Root canal treatment or Endodontic Therapy is a procedure that removes damaged or diseased tissue from the inside of a tooth, to relieve the pain of toothache or infection, and significantly prolong the life of a tooth. Root canal treatment is often the final way to retain a tooth which would otherwise need extraction.
A tooth consists of two parts: the crown, what we see as the tooth in the mouth; and the root, the anchor that holds the tooth in the jawbone. The outer layer of a tooth is composed of enamel. The layer beneath this is called dentine. Dentine surrounds a central hollow channel within the tooth called the root canal. A root canal houses a complex bundle of nerves and blood vessels, termed pulp, which enables sensation and nourishes the tooth. It is this part of the tooth that gets treated during root canal treatment.
Why Do I Need A Root Canal?
Inflammation and infection of the pulp may occur following dental decay, deep fillings, cracks, trauma, gum disease or teeth grinding. If the pulp experiences damage or disease, a tooth may become sensitive to heat or cold, cause varying degrees of pain, soreness and swelling in nearby gums, become discoloured, or, occasionally, give no pain at all. Sometimes a problem may be identified on a routine dental radiograph before symptoms have developed.
The effects of irreversible pulp damage can be treated by one of two ways - removing the dead or diseased pulp tissue with root canal therapy, or, alternatively, removing the whole tooth. Root canal treatment, where possible, is far superior to tooth removal as it is able to preserve a natural tooth for many years. It has a high rate of healing if the tooth is restored, as recommended, directly after treatment.
What’s Involved in Root Canal Treatment?
Root canal treatment involves creating a small hole thorough the top of the tooth to access the canal space. The dead or diseased pulp tissue is then removed from the tooth’s root canals, of which there may be more than one. This element of the procedure is called a pulpectomy. The inside of the tooth then needs to be disinfected before being sealed with a biocompatible filling material and the access hole closed.
This process is complex and may require between 1 to 3 appointments to complete. Local anaesthesia is always used and the tooth is isolated from the mouth with a non-latex barrier called dental dam. Dental dam is required to prevent recontamination of the root canal by mouth bacteria and saliva during treatment, and for your safety. After root canal treatment is completed, a crown may be recommended to preserve the seal over the root filling and protect the remaining tooth structure to prevent tooth fracture.
Emergencies, Re-Treatments And Referrals
At Melbourne Dentistry, we can alleviate your emergency toothache and undertake root canal treatments for teeth, as is necessary. Referral to a specialist Endodontist may be advised if there is a complex problem or significant crack line through a tooth, which requires further evaluation.
As with any procedure, a tooth may not respond to the initial treatment. If an infection persists following initial root canal treatment, or a new infection develops for a previously treated tooth, it is possible for root canal treatment to be redone, to preserve the tooth. Complications may exist that prevented complete healing after the initial procedure, so referral to an Endodontist may be advised for potential retreatment.
Root Canal Therapy may sometimes become necessary in Baby Teeth.
Children may occasionally require root canal therapy of deciduous teeth when tooth decay has progressed deep within a baby tooth and oral bacteria have compromised the nerve of the tooth, or a baby tooth has suffered a traumatic injury from an accident.
Pulpotomy or Pulpectomy?
Deciduous Pulpotomy or Pulpectomy procedures are undertaken to treat pulp tissue inside a primary tooth in order to prevent symptoms of pain and inflammation, infection, swelling, and early root resorption to avoid the unscheduled loss of a baby tooth. These treatments also prevent infection affecting the developing permanent tooth below, allow a baby tooth to be retained (to maintain the space available for the permanent successor), and most importantly, protect a young child from a potentially traumatic dental experience.
Deciduous Tooth Pulpotomy A pulpotomy involves removal of decay and inflamed (but still vital) pulp tissue in only the crown portion of a tooth. A dressing is then placed over the remaining pulp tissue and the baby tooth may be restored with a NuSmile® ZR Paediatric porcelain crown.
Deciduous Tooth Pulpectomy A pulpectomy may be recommended when spontaneous pain or toothache occur at night indicating irreversible inflammation of the pulp. In these circumstances, the entire pulp (all the way down to the root tips) needs to be removed. All root canals within the baby tooth are cleaned, disinfected, and filled with a medicated and resorbable root canal filling material. Following a pulpectomy, a deciduous tooth should be restored with a paediatric crown for structural support.
Will Root Canal Therapy work in a Baby Tooth?
Deciduous root canal therapy may be considered successful if it manages the infection and inflammation within a baby tooth and allows the tooth to exfoliate close to the eruption time of the permanent successor below it.
But, sometimes, it is not possible to treat or save a baby tooth with pulp therapy. If insufficient tooth structure remains due to extensive decay or fracture, if an abscess is present, or if significant root resorption has already occurred and a baby tooth is close to exfoliating, is mobile, or is deemed unrestorable, an extraction may become necessary.
A space maintainer may then need to be considered to keep the space available for the permanent successor (if its eruption is a long way off).