Root Canal Treatment

If you’re about to have your first root canal treatment, you might be feeling pretty apprehensive about the whole thing. Millions of teeth are treated and saved with root canal treatment.

So let’s start by dispelling a common myth: Root canal treatment really does relieve pain, not cause it — and saves teeth!

Modern root canal treatment is very similar to having a routine filling and usually can be completed in one or two appointments, depending on the condition of your tooth and your personal circumstances. In most of the dental clinics in Delhi, including ‘Smile Delhi-The Dental Clinic‘, 90 percent of the cases are done in one sitting. Dentist in Delhi especially the root canal specialists/ endodontists are using  the latest technique with rotary instruments.  This makes the procedure quick and  more efficient. You can expect a comfortable experience during and after your appointment.

Root Canal Treatment is the procedure done to preserve the infected tooth. Root canal treatment eliminates the diseased and dead pulp tissue and disinfects the pulp chamber. This is not painful; the area is numb and the tissue being removed is either dead or dying. Once the pulp, along with the nerves contained in it, is removed, the tooth itself can no longer feel pain. This helps to retain and protect the teeth in its natural form, thereby stopping the spread, formation of further infection and eventual spreading of the infection to the surrounding tissues.

A tooth is made up of two parts. The crown is the top part of the tooth that’s visible in the mouth. The root extends into the bone of the jaw, anchoring the tooth in position.

Teeth also consist of: enamel (the hard outer coating), dentin (the hard layer that supports the enamel and forms most of the tooth), cementum (a hard material that coats the root’s surface), dental pulp (the soft tissue at the centre of the tooth which contains blood vessels, nerves, and connective tissue and creates the surrounding hard tissues of the tooth during development)

A space inside the tooth called the pulp chamber houses the root canal system and pulp — the living tissue that keeps the tooth vital (alive). The pulp extends from the crown of the tooth to the tip of the roots where it connects to the tissues surrounding the root. The pulp is important during a tooth’s growth and development and during childhood, creates the surrounding hard tissues of the tooth as it helps to grow the root of your tooth during development. In a fully developed tooth, the tooth can survive without the pulp because the tooth continues to be nourished by the tissues surrounding it.

The root canal system extends from the crown of the tooth to the end of the root. A single tooth can have more than one root canal.

Root canal treatment, is needed when the pulp, the soft tissue inside the root canal becomes inflamed or infected. The inflammation or infection is caused by bacteria that live in the mouth and invade the tooth.

Dentist in India and dentist in Delhi, do a good job of explaining to the patients the various reasons of pulp damage, before starting the root canal.

These are;

• Untreated tooth decay-causing bacteria to spread into your tooth and infect the pulp.
• repeated dental procedures on one tooth( leaky fillings or replacing a large filling, for example)
• faulty crowns or a crack, chip or even a root fracture
• Severe gum disease – causing gums to pull away from the teeth, thereby creating a gap called a periodontal pocket, which traps bacteria that can infect the pulp.
• Injury/trauma – due to accident that affects and infects the pulp even if the tooth has no visible cracks.

Any of these issues if left untreated can result in acute inflammation of the pulp, which causes swelling and pressure inside the tooth (that has nowhere to go), leading to tooth pain and, eventually, irreversible damage to the pulp.

The symptoms of a pulp infection include:

• pain when eating hot or cold food
• prolonged sensitivity drinking hot or cold
• pain when biting or chewing
• a loose tooth

As the infection progresses, these symptoms often disappear as the pulp dies. The pulp will begin to die if it’s infected by bacteria, allowing the bacteria to then multiply and spread. Once the pulp dies, the pain may subside initially, your tooth then appears to have healed, but the infection has in fact spread through the root canal system but sometimes to return as an acute (painful) infection spreading into the periapical tissues, particularly the bone. It could also become a chronic (long-standing) infection with symptoms ranging from mild to severe.

Further symptoms eventually occur, such as:

• pain when biting or chewing returning
• tenderness in the lymph nodes as well as nearby bone and gum tissues
• swelling of the gum near the affected tooth
• pus oozing from the affected tooth
• facial swelling
• the tooth becoming a darker colour

It’s important to see your dentist if you develop toothache. If your tooth is infected, the pulp can’t heal by itself.

Saving the natural tooth with root canal treatment has many advantages:

• Efficient chewing
• Normal biting force and sensation
• Natural appearance
• Protects other teeth from excessive wear or strain

How root canal treatment is performed?

To treat the infection in the root canal, the bacteria need to be removed. This can be done by either:

• Removing all the bacteria from the root canal system i.e. diseased pulp (root canal treatment), removing all the decay and the source of infection of the pulp.
• Removing the tooth (extraction) – If the infected pulp is not removed, once the pulp is destroyed it can’t heal and the infection will spread and pain and swelling can result, and it is not recommended to leave an infected tooth in the mouth. Your tooth may have to be removed as some people would prefer to have the tooth out. However, removing the tooth isn’t usually recommended as it’s better to keep as many of your natural teeth as possible.
• After the inflamed or infected pulp (bacteria) have been removed, and the inside of the tooth is carefully cleaned, shaped and disinfected, the root canal is then filled and sealed with a rubber-like material called gutta-percha to prevent any further infection  Afterwards, the tooth is restored with filling for protection. After restoration, the tooth continues to function like any other tooth. However, because a ‘dead’ tooth is more brittle, you may need to have a crown to provide extra support and strength to the tooth.

Root canal treatment is usually very successful. However, if the infection comes back, the treatment can sometimes be repeated.

What happens if the tooth is left untreated?

If left untreated it leads to the formation of an abscess, which is the collection of pus as a result of the multiplying bacteria, and it pushes beyond the root tips. As the abscess expands within the bone, the tooth rises slightly out of its socket making it feel tender when you bite down. Without treatment, this infection can further spread to the surrounding tissues and nerves resulting in

• Nausea
• Fever
• Difficulty in swallowing

Will I feel pain during or after the procedure?

Many procedures are performed to relieve the pain of toothaches caused by pulp inflammation or infection. Dentist in Delhi, especially in reputed dental clinics use modern techniques and anesthetics, so most patients report that they are comfortable during the procedure.

For the first few days after treatment, your tooth may feel sensitive, especially if there was pain or infection before the procedure. This discomfort can be relieved with prescription medications. In the dental clinics in Delhi, dentists give clear instructions to their patients post treatment. Once these instructions are followed properly, patients are quite comfortable.

Your tooth may continue to feel slightly different from your other teeth for some time after your treatment is completed. However, if you have severe pain or pressure or pain that lasts more than a few days, call your dentist.

Recovering from root canal treatment

It’s important to look after your teeth when recovering from root canal treatment.

• You should avoid biting on hard foods until all of your treatment is complete i.e. until it’s restored by your dentist. The unrestored tooth is susceptible to fracture, as it is brittle. So you should see your dentist for a crown as soon as possible. Infact in dental clinic in India, the crown is explained to the patient as an extended part of the root canal treatment.

After your final treatment, your restored tooth shouldn’t be painful, although it may feel sensitive for a few days.

In most cases it’s possible to prevent the need for further root canal treatment by:

• Clean your teeth at least once a day with fluoride toothpaste
• Floss or use inter-dental brushes to clean in between the teeth daily
• Eating habits
• Avoid chewing or biting down until the treatment has been completed
• Reduce the intake of sugary snacks and drinks as it limits the exposure of your teeth to acid, and hence the risk of decay.
• Minimize chewing on the tooth that has undergone or is undergoing root canal treatment until advised otherwise by the dentist to:
• Prevent the temporary filling from coming out and contaminating the interior of the tooth again
• Prevent tooth form breaking or cracking before it has been fully restored
• giving up smoking if you smoke

What are the indications for a root canal treatment?

By Symptoms

• Persistent toothache
• Irreversibly damaged pulp tissue
• Necrosis of the pulp tissue
• Presence of tenderness in your gums near a tooth.
• Presence of swelling in your gums near a tooth
• A tooth that is partially or completely darkened following a trauma/injury
• Prosthetic reasons

Which are the true contraindications for a root canal treatment?

• Advanced periodontal disease
• Inadequate crown- root ratio
• Deep caries of the root and bifurcation caries
• Vertical root fracture
• Internal resorption with perforation
• Extreme root canal anatomy (e.g. dens in dente)

Generally speaking, whatever the cause of root canal or pulpal disease, root canal treatment will be necessary to save the tooth.

Leaving the infected tooth in your mouth may make it worse. There may also be less chance of the root canal treatment working if the infection within your tooth becomes established.

Root canal treatment helps you maintain your natural smile, continue eating the foods you love and limit the need for ongoing dental work. If you continue to care for your teeth and gums in a proper way, most teeth that have had root canal treatment can last a lifetime. However, regular check-ups are necessary. In  many dental clinic in Delhi the patients are given a six monthly reminder for a clean and check-up.

Posted By – Dr. Shriya