To know about a root canal we have to understand the basic structure of the tooth

The portion of the tooth seen in the oral cavity is called the crown of the tooth and portion which is anchored within the jaw bone is called the root. Depending on the size location and function a tooth may have one or more roots. The tooth has this inner core of soft tissue called pulp. The pulp comprises of all the nerves and blood vessels, which keep the tooth alive. In the crown, the pulp is present within a chamber called pulp chamber and it extends into the root via a narrow tapering canal called root canal. The blood vessels and nerves, which travel through this canal, leave the  tooth through a small opening present in the lower end of the tooth ultimately joining with the other major blood vessels and nerves running within the jawbone.

Root canal  treatment is an endodontic procedure where in infected pulpal tissue ( connective tissue including the nerve and fine blood vessels) are removed from the pulp space, which constitute pulp chamber

img1035

in the center of crown and root canal space in the root of tooth. Root canal  is biomechanically prepared and given a shape, disinfected and filled. 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.

Root canal treatment is needed for two main reasons. The first is infection. An untreated cavity is a common cause of pulp infection. The decay erodes the enamel and dentin of the tooth until it reaches a root canal. This allows bacteria to 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. Trauma or a fractured tooth can damage the pulp.  Sometimes, common dental procedures, such as preparing a tooth for a crown, can hurt the pulp. Then the tooth might need a root canal.

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. They also can be overstressed from chewing. Keeping your natural teeth also helps you to avoid other treatments, such as implants or bridges.

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.
  • Severe tooth pain, typically relieved by cold water and increases with the intake of hot liquids.
  • Pain worsens when you lie down and reduces when you sit up.
  • Constant tooth pain.
  • Tooth pain referred to head and ears as well.

To determine whether your tooth needs root canal treatment, your dentist will often perform the following tests:

  • Hot and cold test.
  • X ray of tooth and surrounding bone.

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.
  • Sometimes, in only about 1% of the  cases,there will some pain after root canal or a ‘flare-up’ of the tooth causing pain and sometimes swelling. This usually happens within the first three days following treatment and is caused by dying bacteria inside the tooth that put off toxins as they expire. If this happens, you may need to be on an antibiotic.  Call your dentist and let them advise you what to do.
  • These days, most dentists and Endodontists prescribe medications to get infection under control before a root canal is performed, although it is not necessary or advisable to wait until all the infection is gone before seeking treatment. While you cannot have root canal treatment if you’re severely swollen, an abscessed tooth needs to be treated as soon as possible.
  • Some dentists will begin treatment by draining the abscess first then scheduling the root canal treatment after the infection has subsided.
  • Most of the time, however, there is little or no pain after root canal, if done when first indicated. If there was a lot of infection in the tooth before the root canal, there will be healing time required after the procedure and you may experience some pain. This pain can be moderate to severe and last several days, getting a little better each day.
  • If your tooth hurts when you chew on it, it is still healing and you need to chew on the other side of your mouth until the pain is gone. Some teeth swell in the socket and feel ‘higher’ than the other teeth, disrupting the healing process. If this happens, call your dentist or Endodontist and get an appointment. They can adjust your bite to prevent this tooth from hitting so hard when you bite.
  • Some people are surprised when they experience any pain after root canal thinking the nerves are gone. The nerve inside your tooth is gone, but there are still nerves surrounding the outside of your tooth where in enters the gum.
  • These nerves can be irritated by the procedure or the abscess that caused all your problems to begin with, and can take time to heal.
  • Teeth that have a fracture can still have sensitivity after a root canal, and should be crowned as soon as your dentist can give you an appointment.
  • Avoid chewing on the tooth until your dentist has crowned it. Even after crowning, some teeth that have fracture will be sensitive on occasion, much like a healed broken bone is sometimes sensitive. This is normal and nothing to worry about unless the pain or sensitivity gets severe.
  • A root canal removes the nerve inside your tooth. If you experience sensitivity to hot or cold liquids after your root canal, you may have another tooth involved, as the nerve inside the tooth controls temperature sensations.
  • Extreme pain (which cannot be controlled by a pain killing medication) after root canal is rare and should be reported to your dentist.

Are Root Canal Treatment Safe ?

  • There are people that insist that root canals are not a safe procedure and that no one should ever have one. These people refer to a study done in the early 1900’s of Dr. Weston Price. This study concluded that infected material and bacteria are left in the tooth and continue to infect the body after the root canal is finished, therefore infection remains in the tooth and surrounding jaw bone.
  • The dental community has been accused of everything from total ignorance of this situation, to deliberately covering up these conclusions.
  • The American Association of Endodontists (AAE) website, http://www.aae.org/patients/mythsrootcanal/  has this to say on the subject:
  • “Root canal treatment is a safe and effective procedure.
  • Research studies performed in the 1930s and 1940s and those conducted in later years showed no relationship between the presence of endodontically treated teeth and the presence of illness. Instead, researchers found that people with root canal fillings were no more likely to be ill than people without them.
  • Over the past several years, however, a very small number of dentists and physicians have been claiming that teeth that have received root canal (endodontic) treatment contribute to the occurrence of illness and disease in the body. This claim is based on the outdated research performed by  Dr. Weston Price from 1910-1930. His research stated that bacteria trapped in the teeth during root canal treatment can cause almost any type of disease, including arthritis, heart disease, kidney disease, and others.

Root Canal Alternatives

  • Getting the tooth removed is the only alternative for a tooth that requires root canal therapy.  But most times, having the tooth removed is not the best solution.
  • If you choose to have it removed, adjacent teeth to the missing tooth can shift over time and misalign your bite, possibly developing jaw problems. You won’t be able to chew as well which could result in stomach and digestive problems.
  • Missing front or premolar teeth can be seen when you open your mouth or smile making you unattractive. There are reports of people that could not get a job because of missing teeth that show when they smile.
  • So what are the root canal alternatives? You have two choices: (1) get the tooth pulled and havea “ dental bridge”installed or (2) have a “dental implant” installed.
  • A crown, sometimes called a ‘cap’, is a strong, protective covering for your tooth made to look just like your real tooth. After a root canal, the tooth no longer has a blood supply. Over time it becomes brittle and most dentists recommend a crown afterward to prevent fracturing and loss of the tooth, especially your back or molar teeth which take the most pressure from chewing.
  • If you choose to have the tooth removed, a dental bridge may be required to complete your bite or to restore your smile. A dental bridge is built by grinding down the two teeth on either side of the space left by the pulled tooth, having crowns made for those two teeth with a fake crown attached in the middle to fill the void left by the pulled tooth. This dental bridge, when installed, fills the area and makes it look like you still have your tooth.
  • Cleaning of the dental bridge is harder than a natural tooth, since you now have two teeth attached to one another by the fake one in the middle.
  • A dental bridgeis expensive and is charged by how many crowns it contains.
  • Another root canal alternative is to have the tooth removed and be replaced by a dental implant. A dental implant consist of a dental screw that is placed into the bone at the site of the missing tooth. A fake tooth (a crown) is attached to the screw after the area has healed completely.
  • This process  for a dental implant takes approximately 6 months of healing time to complete.  It is also expensive, costing Rs. 30000-40000 depending upon the implant system used. The advantages of a dental implant are that they do not require any grinding down of other teeth (like a bridge does), can be cleaned more easily than a bridge, and is the most like your real tooth.
  • A root canal and crown for a tooth can be the most economical way to go. If a root canal costs 3000-5000 and was crowned afterward for another Rs.5000-12000, your total would be Rs. 8000-17000, and you would be able to clean around the tooth just like a normal tooth creating much less chance of developing decay in the tooth. (Yes, teeth can still develop decay after having a root canal and crown so cleaning them is still important).
  • over all, a root canal costs less than a dental bridge or dental implant. You should research the alternatives to make an informed decision.

Restoring a Tooth After Root Canal Treatment

After your tooth’s root canal treatment has been completed your dentist will need to discuss with you what additional dental work will be required so to make the tooth fully functional again.

Different types of restorations that a root canal treated tooth might require varies from simply placing a composite filling in access cavity to core build up and crowning to more complex ones requiring post and core build up  and crowning. The type of restoration which your dentist will suggest you depend on  the location of tooth in the mouth and the extent of damage to the tooth. Many times a tooth that has required root canal treatment is one that has a big filling or else has large portions missing due to decay or breakage. These teeth, in this state, are not as sturdy as they once were and for this reason it is commonplace that a dentist will recommend that a tooth that has had root canal treatment should be restored with either a dental crown or else a dental crown in combination with a dental post.

The dental restoration that is chosen for rebuilding a tooth that has had root canal treatment provides another function also. It provides a seal protecting the interior of the tooth. This barrier helps to prevent seepage of bacteria and contaminates from the oral cavity into the interior aspects of the tooth (a phenomenon termed “coronal leakage”). Your dentist will need to advise you as to what they think is best for your situation but, in general, the sooner arrangements can be made to have the permanent dental restoration placed (thus creating the best possible seal) the better.

Placing a post in a tooth that has had root canal treatment.

A “post” is a rod like structure  made up of either metal, or carbon, quartz ,glass fiber or even ceramic. Purpose of putting the post in tooth  is to provide a surface around which a core can be built up. Post does not strengthen the remaining tooth structure in any way. There are two ways to put a post and core in a tooth. The post can be pre-fabricated 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 often is used in front teeth. It takes 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.

How does a dentist place a post in a tooth?

When placing a post a dentist will first use a drill and remove some of the gutta percha filling material that was placed during the tooth’s root canal treatment. They will then cement the post and subsequently place a core of filling material around the post’s upper portion, so to increase the overall amount of structure that will extend up into the crown.

Placing a dental crown on a tooth that has had root canal treatment.

Crowns are dental restorations that cup over the portion of a tooth that lies above the gum line. People sometimes refer to dental crowns as “caps.” Dental crowns can either be gold or else have a porcelain surface so they look white like a tooth’s neighbouring teeth.

A dentist will use a dental crown as a means of improving the appearance of a tooth, restoring a broken tooth to its original shape, and/or strengthening a tooth. Additionally, and very importantly, dental crowns create an excellent seal over a tooth. By this we mean that a crown cemented in place provides a barrier that is helpful in preventing bacteria and contaminates from seeping back into those inner aspects of a tooth where the root canal treatment has been performed. After a tooth has had its root canal treatment completed, any or all of these qualities which a crown can provide may be needed.