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Causes And Treatment Of Root Canal Disease

Why Does My Tooth Need Root Canal Treatment?

A tooth generally needs a root canal procedure because the pulpal tissue inside the tooth has become irreversibly injured because of root canal disease. The tooth pulp is composed of elements similar to any other tissue in the body and is susceptible to injury from bacterial decay, repeated or extensive dental procedures, traumatic accidents, or advanced periodontal disease. Pulpal disease occurs in an anatomically complex space termed the root canal system. When appropriate, root canal treatment is directed towards removing inflamed or abscessed tissue, disinfecting, and preparing this space to receive a biocompatible filling material. Once the root canal system has been sealed and a protective crown placed by an endodontist, the tooth can be retained as a healthy and functional member of the dental arch.

What Are the Usual Events That Trigger Root Canal Disease?

Events that may trigger root canal disease include:

• Decay: Dental decay contains bacteria that can infect the tooth pulp. Decay can progress through the outer enamel surface of the tooth into the underlying dentin, which is a hard, yet porous, structure. Ultimately, decay can invade the dental pulp and cause pulpal injury, which leads to an inflammatory condition that can potentially become an abscess. As dental decay and its associated bacteria invade the pulpal tissue, a patient may experience no discomfort or, in other instances, the pain may be acute.
• Traumatic events: The tooth pulp is vulnerable to trauma. A blow to the mouth may lead to a variety of dental injuries. A traumatized tooth may appear whole but exhibit root canal disease at a later date. A tooth may be only slightly chipped or it may be fractured to the extent that its clinical crown is broken off and the pulpal tissue is exposed. In severe situations, the root can be fractured within the bone or the tooth completely knocked out of the mouth, which is called an "avulsion." Frequently, these traumatic events will irreversibly damage the tooth pulp by causing bacterial contamination or by interfering with the tooth's blood supply and its ability to repair. Some teeth are traumatized to the extent that they are not treatable and must be removed.
• Repetitive or extensive dental procedures: The tooth pulp is also vulnerable to injury from repetitive or extensive dental procedures. Subjecting a previously injured pulp to the additional trauma of even the best planned and performed dental surgery may be enough to cause the pulpal tissue to become irreversibly inflamed and the tooth to require root canal treatment. The dentist may or may not be able to predict this outcome in advance. At times, based on the examination and treatment plan, the dentist may recommend the removal of the dental pulp before performing other planned dental procedures. In these situations, the tooth pulp is removed so that it will not become problematic at a later date under a new, and possibly complex, restoration. At times, initiating a root canal procedure through an existing restoration may compromise its integrity.
• Periodontal disease: Infection in the gum and bone around the tooth is referred to as periodontal or gum disease. Advanced periodontal disease may compromise the blood supply to the dental pulp and ultimately, bacteria may enter and infect the pulpal tissue in the root canal space.

By Clifford J. Ruddle, DDS, in collaboration with Philip M. Smith, DDS

+Jim Du Molin is a leading Internet search expert helping individuals and families connect with the right dentist in their area. Visit his author page.

Will I Be Comfortable During My Root Canal Treatment?

The answer should be an emphatic "YES!" Fortunately, dentistry has developed new techniques for delivering local anesthetics painlessly. These techniques also assure that the anesthetics act more rapidly and produce a more "profound" level of anesthesia. Additionally, modern dental procedures utilize better technologies that are generally much less traumatic and invasive than those of the past. The result of these advancements is that patients should have minimal or no discomfort during the tooth numbing and/or treatment procedures. Root canal treatment should not cause pain, but rather relieve it and keep it from reoccurring. Unfortunately, dental pain may also have a psychological component, possibly stemming from a negative past experience, a story in the media, or even fear of the unknown. Sometimes these situations can prove challenging for the patient and the endodontist to control. Examples include:

• Patients who associate tooth pain with a past root canal procedure when, in fact, the pain they remember was experienced prior to their emergency visit. Oftentimes, this pain develops over a period of several hours to a few days and is allowed to build and worsen before seeking treatment. Once the patient seeks emergency care from a root canal dentist, the endodontics treatment should not be uncomfortable and should provide quick and certain relief from any painful symptoms stemming from root canal disease.
• Patients may become very anxious when being examined or treated dentally because the mouth is such an important part of the body and psyche. Some patients may feel anxious and vulnerable during a root canal procedure because of their positioning in the dental chair with members of the dental team working above them in such close and intimate proximity.

These and other distresses are real to the patient. Much of the time, however, the distress can be reduced or eliminated if the patient discusses it with the endodontist and gets understanding and reassurance. The doctor and the patient must work together in these situations to make certain that the patient feels as comfortable, trusting, and informed as possible in the dental environment. Most individuals can do this satisfactorily. If patients continue to feel significant distress, even after having these discussions with the dentists, they should be aware that there are therapeutic methods that can be used and for which they might be candidates. These may include:

• Oral sedation dentistry involves ingesting a sedative pill or liquid before the appointment. This can help anxious patients a great deal and make the treatment experience much less stressful.
• Nitrous oxide analgesia, known as "laughing gas," can be inhaled along with oxygen to make patients feel less anxious and more comfortable.
• Intravenous sedation can be administered in a dental facility by a specially trained and certified dental team or by a specially trained dental anesthesiologist. With intravenous sedation, patients are not asleep and they can still respond, but they will not feel or remember anything. This technique works very well in creating a pleasant experience for many anxious patients and is a good anesthetic method for more lengthy dental procedures.
• Hospital dentistry is conducted in an environment where a variety of anesthetic methods are available and can be used under the safest medical conditions. General anesthetic and intravenous sedation can both be utilized in the hospital setting.

These sedative techniques and medicines may also be helpful if particularly lengthy root canal treatment procedures are necessary in specific situations.

With all of the advancements in pharmaceuticals and in their delivery, there should be no need for any patient to delay endodontics treatment because of fear that the treatment will be painful.

By Clifford J. Ruddle, DDS, in collaboration with Philip M. Smith, DDS

+Jim Du Molin is a leading Internet search expert helping individuals and families connect with the right dentist in their area. Visit his author page.