Root Canal Treatment

Sudden pain / acute pain / sensitivity to hot or cold / pain on biting
Time to be Alert!! Your tooth may be damaged enough such that simple restoration (filling) treatment alone may not suffice. To get immediate relief, you need to meet a dentist. Your teeth maybe cracked, have loose restoration (filling) or simple cavity which can lead to passive destruction of tooth.

Your dentist will take X-rays to know the internal structure of the tooth and surrounding bone and estimate the extent of damage. If the vital part of tooth called pulp (which is responsible for painful sensation) is involved, it has to be removed, cleaned and replaced with an artificial nerve. This can take one to three sittings depending upon the infection inside the tooth. With delicate instruments called the Root Canal Instruments or files, infection is removed, flushed out with irrigants. Tooth canals are cleaned and then filled with artificial nerve. The tooth is now non-responsive to hot, cold or any painful stimulus. This whole procedure is known as Root Canal Treatment (R. C. T.). R.C.T. is the only treatment which can save the tooth that has been badly damaged due to decay/injury and has reached almost extraction stage.

Good success rate is achieved if R.C.T. is started as soon as possible after problem is identified. If treated early and with the use of local anaesthesia, it causes almost "No Discomfort" to the patient and is totally painless. The success rate of R.C.T. is as high as 95% provided certain criteria / factors are taken care of:

Long standing infection or abscess can affect the periodontium, thus decreasing the success rate. Early diagnosis followed by immediate treatment planning is very important for achieving good success rate.

After Root Canal Treatment, in order to make the tooth fully functional again, the tooth should be restored with either a dental crown or, a dental crown in combination with a dental post. Dental crown provides a seal protecting the interior of the tooth. This barrier helps to prevent seepage of bacteria and contaminates from the oral cavity into the interior aspects of the tooth. A dental crown improves the appearance of the tooth, restoring tooth to its original shape and adding strength to the tooth. Additionally and very importantly dental crowns create an excellent seal over a tooth. Crown cemented in place provides a barrier that is helpful in preventing bacteria and contaminates from seeping back into those inner aspects of a tooth where the root canal treatment has been performed.

Placing a Post in a tooth that has had root canal treatment
A "Post" is like a pillar rod which provides retention and allows building up of the fragile tooth. Posts are usually placed in those teeth which have extensive portions of their natural tooth structure missing. The greater the amounts of the build up tooth over the post , the more stable the crown will be. In those cases where a great deal of tooth structure is missing a dentist will "build up" the height of the tooth using dental filling material. A dental Post provides a way for the dentist to securely anchor this filling material into the core of the tooth.

Helpful Information about Root Canal Treatment offered by Dr.Sandeep Gulati:
Endodontics Treatment / Root Canal Treatment in India : Root canal is a dental procedure which helps in removing the entire internal parts, mainly pulp chamber of the tooth. It also involves the filling of the prepared empty cavity with a suitable bio-compatible material. This procedure is done and advised only when the tooth can not compensate restoring material in a small cavity on the surface. The procedure involves the removal of the nervous elements of the tooth which have been infected or decayed already due to microbial action or any physical pressures. The procedure that involves the root canal is also called as root canal therapy or root canal treatment. This is the only procedure that can help when the entire pulp and its contents are decayed. This procedure of root canal treatment can be done by the one who specializes in this field who is an Endodontist.

How is a root canal treatment done?
1. The dentist diagnoses a patient and advices for the treatment if the root canal is decayed.

2. The tooth area is isolated with the help of rubber dam kit, which is a rubber sheet fitted with the help of clamps or clips around the tooth which is going to be treated. This isolation helps in ease of operation for the dentist and prevents the entry of mixing of fluids from the motor and the saliva in the mouth.

3. The dentist would then prepare a cavity by the help of an aerotor which is done with proper outline and depth into the root, but this does not eliminate all the contents of the pulp chamber. Then the root canal files are used to entirely clean the root. These root canal files increase in thickness when they enter the root and help in removal of the pulp of the tooth.

4. After this is done, there are 2 ways of which one is chosen by the dentist - Either do everything else in a single seating or sealing the cavity with a soothing medicine with a temporary filling material for a week until the next seating is called for the completion of the procedure.

5. The use of soothing medicine is that it prevents the spread of further infection, if there was any prior to the cavity preparation, or also prevention of occurrence of any new infection in that region.

6. The final stage includes the filling of the canal with some plastic material called Gutta Percha which are bio-compatible, and after the canal is filled, a suitable and aesthetic regular cement filling is done over it, which can be accompanied with crown placement sometimes.

How many seatings are required?
The Endodontist/Dentist would try to make the treatment planning for the ease of the patient, but there are a few factors which decide the amount of chair time and the number of seatings:

1. The position of tooth in the mouth, maxillary molars take more time than the mandibular ones.
2. Number of roots present in a tooth and number of root canals seen in the roots, as each of the canal is to be emptied and filled with the filling material.
3. The length and thickness of root canals.
4. Previous procedures - If the tooth has gone through some treatment earlier, like crown placement, then it takes more time for the entire procedure rather than the normal tooth with some small filling

Some Facts to remember about Root Canal Treatment:
Root canals are done to protect a tooth, the calcified tissues of the tooth. This helps in maintaining the jaw integrity. If the entire tooth is extracted, the space in between the adjacent teeth can lead to shifting around of those teeth if a bridge or implant placement is not done rightly there. So, a root canal treatment is advised for the protection of the tooth during an infection.

The thickness of the calcified structure would be considered by the dentist as they are more brittle and can break down. So to maintain and restore a tooth structure, crown placement is usually done. Any endodontic infection is accompanied with swelling due to inflammation of that region, which occurs after the necrosis or death of the oral tissue. This, if not taken care of, will spread to all the parts of the oral cavity and sometimes would lead to some medical complications in severe cases. When root canal is done, it does not make the tooth entirely dead. Removal of the pulp contents do not make the tooth dead. The reason for this is that the tooth still gets adequate nourishment from the adjacent tissues and from the alveolar bone. So it is not regarded as a dead tooth, and it can be restored and maintains the integrity of the alveolar bone and dental arch when a crown is placed over it.

When is Root Canal Treatment advised?
1. Severe toothache which is during chewing or during contact with any extreme hot or extreme cold temperature material which is usually tolerated by the mouth.
2. Constant tooth pain during mastication or chewing.
3. Darkening of the tooth.
4. Swelling seen in the areas of gums around the tooth.

Believe in these facts before going for a Root Canal Treatment:
1. Patients fear of root canal treatment - It was believed to be one of the most painful procedure in dentistry and every patient who was advised to have root canal done used to fear to go to the dentist. But this is not a problem now, as good anesthetics are available which can subside the pain.

2. It is not time consuming - Earlier it used to take many visits for the completion of the root canal and this caused disturbance in the schedules of the patients and it was a hard task for them. Now it takes not more than 2 visits for the completion of the entire procedure.

3. Pain is not the only symptom - As said above, root canal should be done to prevent an infection, only the pain can not be taken as a factor to consider. If there is no pain in a particular region but there is some swelling with discoloration, the dentist have to properly check for the infection.

4. Better than extraction - It was believed entirely reverse of this. People used to believe in the fact that getting the tooth removed completely would be better than having root canal done. But maintaining the natural tooth for long can be helpful in proper chewing and strengthening of the tooth. Also the cost for extraction is followed by its next procedure like removable denture or implant, which costs more than a root canal procedure.

5. Pregnant Women - There are suitable anesthetics available for pregnant women and the x-ray required during the root canal treatment is small and focused only in the mouth region, so does not affect the abdominal region. So there is no restriction for pregnant women and they can have the root canal done, but prior to the treatment, the dentist should be kept aware about the fact that the patient is pregnant.




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