The dental pulp is the name given to the soft tissue that runs through the canal or canals in the middle of the root or roots of a tooth. The pulp consists mainly of nerves and blood vessels and its function is to provide nutrition for a developing tooth and to provide sensory feedback for an erupted tooth.. The most common cause of pulp damage is deep decay that reaches the pulp. Other causes of pulp damage include trauma to the teeth, loose fillings resulting in decay, excessive tooth wear and gum disease. These processes can lead to infection and death of the pulp.

The infection may then spread through the opening at the tip of the root to the surrounding bone, resulting in an abscess which may be very painful and cause swelling. Such an abscess may show up on an X-ray of the tooth.

What is a Root Canal Treatment ?

Root canal treatment (also called Endodontic Treatment) is needed when the blood or nerve supply of the tooth (known as the pulp) is infected through decay or injury. Root canal therapy should be commenced and completed as soon as possible in order to prevent the possibility of the infection around the tooth spreading and causing more widespread and potentially serious infection around the body, manifesting in such things as facial swelling and fever which may occasionally require hospitalization. The localized spread of an abscess is also important and in time, if left untreated, may result in the loss of supporting bone around the root of the tooth and eventually loss of the tooth.

The aim of the treatment "is to remove all infection from the root canal. The root is then cleaned and filled to prevent any further infection."

For those patients where swelling and fever are already present, a course of antibiotics may be prescribed. Antibiotics are not a substitute for root canal therapy, for the reason that there is no longer a blood supply to the inside of an infected tooth so that there is no way for the antibiotics to be carried into the inside of such a tooth to eliminate the infection. The purpose of antibiotics is to stop the infection that is outside the tooth from spreading and to help the body fight what is already there.

Typical Signs and Symptoms….

Throbbing pain in the tooth, especially at night.
Pain on consuming hot and cold food.
Swelling and soreness in the gums, surrounding the tooth.
The tooth may be painful to chew on.
Teeth that are severely wornout.
Discolouration of the tooth.

The Root Canal Procedure

Root canal therapy may be done over a number of visits, typically two or three, in the case of teeth with active or long-standing and extensive infection but sometimes it may be possible to complete the treatment in a single visit if the infection is of recent origin and relatively mild in symptoms.

The tooth is anaesthetized and opening is made through the crown of the tooth to the pulp chamber.
X-Rays are taken to ensure that the full length of the root canal is treated. Special files are used to clean the infection and unhealthy pulp and shape the canals. Irrigation is used to clean small offshoots of the main canal. If the roots are unusually shaped or there are other complications, Apical Surgery (Apicoectomy) is advised.

When the space has been cleaned and shaped, root canal will be filled with a biocompatible material. This is usually a flexible plastic material called "gutta-percha” ensuring that the root canals are completely sealed. Normally, a temporary filling will be inserted to close the opening. The temporary filling will be removed before the tooth is restored. If there is no sign of infection the tooth is restored with a permanent filling.

Apicoectomy

Apicoectomy means the "removal of the apex of the root."

During periapical surgery, a small piece of the tip of the root is
removed.
The root canal is then sealed with a special material.
This is necessary when some infection remains at the end of the root.
The purpose of this apicoectomy is to make sure that there is no remaining infection in the area.

Following root canal therapy, careful restoration of the tooth is of paramount importance.

Teeth, which have had root canal therapy, tend to dry out and become brittle, hence prone to fracture, during chewing. Heavily restored teeth, which have had root canal therapy, are even more at risk. You have already paid a fair sum for your root canal therapy and the last thing you would want to happen is for such a tooth to break apart during chewing, requiring its removal.

The general recommendation is that a tooth, which has had root canal therapy and where such a tooth is missing from its structure more than the small access cavity cut for the root canal instrumentation, be restored with a full coverage crown as soon as possible, in order to protect it from fracture. The patient should not bite on the tooth following the root canal therapy until a crown has restored such a tooth.

In some cases the root filled tooth may lack sufficient remaining visible tooth structure to support a crown. In such a situation, a post may be inserted into the root canal and a foundation or core built up to support the final crown.
     
Is there an alternative to Root Canal Treatment ?

The only alternative method of removing the infection is to extract your tooth. Then if you do not have the tooth replaced with an artificial one, the adjoining teeth will shift, interfering with biting, chewing and appearance. Loss of a tooth can lead to many other complex problems in the region including gum disease, decay of other teeth, jaw joint degeneration and jaw muscle problems.

Replacing your tooth, which may have been saved through root canal therapy, with an artificial one, may be a more expensive option than saving the tooth in the first place. Alternatively, the replacement may be less efficient in chewing and biting or it may involve treatment of your adjacent teeth, which may harm them.

Weighing up the alternatives, you are much better off having the tooth saved through root canal therapy and crowning.

Even though endodontic treatment is one of the most successful and predictable procedures in modern dentistry, failures can occur. Some indications of failure include swelling, soreness, or the persistence of abscess at the root tip as identified in an x-ray. When this happens, a root canal revision procedure also referred to as "retreatment" may be warranted. Retreatment is a non-surgical approach. It basically consists of redoing the root canal and is a second chance on maintaining the tooth.

Once retreatment has been selected as a solution to your problem, the tooth has to be reopened to gain access to the root canal filling material. This restorative material will be removed to enable access to the root canal. The canals have to be cleaned and carefully examine the inside of the problematic tooth. Once cleaned, the doctors will fill and seal the canals and place a temporary filling in the tooth.

At this point, you will need to return to your dentist as soon as possible in order to have a new crown or restoration placed on the tooth to restore full functionality.
         
        

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