Endodontics or treatment of the root canal


What causes the damaging of the pulp ("the nerve")?


The most common cause is definitely a deep caries when the bacteria from the caries cavity act directly on the dental pulp – the result can be the inflammation (which you will definitely feel) or the tissue dying away, the so called necrosis, which can pass without clear symptoms. More rarely the same kind of changes can be caused by some kind of trauma – physical, such as a blow (especially during a fall), chemical (which were more often when the materials used in dental medicine weren't so strictly controlled) or heat (drilling the tooth without cooling it adequately).


Which symptoms indicate that the pulp ("the nerve”) is damaged?


The basic symptom is the pain which can be spontaneous or occurs after some sort of provocation and lasts longer than 10 seconds. Very often with the acute inflammation the pain is more intense at night and reacts poorly to medicaments. It is possible that the tooth will "bother you” during meals or if you touch the bone in the area of the root, you may also notice a small "pimple”, that is to say fistula, on the gums on top of the tooth. It can be very unpleasant if the first symptom is swelling, especially when the person wakes up in the morning with a swollen cheek without any "warning” beforehand.


Why is it, in any of these cases, important to treat the root canal as soon as possible? Why can't it be solved with just the antibiotics and pain medicaments? The answer is simple: the antibiotic can't reach the source of infection, namely the bacteria which are causing problems – they are situated inside the root canal where they are well-hidden and well-protected and the only way to destroy them is the root canal treatment. Besides, if the situation calms down by itself that doesn't mean that the disease isn't developing and spreading further, the next step is spreading of the disease into the bone which reacts by creating cavities in the area of the tip of the root – this is called a granuloma, and in the advanced stages there can be a cyst. If the cavity becomes too big the possibility of treatment is significantly reduced.


What exactly does root canal treatment include?


The first step is diagnostics (RVG) and of course local anaesthesia – in some cases (such as granuloma) it is not necessary because the tooth is already "dead”. The next step is removing the caries, to skip this step would mean to leave the bacteria which could cause more problems. Only after this step we can start treating the root canals and in one tooth there can be from 1 to 4 canals. The knowledge and experience of the operator is important in finding all the canals and in determining possible morphological variations of their location and shape. The exact length of the canal is determined with the apex locator which is the most precise measuring instrument and with the X-ray images. The canals can be treated manually or mechanically. Before filling it the canal has to be sterilized with ozone and if we decide to postpone filling the canal (7 to 10 days) we will put a disinfectant paste based on calcium hydroxide. Filling the canal with warm or cold
gutta-percha will allow hermetic sealing of the treated area and prevent further contact of the bacteria with the bone, in case of any sort of complications gutta-percha is easily removed from the canal and that is very important. All of this allows us to save more than 95% of natural teeth from extraction. Bare in mind that you must not postpone finishing the treatment with a filling or a crown for more than a month.


How long does the treatment last?


Despite the benefits of modern dental medicine there are still many people who believe that a tooth simply can't be cured in 1-2 appointments. That is not true. With the reduction of time of the treatment there is less chance that the bacteria from the saliva will enter the space in the root canal and maintain the infection, so the correct thing to do is to complete the treatment within maximally 3 visits.


A few comments on myths and prejudices on tooth treatment


  • the treated teeth will have to be extracted sooner or later – so far from the truth, treated teeth can last a lifetime and provide a good support for prosthetic substitutes

  • if the tooth doesn't hurt it doesn't have to be treated – myth from the age when x-ray analysis didn't exist. Today we know that the chronic processes (such as a granuloma or a cyst) do not cause pain. This certainly doesn't mean that the tooth should be "left alone"

  • it is better to extract the tooth than to treat it – to some this will seem like an appealing option, but if we take in consideration oral health and cost of replacing the lost tooth the treatment is a far better option. If the tooth is filed down in order to receive the crown it has to be treated – there is no prove for this. Sometimes it is necessary to treat the tooth after it has been filed down, but this is true in the cases of very inclined teeth where the axis of the tooth is being corrected by filing the tooth.

  • Tooth treatment is very painful – today with the local anaesthesia we are able to eliminate almost completely any kind of unpleasant feeling during the treatment. The temporary symptoms of sensitivity when the anaesthetic starts to wear off are easily controlled with pain medication.

  • Pregnant women should avoid tooth treatment – not at all! The pain, the infection and the potential medicaments used to control the symptoms can harm the pregnant woman and the unborn child more than the treatment itself. However it is advisable to postpone any treatment during the first trimester.