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Endodontics: What Happens at a Root Canal Appointment?

At the root canal treatment appointment, whether it is an emergency visit or a regularly scheduled visit, the patient will be cared for by various members of a trained and professional team. A primary goal of the dental team is to make certain that the patient is comfortable physically and emotionally during every stage of treatment. In addition to relieving tooth pain, if present, the goals of endodontic treatment are to eliminate endodontic disease and move the patient towards a state of health. With modern endodontic techniques, these goals can generally be achieved. Root canal treatment may take one or more visits to complete and usually progresses through the following stages:

1. The dentist reviews the findings and recommendations from the examination and consultation visit. If any additional radiographs are needed before starting treatment, they may be taken at this time.
2. The patient is typically given a local anesthetic. With newer techniques and devices, these anesthetics can usually be administered painlessly. The tooth can be made "profoundly" numb so that the patient is completely comfortable during treatment.
3. After achieving the required level of anesthesia, the dentist "isolates" the tooth using a "dental dam." This is a sheet of rubber material that fits over the tooth to be treated and forms a tight seal around it. The rubber dam serves to keep the saliva away from the area being treated and it also prevents the various disinfecting and cleaning solutions used during the procedure within the tooth from entering the mouth.
4. After the tooth has been isolated, the dentist prepares a window (an "access" opening) through the biting surface of the tooth in order to gain access into the diseased root canal space.
5. Once the access preparation is complete, the dentist begins to "clean" the root canal space by removing the diseased pulp tissue, bacteria, and related irritants. This is done using special solutions and small flexible instruments, called "files." The solutions penetrate and clean areas of the canal where the instruments cannot physically reach.
6. As the root canal system is being cleaned, it is also being "shaped." Shaping is the process of enlarging the root canal space in such a way that it can be thoroughly cleaned and subsequently filled and sealed. A root canal space that is not properly shaped may still harbor bacteria.
7. Following cleaning and shaping procedures, the root canal space is ideally filled and sealed in all its dimensions by a dentist. This is most commonly accomplished using a sealing cement in combination with a unique material called "gutta percha." Gutta percha is a special material that can be softened with heat and then pressure molded to precisely fill the root canal space.
8. Once the tooth is three-dimensionally sealed, it is generally "provisionalized" (temporarily restored) until a more long-lasting protective restoration can be placed. A protective restoration helps minimize the chances of future tooth fracture.

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

Root Canal Therapy- The Procedure To Relieve Your Pain

Many people flinch when their dentists tell them they need root canal therapy. While dentists are sympathetic to fears of pain, they also want patients to know that root canal procedure has three purposes:

• Stop the root canal symptoms of a toothache;
• Prevent bacteria and pain from spreading into the jaw; and
• Maintain the original tooth instead of replacing it with a denture or bridge.

Root canals are actually channels that run from the root of the tooth, which connects to the bone, up to the top surface of the tooth. The canal contains blood vessels, nerves and the complex cells that make up the living tissue inside the tooth. This lifeline inside the tooth is called the pulp.

When a tooth is decayed or cracked, bacteria can get to the pulp. The acid from the bacteria irritates the pulp and it becomes inflamed; it's the same process you watch when other parts of your body become infected. When the pulp tissue becomes inflamed, it's harder for blood to flow to the tissue, and the resulting pressure creates the pain symptoms inside your tooth.

There are two ways to get relief from root canal pain: perform the root canal procedure, or pull the tooth, clean the gum below, and replace the tooth with a denture or bridge. Dentists advise pulling teeth as a last resort because they know that your natural teeth are the ones best suited for your mouth.

It's important to have the root canal procedure done quickly. The bacteria will travel down the canal to the root and into the jawbone. If this happens, the pain of your toothache will spread to your jaw. Even more important, the infection can cause your jawbone to deteriorate and weaken the structure that holds your teeth.

The best way to avoid root canal therapy is to take good daily care of your teeth to prevent the growth and spread of bacteria. Brushing and flossing are important.

Just as important are regular trips to the dentist, to check for the first sign of decay or cracks that could eventually lead to an abscessed tooth. In this case, an ounce of prevention really is worth a pound of cure!

By Brian J. Gray, DDS, MAGD, FICO