Root Canal (Endodontic) Treatment

Endodontic treatment is commonly known as “root canal.” “Endo” is the Greek word for “inside” and “odont” is Greek for “tooth.” Endodontic treatment treats the inside of the tooth.

To understand endodontic treatment, it helps to know something about the anatomy of the tooth. Inside the tooth, under the white enamel and a hard layer called the dentin, is a soft tissue called the pulp. The pulp contains blood vessels, nerves, and connective tissue, and creates the surrounding hard tissues of the tooth during development.

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. However, once a tooth is fully mature it can survive without the pulp, because the tooth continues to be nourished by the tissues surrounding it.

What Is an Endodontist?
The dental school curriculum includes the instruction and practice of endodontic treatment. An endodontist is the dental specialist, with two additional years of training in the management of pulpal disease and orofacial pain. The endodontist is especially skilled in the management of stubborn, challenging cases and retreatment.

Endodontic Treatment Objectives

  • Relief of pain, if present.
  • Removal of pulp from root(s) of tooth.
  • Disinfection of root and surrounding bone; this phase may take several appointments if infection is severe.
  • Complete filling of root canals.
  • Root canal treatment is an attempt to retain a tooth which may otherwise require extraction. Although root canal therapy has a high degree of success, it cannot be guaranteed.
  • Occasionally, a tooth which has had root canal therapy may require retreatment, surgery or even extraction.

Nonsurgical Root Canal
The objective of performing root canal therapy is to remove the diseased tissue within the root canal system. The pulp, which supplies the blood supply and the nerve inside the tooth, can become inflamed or infected due to deep decay, repeated dental procedures, periodontal disease, and/or cracks or chips in fillings or teeth. The symptoms associated with root canal treatment include lingering pain to cold or hot, inability to chew, and/or spontaneous pain. Swelling and tenderness around the gum tissue, at or near the end of the roots, can also be symptoms of an infected tooth.

The Importance of Dental X-Rays
X-rays provide an invaluable tool in endodontic diagnosis and treatment. Root canal treatment without X-rays is like diving into a pool without knowing the depth of the water.

Endodontic Retreatment
Endodontic retreatment becomes necessary when a tooth does not heal after the initial root canal therapy. The reasons for this are numerous and can include:

  • Narrow or curved canals that could not be negotiated during the initial treatment.
  • New decay under an old filling or crown.
  • An ill-fitting restoration that caused leakage of bacteria along the side of the root canal filling, therefore causing an infection.

Endodontic Surgery
In a few cases where nonsurgical endodontic treatment cannot save the tooth, endodontic surgery becomes necessary. The basic idea is to clean out the infection at the end of the root and to seal the root end with a filling. This procedure is called an “apicoectomy.”

Cracked teeth
Cracked teeth usually occur due to many years of grinding, clenching, and chewing on hard objects, especially ice. Symptoms associated with cracked teeth include:

  • Erratic pain upon chewing, especially during biting w/relief upon opening.
  • Extreme sensitivity to hot and cold.

There are many different types of cracks and these are as follows:

  • Craze lines
  • Fractured cusps
  • Cracked tooth
  • Split tooth
  • Vertical root fracture

Traumatic Dental Injuries
There are several traumatic dental injuries that can occur:

  • Fractured or chipped teeth
  • Dislodged teeth
  • Avulsed teeth
  • Root fractures

Fractured or chipped teeth can be repaired with simple fillings, or if the nerve is exposed, a root canal might be needed. Teeth can also be dislodged in several ways. Teeth can be pushed in and pushed partially out of socket and malpositioned. Usually stabilizing the teeth and testing them for vitality is all that is needed. If the nerve tests abnormally, then root canal therapy might be necessary. You should contact your dentist immediately since time lapse after a traumatic incident is critical.

The worst prognosis is usually associated with avulsed teeth. This is because the supporting structures for the tooth can become irreversibly damaged. If the tooth is placed back in the socket within a reasonable period of time then there is a chance to save that tooth. It is important not to handle the root of the tooth excessively and to place it in a moist environment. Milk, salt water, or specific solutions sold at local drug stores are good mediums for preserving the tooth. Try to get to your dentist as soon as possible.

Permanent Restorations
Upon completion of root canal therapy by an endodontist, the patient will be advised, if necessary, to return to their general dentist for a permanent restoration and a crown if the tooth is towards the back of the mouth. It is the patient’s responsibility and is necessary to safeguard the integrity of the tooth structure.