Family Dental Care Palo Alto, CA
Palo Alto Dentist
Appointments: (650) 566-0999
Rabindra Sahdev D.D.S.
Palo Alto Dentist
882C Emerson Street
Palo Alto, CA 94301
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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:
- 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.
- 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.
- 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.
- 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.
- 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.
- 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.
- 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.
- 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
The Endodontist and a Successful Root Canal Treatment
Many international scientific studies demonstrate that root canal treatment is generally successful and provides an excellent long-term prognosis when the dental surgery is properly performed utilizing sound biological and mechanical concepts. As with any clinical situation, there are factors that must be considered when discussing root canal procedure outcomes with your dentist or endodontist:
- Root canal treatment has not always been as successful as it is today. Fortunately, the guiding principles of modern endodontics can now be utilized to deliver very predictable results over a patient's lifetime. Some of these principles were unknown or misunderstood in the past and, consequently, many teeth have had endodontics treatment based on concepts, techniques, and materials that are not considered optimal by today's standards. Even so, some of these teeth have given, and will continue to give, additional years of good service. In other instances, previously treated teeth exhibit bacterial leakage that may or may not be accompanied by clinical symptoms. Failing endodontically treated teeth can generally be successfully retreated by an endodontist using modern biological concepts, technologies, and techniques.
- Root canal treatment can be successful even if a tooth is severely damaged by decay, trauma, or other destructive events. In cases such as this, it may be necessary to reinforce the tooth by placing a post into the root before a crown can be placed. In these situations, the root canal dentist must weigh risks versus benefits during the treatment planning process.
- The success of root canal treatment is greatly enhanced when the tooth receives a protective restoration after completion of the treatment. When a protective crown is not placed, the root canal filling may leak or the tooth may develop additional decay or even fracture. Once a root fracture has occurred, there is generally no predictable treatment or dental surgery to save the tooth.
- For an endodontic treatment to be successful, the periodontal supporting structures of the tooth must be healthy or capable of being returned to a state of health with periodontal treatment. Other specialty consultations may also be necessary depending on the findings in a particular situation.
- To insure that root canal treatment is working, the particular tooth should be evaluated over time. Teeth are subject to enormous shifts in temperature (such as hot coffee vs. ice cream), tremendous mechanical loads (in pounds per square inch), and constant exposure to the bacteria in saliva. Periodic re-evaluation allows the dentist to examine the results of past treatments and to intervene early if new damage or breakdown is occurring.
As with any human endeavor, there are certain clinical situations in which dental surgery does not work even with the best efforts that modern dentistry can offer. Fortunately, these cases are infrequent and, if they occur, many of the teeth can be successfully retreated by an endodontist. A root canal procedure, when appropriately planned and well-performed by your dentist or endodontist, is the most cost-effective and predictable treatment alternative in most clinical situations.
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