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Root Canals
Root canals vary tremendously by the number and shape of canals as seen in the above diagrams. WHAT IS A ROOT CANAL? The phrase "root canal' can refer to different things depending on how it is used. A root canal is literally the space within the root of a tooth which contains tissue and blood vessels. A root canal also refers to a dental procedure used to treat endodontic disease. WHAT IS ENDODONTIC DISEASE? Endodontics is the study of the structures inside the tooth. The inner core is the pulp which originates at the end of the roots and travels through small canals to a chamber inside the crown of each tooth. The pulp supplies sensation and nourishment to the tooth, and is similar in content to the tissue in your finger tip. Endodontic disease refers to damaged pulp tissue. Pulp tissue is delicate, as is other tissue in your body. It contains nerves and blood vessels and can easily be damaged. Severe damage will cause progressive destruction of the pulp. As the pulp is destroyed, the canal or chamber becomes empty or filled with fluid. Bacteria may then form infection in the empty space. This infection may extend beyond the tooth to the surrounding bone and gums, and can cause pain from the nerves within the remaining pulp or surrounding bone and gums. WHAT CAUSES THE NEED FOR ROOT CANAL TREATMENT? Endodontic disease is caused by damage to the pulp. Trauma from excessive force or deep cavities is the most common cause of permanent damage. The effects of trauma may be recognized immediately or may not be diagnosed for long periods of time. Moderate trauma may cause injury to the pulp which is reversible, and the pulp will heal by itself. WHAT INDICATES A ROOT CANAL IS NEEDED? The signs and symptoms for diagnosing endodontic problems which might require a root canal include: sensitivity to hot or cold; pain when chewing; tooth mobility; pus formation; and, bone loss (visible in x-rays). The signs and symptoms will vary depending on how advanced the endodontic disease has become and how rapidly it is forming. In the moderate form of the disease, hyperemia a swollen pulp may cause sensitivity to cold. Advanced infection may cause sensitivity to hot, cold and chewing. Eventually tooth mobility, pus formation and bone destruction are possible as the infection progresses. However, a very slow occurring infection may have no symptoms until it is very advanced. WHAT IS ROOT CANAL TREATMENT? Root canal treatment eliminates infection, or the potential for infection, by removing damaged pulp from within the tooth and sealing the canal against bacteria. Access to the interior of the tooth is obtained by drilling through the biting surface of back teeth and through the back of front teeth. The pulp is then removed by careful filing of the canals, using tiny metal files. The filing also shapes the canals to accept filling material. The remaining contents of the empty canals (e.g. dust from the filing, bits of pulp) are removed by washing out the canals with special liquids. This irrigation process also reaches areas inaccessible to filing. The cleaned canals are sealed with an endodontic filling material. This prevents bacteria from re-entering the space so infection is controlled. If infection has extended into the bone, the dentist may recommend the use of antibiotics as well. Endodontic procedures require isolation, sterilization and x-rays. A piece of rubber, called a rubber dam, is placed over the tooth to avoid contamination from saliva while the work proceeds. The work area is then sterilized before procedures begin. X-rays are used to ensure the accuracy of the procedures (i.e. the completeness of the cleaning and filling). HOW ARE ROOT CANALLED TEETH RESTORED? A hole must be drilled in the tooth to do a root canal. In addition, the removal of the pulp deprives the tooth of its source of nourishment and will cause the tooth to become brittle. For this reason, root canal therapy always includes restorative work, usually a post and crown which surrounds the tooth and provides support. IS A ROOT CANAL A DIFFICULT PROCEDURE? The shape of the pulp, and canals, is diverse. This can require extra care during the root canal procedure. The front teeth usually have one canal, but can have two. Bicuspids are similar, but the occurrence of two canals is more frequent. Molars have three and sometimes four canals. Within the roots, two canals may join to form one canal and split into two again. Canals may enter from the side of the tooth and are known as accessory canals. A delta formation refers to canals which split into many canals at the very end. It is the wide variation in the shape and number of canals which complicates diagnosis and treatment of endodontic disease. IS A ROOT CANAL PAINFUL? Usually not. However, if an infection is not controlled, if thorough cleaning is not done, or if bone is traumatized, there may be pain when the novocaine wears off. Fortunately, it is rarely a painful experience especially when being done. IS ROOT CANAL THERAPY SUCCESSFUL? Yes. Root canals are very successful. Root canal therapy which seals 100% of the pulp space is close to 100% successful. Reoccurrence of infection is the most common failure. This can be caused by incomplete filling of the space, or by infection which could not be reached from within the tooth. A tooth can be lost if it fractures after endodontic therapy. Fracture is common if the tooth is not properly restored. Treatment of failures may involve surgical removal of the end of the root or extraction of the tooth. Fortunately, failures are a rare occurrence. CAN ROOT CANALS BE PREVENTED? Yes. Early diagnosis and treatment of cavities, along with avoiding trauma to the teeth, will prevent the need for root canal therapy. Infection is best diagnosed by symptoms and routine full mouth x-rays. Early treatment also increases the success rate and helps eliminate problems. Copyright 2001 www.dentaleducator.com |
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