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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

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An Endodontist Explains "What Is A Root Canal"?

We use our teeth so much during the day that we often forget how complex they are, that is, until we feel pain. Underneath each tooth is a soft tissue area, called the pulp, that carries nerves, veins, arteries, and lymph vessels. These are all channels of connection between our teeth and the rest of our bodies. These connections run from the top of the tooth down to its root by way of a root canal. Each tooth has at least one root canal, but may have as many as four or five, depending on the number of roots below that tooth.

How Do Root Canal Problems Occur?

When a tooth is cracked or has a deep cavity, saliva and the bacteria in it can get to the tooth pulp. An infection is likely to result and, without root canal treatment by endodontist, the pulp will die. The infection may cause pus to gather at the tip of the root, creating an abscess that can attack the bone. The abscess must be cleaned up to prevent deterioration, and the damaged tooth pulp must be removed by a root canal dentist.

Problems That Cause Root Canal Pain

When the pulp is damaged or dead, pressure is created inside the tooth. That pressure creates pain when you bite down on the tooth, chew on it, or when it feels the heat or cold of food and drinks.

Saving the Tooth with a Root Canal

Repairing the root canal is the way to save the entire tooth. The other alternative is to pull the tooth entirely. However, leaving that space empty may create other problems, like making chewing and biting more difficult. Teeth may also shift their position if missing teeth are not there to hold the space. If you decide to have the dentist pull the tooth and replace it with a denture or bridge, the cost will be significantly more than the cost of a root canal procedure.

What Is Root Canal Therapy and How Is It Performed?

To prevent further damage, ease any discomfort, and save the tooth, your dentist or endodontist (a dentist specializing in treating the tooth pulp) will perform a root canal procedure. Without endodontics therapy, tooth loss will occur. This therapy requires one or more dental visits to complete, depending on the extent of the infection.

Endodontists will first administer medication to make sure you will be comfortable. An opening is made in the top of your tooth and the diseased pulp removed. The root canal will be thoroughly cleaned and enlarged so it can be filled with a material that prevents bacteria from re-entering. Your tooth will not be permanently sealed until the infection has cleared. When the root canal is filled and the infection is gone, your tooth may need to be covered with a crown that will look and function just like your original tooth.

Root canal therapy is a tooth-saver. It has a very high rate of success (more than 90%)! To follow up, your dentist or endodontist will make sure that the root canal is intact and that the infection has cleared.

Endodontists recognize that root canal therapy has an image problem. Part of this is due to the type of treatment available more than a half-century ago when local anesthetics weren't as effective. It was also before the advent of antibiotics used to control the infection and pain associated with it. Research and technology now offer your endodontist valuable ways to reduce patient pain and anxiety during the root canal procedure. Probably, the greatest factor contributing to this negative perception is that people wait until they are in pain before seeking treatment. Obviously, regular visits are an important preventive measure.

With modern therapy, root canal treatment can be approached with confidence -- getting to the root of the problem, but without the pain.

By Brian J. Gray, DDS, MAGD, FICO