic treatment may include:
- Sensitivity to cold and hot. Severe pain which lasts for some time after the hot or cold has been removed is a sign that the pulp may have irreversible damage. Sensitivity to hot and cold may also be due to dental decay, gum recession or a tooth crack.
- Pain on chewing or pressure. This may also indicate a crack in a tooth, or periodontal disease or a endodontic abscess.
Prolonged pain sensitivity to hot and cold is usually one of the early symptoms of pulp damage. The pulp is 'alive' at this stage but the damage to it has been so great that the pulp tissue is unable to heal itself and will continue getting worse until it degenerates totally and 'dies'. Hot and cold expands and contacts the pulp tissue causing pain. Often at this stage hot causes pain which may take minutes to subside and this may be relieved by the placement of cold on the tooth. In an undamaged pulp the tissue has mechanisms to control this expansion/contraction so pain isn't experienced.
The cause of pain when a tooth 'dies' is the pressure, of the 'dead' contents of the inside of the tooth (consisting of dead pulp tissue, debris, and bacteria), on the surrounding bone and gums (periodontal ligament ) so the tooth often feels painful to touch yet may not be sensitive to changes in temperature. Symptoms most commonly associated with a 'dead' nerve are a tooth that hurts to bite on, becomes sore to touch or push on, and in acute stages facial swelling occurs.
How do you do root canal (endodontic) treatment?
Before treatment commences a dentist or specialist endodontist will try to determine whether a tooth is likely to be able to be successfully treated and to be restored as a functional or cosmetic part of your mouth. This is done using radiographs (x-rays), visual examination and periodontal examinations.
Endodontic treatment of a tooth involves:
- Making the tooth comfortable: Most times we make the tooth numb (usual way - you just shut your eyes and start planing your next major birthday and ... easy isn't it!). Sometimes we don't need to make your tooth numb because the nerve is goooooone!
- Rain Coat: We need to keep the tooth free from any other germs and bacteria that live in your mouth. A rubber cloth (RUBBER DAM) is placed over your tooth to keep saliva out. This is great for you because you don't have to worry about the water getting into your mouth or the strange tasting liquids used to wash your tooth.
- Preparing the tooth: It may be necessary to remove any restorations (fillings or crowns) in teeth before the root canal treatment. This to attempt to seal out bacteria. Usually a temporary restoration (filling or crown) is placed in the tooth until the root canal treatment is completed. Then a final restoration will be placed in the tooth.
- Finding the root canals of a tooth: To find the root canals we drill through the biting surfaces of the back teeth and through the back of the front teeth. Each tooth is unique. Teeth have differing numbers of root canals and different shapes. Research has show us the most common positions of canals and the most common numbers of canals and we even have some idea of the standard lengths of roots of teeth.
- Cleaning the root canals: Tiny metal files are used to carefully clean the 'gunk' (pulp, bacteria, pus etc.) out of the root canals. These tiny metal files are used to shape the root canals to accept the filling material. The canals are also washed with special liquids.
- Filling the root canals: Root canals are cleaned, dried and then filled. The filling is aims to fill and seal the root canal so bacteria reentering the root canal. Different materials can be used for this. A common filling material is called "gutta percha" and it is cemented in the tooth.
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