Root canal

Introduction

Root canal treatment is undertaken by millions of patients around the globe and it is considered one of the safest dental procedures. The main purpose of the process is to remove the diseased tissue and bacteria present in the tooth canal so that any infection of the same can be eliminated.  The process also relieves dental pain and inflammation of the gum. While many believe that root canal is one of the most unpleasant dental procedures practiced, in reality, it is not so. During the procedure, an endodontist removes the infected pulp from inside the tooth, cleans, disinfects, shapes the root canals, and finally places a filling to seal the space. The process is simple and is generally conducted in one or two appointments, depending on the condition of the tooth and the personal circumstances of the patient. The entire process is mostly painless and the recovery time is very less. This allows the patient to get back to using their teeth in a normal manner in a short period of time.

In the structure of the teeth, the upper white part is called the enamel. Just underneath the enamel, is the dentin (a layer that supports the enamel). Underneath it, is the pulp made of soft tissues. The pulp has nerves, connective tissues, and blood vessels. It helps in the development of the tooth. A developed tooth continues to survive without the pulp as it gets its nourishment from the surrounding tissues. So, the root canal is not the treatment of the tooth but the hollow section below it that contains the pulp. The nerves in the pulp help to feel the sensations of hot and cold items but do not play an important role in the overall functioning of the tooth.

The causes behind a root canal treatment

Root canal treatment is done to repair and save a tooth that has become infected due to a cavity or for some other reason. Unless the infected tissue is removed, the region will continue to decay and cause problems due to the multiplication of bacteria in the canal chamber. In extreme cases, a pus-filled pocket called an abscess is formed below the tooth that severely affects the functioning of the tooth. An infection in the pulp can arise from a crack or chip in the tooth or from procedures on it. In some cases, the pulp can be subject to an injury even though there are no visible marks on the tooth. This can also happen in case there is a trauma to the face or the jaw area. The infection can also lead to the following issues.

• Swelling and pain that may spread to other areas of the face, neck, or head.
• Loss of bone in and around the root tip.
• Drainage problems can extend out of the root region. In extreme cases, a hole can occur through the side of the tooth, with drainage occurring into the gums or through the cheek into the skin.

The nerves and the blood vessels in the pulp go through the canal which is a narrow space. The canals then branch out and come out from the root tip and connect to the rest of the body.

So, an infection in the pulp can spread to the other tissues, bone, and supporting structures if the right preventive measures are not taken. Such an infection is hard to cure even with the use of antibiotics. So, a root canal treatment not only safeguards the oral health of the patient but the general health as well.

Symptoms for the requirement of root canal

There are quite a few symptoms that indicate that the pulp chamber is infected. Some of these are listed below.

• Severe toothache and sharp pain upon chewing or application of pressure on the tooth. Continuous throbbing pain can also occur.
• Prolonged sensitivity to hot or cold temperatures even after the source object is removed.
• Discolouration or darkening of the tooth can also spread to the gums.
• Swelling and tenderness in nearby gums.
• The formation of a persistent or recurring pimple on the gums.

Endodontic treatment can save the tooth and is a better option than a tooth extraction. It also prevents the problem from occurring again by preventing any further bacterial infection. The procedure is done under anaesthesia and the tooth is restored with a permanent filling material. A dental crown or cap is provided to strengthen it. Under proper care, a root-canal-treated tooth can last for decades.

The procedure for root canal therapy

The entire procedure consists of three basic steps which are described as under.

Step 1: Cleaning of the root canal

Initially, the endodontist applies an anaesthetic to the tooth through an injection so that the procedure can be performed in a pain-free manner. The next step involves the use of a dental dam which is a small sheet of rubber that isolates the tooth to keep it clean and dry during the procedure. The other instruments that are used involve small drills and files to work on the top part of the tooth and create an opening through which the canal can be accessed. Then the dentist removes all the infected material present inside the root canal. The full length of the tooth is accessed and the sides of the root canals are scraped to clean them properly.

Step 2: Filling the root canal

In the next step, the dentist cleans, shapes the canal, and decontaminates the area, using special files and solutions to irrigate the canal. Any pulp material is washed away with a spray of water. An antimicrobial solution is also used to prevent contamination and eliminate any bacteria that might be left. The doctor then fills the tooth with a rubber-like material and uses adhesive cement and seals the canals completely.

After root canal therapy, the patient will not feel any pain or sensation in the teeth since the nerves and surrounding tissue have been removed. In general, the entire treatment can be completed in one appointment. In case there are curved canals, multi-canals, or a high level of infection, additional appointments may be needed.

Step 3: Adding a crown and filling

The pulp canal is then filled with some particular materials and the opening in the tooth is closed with a temporary filling. But the tooth now is more fragile. In the absence of pulp, it receives nourishment from the ligament that helps it to attach to the bone. Though the supply is adequate, with time, the tooth can become brittle, so the crown and the filling protect it. The crown is designed to match the shape of the tooth and is placed effectively to perform the normal chewing functions. There is a gap of a few days between the root canal procedure and crown placement and in that period, the patient needs to remain careful. Chewing hard items with that tooth and putting pressure on it is not safe during that period.

The advantages of a root canal

A root canal is a safe and effective process that can keep the teeth healthy in the long run. Some major advantages of the process are mentioned below.

• The process provides relief from pain and discomfort and prevents the spread of the infection to the other areas and the neighbouring teeth. Once the infected pulp is removed, the bacterial infection has no space to spread and the entire process is safe and relatively more comfortable.
• The process also makes the teeth more attractive by using a crown that has been crafted from high-quality materials. The right amount of finishing is also accompanied by the high level of strength that the material provides.
• This is the right process for saving teeth once they get infected. The other option is tooth extraction which is a rather strenuous procedure. The tooth can return back to a healthy condition and continue functioning normally while good oral health and hygiene are maintained.
• A missing tooth can result in the degradation of the jawbone with time and a root canal treatment prevents this from happening. Allowing the infection to remain can cause further damage to the entire region.
• Poor oral health can have a major impact on overall health and can lead to heart disease, diabetes, respiratory infections, and gastrointestinal infections. This treatment can help in enhancing the overall well-being of the patient and also provides a cost-efficient solution to dental problems.
• The process is not painful as anaesthesia is used and is well suited for young as well as aged patients. It is as easily conducted as any other dental procedure like a tooth filling or having a wisdom tooth removed.

Misconceptions around root canal

Patients not familiar with the nature of the procedure often find the idea of a root canal intimidating. In addition, there are quite a few myths or misconceptions around the process.

• As many people believe, the treatment is not painful. Due to the advancement of medical technology and the use of the right equipment, the process does not involve more pain or discomfort than any other tooth treatment. In addition, endodontists are well trained in pain management and can handle any situation quickly.
• Any idea that a root canal and crown can lead to illness in the future is not based on facts and evidence. There is also a belief that a root canal can lead to cancer which is not true. There is no link between a root canal treatment and other diseases and such rumours only cause undue distress to patients.
• Pulling out a tooth is not a better choice than a root canal treatment as often believed. The extraction can have an impact on adjacent teeth and the supporting tissues too. Endodontic treatments have a high rate of success while tooth extraction has risk factors that include infection, soreness, and a lingering numbness.

Precautions to be taken for a root canal treatment

As stated earlier, one should not chew or bite on the treated tooth that has undergone treatment unless it has been fully restored by using a crown. It is best to consume soft food and avoid hard and crunchy food unless the crown is placed. Hard items can cause damage to the temporary filling that has been placed inside the teeth. The crown needs to be replaced as early as possible to get back full teeth functionality. In general, most endodontically treated teeth last as long as the natural teeth. In case there is pain after the procedure, the painkillers and anti-inflammatory medicine prescribed by the doctor can be taken. In a few cases, a tooth that has undergone a root canal treatment may not heal or the pain can continue. There can also be additional very narrow or curved canals that could not be treated during the original procedure. In such cases, redoing the procedure can save the tooth. It is important to visit the doctor in case pain or inflammation persists in the tooth. It is also necessary to maintain oral hygiene after the treatment and keep the teeth clean by regular brushing.

Conclusion

The root canal treatment is one of the safest and painless procedures that can fully restore an infected tooth. It is a commonly practiced and proven treatment that can be undertaken without any cause of fear. To ensure that the treatment works perfectly it is important to follow the instructions of the dentist and maintain a healthy routine of brushing, flossing, and regular check-ups. Before undergoing any treatment, it is also important to discuss the options and the details of the procedure with the endodontist or dentist. While taking the right steps to restore your teeth back to health, it is necessary to take informed steps. If you face any further issues with the teeth after the process, make sure that you revisit the doctor.

References

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