Root Canal Treatment - Endodontics

The word endodontic comes from the Greek word eno meaning "within" and the Greek word odous meaning "tooth". Endodontic therapy, also known as a root canal (therapy), is a treatment of the tooth aimed at clearing infection, as well as protecting the tooth from subsequent infections. The treatment is carried out in the pulp of the tooth.

The term "root canal" when meaning endodontic therapy is, in fact, wrong. Root canals are part of a tooth, the hollows within a tooth where the nerve tissue, blood vessels, and some other cells are located. Root canal is a place in a tooth, while endodontic therapy is a dental procedure. However, the term "root canal" has become widely used with the meaning of endodontic therapy.

Endodontic therapy involves the complete removal of everything that lies in the root canal. The hollow area is then cleaned, shaped and decontaminated. Miniscule files and irrigation solutions are used. An inert filling, such as gutta percha, fills up the hollow, along with a eugenol-based cement.

After endodontic therapy the tooth is dead. The patient will no longer feel any pain on that tooth because the nerve tissue has been taken out and the infection has been eliminated.

Patients are frequently fearful of undergoing endodontic therapy. This fear is unwarranted as the procedure, when carried out by a trained dental surgeon, is relatively painless.

The tooth has two basic parts

There are two basic parts to a tooth, the crown and the roots. The crown is mainly above your gum, while the roots are below the gum and attach your tooth to your jawbone. Pulp, which exists inside the crown and the root, is made of soft tissue and keeps your tooth nourished.

Enamel:

the outer layer of the crown is called the enamel. Enamel is the hardest and most highly mineralized substance in our body - 96% of a tooth's enamel consists of mineral, the rest is made of organic matter and water.

Dentin:

is yellow in appearance. The color of our teeth is influenced by the color of our dentin, as the enamel is translucent. Dentin is necessary for the support of the enamel - it is less brittle and less mineralized than the enamel. 70% of dentin is hydroxylapatite (a mineral), 20% is organic matter, and 10% is water.

Dental pulp:

is in the center of the tooth. Part of the tooth is inside the crown, and part of it is inside the root, in the root canal. The pulp consists of soft tissue and ondoplasts (type of cells). The dental pulp produces dentin, supplies surrounding mineralized tissue with moisture and nutrients, and senses extremes of temperature and pressure as pain. The pulp has a network of nerves and blood vessels.

When the dental pulp (or root canal area) is diseased or injured

If the pulp cannot repair itself (when it is injured or diseased) it dies. Pulp death can occur as a result of a deep cavity or a cracked tooth. Bacteria get in, either through a crack, a cavity or a loose filling, and eventually destroy the pulp. When bacteria penetrate through the root openings the bone will become infected. An infection in the bone will eventually weaken it and break it down, the ligaments around the tooth will swell and the tooth will become loose.

The patient with a pulp (root canal) injury will find his tooth is very sensitive to high and low temperatures, he may feel pain when chewing, and there may be a continuous throbbing pain.

Endodontic therapy (root canal therapy)

Without treatment the infection will spread and the tooth will eventually loosen and fall out. Some patients may prefer to have the tooth pulled out, especially if it hurts a lot. However, extracting a tooth may cause the surrounding teeth to become crooked. If your teeth are crooked you cannot usually manage a good bite. Endodontic therapy will usually stop the tooth from falling out and eliminate the pain.

Dentists say endodontic therapy requires three sessions. A dentist who specializes in problems of the pulp (root canal) is called an endodontist. Endodontic therapy might be carried out by an endodontist or a dental surgeon. He/she will take out the diseased pulp. The whole area around the root canal (the area where the pulp was) will be cleaned and sealed. The procedure is relatively painless as the patient is given a local anesthetic.

When the dentist decides that the procedure has been a success, he/she may either add a filling or place a crown. This is to protect the tooth. A tooth that has the root canal filled is more fragile than a normal tooth.

Can endodontic therapy go wrong?

Some teeth may have four root canals, while the dentist only found three. If the dentist did not find that fourth canal the infection might continue and spread into the bone. The better the dentist, and the better his/her equipment, the less likely it is that this might happen. It is important that the dentist makes sure the filling goes deep enough into the canal, to fill it up. During the procedure it is possible the root of the tooth cracks, making it hard to fill the tooth effectively. In virtually all these cases, a specialist can re-treat what happened.

Today there are three options:

  1. Extraction.
  2. Endodontic therapy.
  3. Tooth implant.

In the past, the dentist and the patient had just two options to consider, extraction or endodontic therapy. Another option today is to extract the tooth and place an implant. An implant is more expensive.