Root canal treatment
Root canal treatment, also known as endodontic treatment, consists in removing from the tooth chamber and root canals infected with pulp bacteria, which patients commonly (though not quite properly) call a nerve. In fact, the pulp is a delicate, gelatinous tissue, extremely richly innervated and vascularized. In the tooth, it primarily performs a nutritional function, it also allows tissue repair (dentin formation). Another important function of the pulp is sensory function, which is based on recording pain regardless of the location and type of stimulus.
What does a dentist need a microscope for?
The effectiveness of root canal treatment is greatly influenced by the use of a microscope, enabling the dentist to carefully examine the interior of the affected tooth and to locate all, even the thinnest, canals. Not so long ago, skipping the canal during treatment was the most common cause of endodontic failure.
The use of a microscope also allows endodontists to increase the precision of the procedure itself. The enlarged dentist can assess the length and course of the canals much easier than a doctor based only on x-rays. Also, activities such as removing broken tools or unclogging narrow canals have become easier through the use of a microscope.
What does a dentist need a cofferdam for?
Asepticity of the treatment field is an extremely important factor in endodontist work. The cofferdam – i.e. a thin sheet of natural rubber – enables the isolation of the treated tooth from saliva and the inside of the mouth full of bacteria. The cofferdam creates an effective aseptic barrier and guarantees sterility of the operating field.
What does a dentist need an X-ray examination for?
X-ray examination is a diagnostic tool that greatly increases the effectiveness of treatment. The variety of symptoms associated with pulp disease and periapical tissues means that making an accurate diagnosis is not always easy. The X-ray image provides the doctor with a lot of valuable information that helps to make the correct diagnosis and choose the appropriate therapeutic method.
X-ray examination – 3D tomography:
- makes it easier to assess the stage of the disease,
- reveals all the details of the tooth anatomy: the course and number of canals, the presence of additional or obstructed (obliterated) canals,
- tooth root development stage,
- allows to determine the presence of inflammatory changes in periapical tissues.
Based on the analysis of X-ray examination – 3D tomography, the dentist can also determine:
- extent and depth of filling,
- presence of broken tools in the dental canal,
- correct or incorrect filling of the canals (lack of tightness, visible empty spaces in the tooth cavity),
- of endo-perio inflammatory lesions.
In the case of irreversible pulpitis, root canal treatment is the only method (except for extraction). By enucleating the inside of a tooth attacked by pulp bacteria, the dentist removes the focus of infection, which is a potential source of a serious infection, which over time can spread to many organs and contribute to the development of dangerous systemic diseases.
Although age is not a contraindication to endodontic treatment, it happens that the dentist has to postpone root canal treatment in a child due to incomplete root apex formation with living pulp. In contrast, the elderly often have sclerosis of the canals (root canal lumen closure), which may hinder or even prevent their development.
It should be emphasized that pulpitis is not always painful – the type and nature of pain depend on the stage of the disease. It is often the case that a dead or gangrenous pulp does not give clear pain. A tooth may discreetly ache when weather changes or biting, but it is not a spontaneous, continuous, unbearable pain, which in the opinion of most patients is a typical symptom of “neuritis”. It happens, however, that chronic pulpitis is exacerbated, and then there may be severe, severe pain suggesting the existence of periapical lesions.
Question about general health (past illnesses, drug allergies, recent medical procedures) – is a standard element of medical history, which every dentist should carry out before proceeding with the procedure. However, providing current laboratory tests is necessary primarily when root canal treatment is to be performed under general anesthesia.
It happens that after the end of edodontic treatment, the patient still experiences severe pain. The cause of the pain may be an infected pulp that has remained in the channels not properly filled or overlooked by the dentist. In this case, the bacteria found in the diseased pulp get through the periapical opening to the tissues surrounding the dental root, and then cause their inflammation. Another common cause of pain arising after root canal treatment is to push the sealing material out of the tooth root or fracture of the endodontic instrument inside the root canal (without attempting to remove it).
It should be emphasized that root canal treatment does not always give satisfactory results. Sometimes – despite the dentist’s genuine effort – a sick tooth can no longer be saved. It is worth knowing that the risk of complications increases in the following cases:
- root canals have a complicated structure (they are curved) or have an unusual course or are obstructed,
- the tooth was already root canal treatment
In the past – for the doctor to proceed to remove infected live pulp from the chamber and root canals – it was necessary to poison the tooth, i.e. devitalisation. It consisted in opening the tooth chamber and filling its interior with a highly toxic substance (paraformaldehyde). This preparation – commonly known as poison – caused a gradual death of nerves in the pulp. Admittedly, devitalization allowed for cleaning the canals without exposing the patient to pain that was difficult to bear, but in itself it was also very painful. According to the latest standards of modern endodontics, the use of devitalizing preparations (so-called poisons) – is a mistake. If the living pulp is strongly inflamed – the dentist administers local anesthesia, which quickly and effectively relieves the sensation of pain.