Endodontics

Endodontics is the branch of dentistry that deals with the diagnosis, prevention and treatment of diseases that arise from the soft tissues inside the tooth. These tissues are referred to as the dental pulp and they occupy the root canal space .Thus endodontic treatment is also called root canal treatment..

A root canal therapy refers to the process by which a dentist treats the inner aspects of that is occupied by its pulp area inside a tooth that is occupied by its “ pulp tissue “. He used to repair and save a tooth that is badly decayed or becomes infected. Inside the tooth hard outer shell is a nourishing pulp of blood vessels, lymph vessels and nerves. Root canal allow these vessels and nerves to extend to connect to the rest of the body systems. Deep tooth decay, or injury can cause serious damage and infection, cleans out the infected pulp chamber and canals and replaces the organic material with an insert filling.

Severe tooth decay or injury that causes an abscess (infection) in the bone surrounding the tooth. Because the tooth will not heal by itself. Without treatment, infection will spread, bone around the tooth will begin to degenerate, and the tooth may fall out. Pain usually worsens until one is forced to seek emergency dental attention.

The infection in the tooth can cause :

• Swelling that may spread to other areas of the face, neck or head.
• Bone loss around the tip of the root.
• Drainage problems extending outward from the root. A hole can occur through the side of the tooth with drainage into the gums or through the side of the tooth with drainage into the gums or through the cheek with drainage into the skin.

Symptom / No symptoms:

• Severe tooth ache pain upon chewing or application of pressure.
• Prolonged sensitivity / pain to heat or cold temperatures ( after the hot or cold has been removed).
• Discoloration ( a darkening of the tooth ).
• Swelling and tenderness in the neatly gums.
• A persistent or recurring pimple on the gums.

Why is Root canal treatment needed?
If the pulp becomes infected, the infection may spread through the root canal system of the tooth. This may eventually lead to an abscess. An abscess is an inflamed area in which pus collects and can cause swelling of the tissues around the tooth.The symptoms of an abscess can range from dull ache to severe pain and the tooth may be tender when you bite. If root canal treatment is not carried out, the infection will spread and the tooth may need to be taken out.

How painful is the root canal treatment?
Most of the pain associated with a root canal is felt before treatment. In some cases, the tooth is highly sensitive while in others a throbbing pain is felt which may be accompanied by a swelling. There is usually some difficulty in eating.

The actual treatment itself is not necessarily painful. In cases with hypersensitivity, an anesthetic injection is given to numb the area after which the patient usually does not feel anything. In cases with severe infection antibiotics are prescribed to control the infection and hence the pain.

For the first few days after treatment the tooth may feel sensitive, specially if there was a lot of pain or infection before treatment. If so, you may be advised a pain killer or even antibiotics.

Common symptoms requiring an RCT:

• 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. 
• Pain stays for a long time after consuming cold things.
• Swelling around the tooth .
• Constant tooth pain.
• pain when chewing.
• Tooth pain referred to head and ears as well.
• Tooth sensitivity on consuming sweets.

If you have any of the above stated symptoms, it would be advisable that you visit your dentist, since he is the best person to judge whether you have a root canal disease or not, as some of these symptoms may be due to other problems as well.

Treatment procedure:
Root Canal Treatment can often be performed in one or two visits and involves the following steps.

Step 1- After the tooth is anaesthetized, opening is made through the crown into pulp chamber. 



Step 2-The lengths of the roots’ canals determined



Step 3- Unhealthy pulp is removed. Canals are cleaned, enlarged and shaped using excessively larger endodontic files.



Step 4-Canals are filled and sealed . a metal post may be added for structural support or to retain restorative material.



Step 5-The tooth is sealed with a temporary filling. Usually gold or porcelain crown adds further protection



What will my tooth look like after treatment?
In the past, a root filled tooth would often darken after treatment. However, with modern techniques this does not usually happen. If there is any discoloration there are several treatments available to restore the natural appearance.

Why does a root canal need to be re-treated and how will it be done?
A small percentage of root canals may get re-infected due to the following reasons:

• Root canals are complex and often there is more than one canal in each root. Some canals are extremely difficult to see and may be missed even with sophisticated instruments.
• In other cases, the roots of the teeth are curved and the canals very narrow, making it impossible to clean or seal the entire canal system rendering it susceptible to re-infection.
• New decay and a loose or broken filling can expose the root canal filling to bacteria and saliva, causing the tooth to be re-infected.
• Lastly, treatment may fail because the root canal was not thoroughly cleansed or sealed in the first instance.
• For re-treatment of a root canal the tooth is re-opened, the old filling is removed; the canals are re-cleaned and re-filled. Some cases require surgical intervention.

What is endodontic surgery?
In some cases the infection persists or recurs around the tooth even after routine root canal therapy has been completed. In such cases it becomes necessary to surgically access the infection through the gum and bone tissues and clean it out from around the root of the tooth. This is called “Surgical Root Canal Therapy”(SRCT).

There are different types of endodontic surgeries. The most common is the Apicoectomy, where an opening is made in the gum region of the problem tooth and the infected tissue removed along with a part of the root. The end of the remaining root is then sealed with a small filling, stitches are made in the gum tissue and healing generally proceeds uneventfully.

Other types of endodontic surgeries include:

• Curettage (removing of only inflamed tissue) 
• Root Amputation (selected removal of roots) 
• Hemisection (dividing the tooth in half) 
• Intentional Replantation (removing and reinserting the tooth)

What are the alternatives to root canal treatment?
The alternative is to have the tooth out. Once the pulp is destroyed, it can’t heal and it is not recommended to leave an infected tooth in the mouth. Although some people would prefer an extraction, it is usually best to keep as many as natural teeth as possible.

The extracted tooth will have to be replaced by a denture, bridge or implant. Otherwise, the neighbouring teeth will move into the space, creating problems with eating and cleaning. These problems can cause gum disease and new cavities.

Will the tooth be safe after treatment?
Yes. However, as a dead tooth is more brittle, it may be necessary to restore the tooth with a crown to provide extra support and strength to the tooth.

How long will the restored tooth last?
Your restored tooth could last a lifetime, if you continue to care for your teeth and gums. However, regular checkups are necessary. As long as the roots of a treated tooth are nourished by the tissues around it, your tooth will remain healthy.

What about after care?
Root treated teeth should be treated just the same as any other tooth. Remember to clean your teeth at least twice a day preferably with a fluoride tooth paste and floss daily. Cut down on sugary snacks and keep them only to mealtimes if possible. See your dentist as often as they recommend for regular check up.

How many sittings are required?
The dentist would try to make the treatment planning for the ease of the patient, but there are a few factors which decide the amount of chair time and the number of sittings :

• The position of tooth in the mouth, maxillary molars take more time than the mandibular ones.
• Number of roots present in a tooth and number of root canals seen in the roots, as each of the canal is to be emptied and filled with the filling material.
• The length and thickness of root canals.
• Previous procedures - If the tooth has gone through some treatment earlier, like crown placement, then it takes more time for the entire procedure rather than the normal tooth with some small filling.

Root canals are done to protect a tooth, the calcified tissues of the tooth. This helps in maintaining the jaw integrity. If the entire tooth is extracted, the space in between the adjacent teeth can lead to shifting around of those teeth if a bridge or implant placement is not done rightly there. So, a root canal treatment is advised for the protection of the tooth during an infection.

Any endodontic infection is accompanied with swelling due to inflammation of that region, which occurs after the necrosis or death of the oral tissue. This, if not taken care of, will spread to all the parts of the oral cavity and sometimes would lead to some medical complications in severe cases.

When root canal is done, it does not make the tooth entirely dead. Removal of the pulp contents do not make the tooth dead. The reason for this is that the tooth still gets adequate nourishment from the adjacent tissues and from the alveolar bone. So it is not regarded as a dead tooth, and it can be restored and maintains the integrity of the alveolar bone and dental arch when a crown is placed over it.