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What
is a root canal?
Underneath your tooth's outer enamel and within the dentin is an
area of soft tissue called the pulp, which carries the tooth's nerves,
veins, arteries and lymph vessels. Root canals are very small,
thin divisions that branch off from the top pulp chamber down to
the tip of the root. A tooth has at least one but no more
than four root canals.
Why
do I feel pain?
When the pulp becomes infected due to a deep cavity or fracture
that allows bacteria to seep in, or injury due to trauma, it can
die. Damaged or dead pulp causes increased blood flow and
cellular activity, and pressure cannot be relieved from inside the
tooth. Pain in the tooth is commonly felt when biting down,
chewing on it and applying hot or cold foods and drinks.
Why
do I need root canal therapy?
Because the tooth will not heal by itself. Without treatment,
the infection will spread, bone around the tooth will begin to degenerate,
and the tooth may fall-out. Pain usually worsens until one
is forced to seek emergency dental attention. The only alternative
is usually extraction of the tooth, which can cause surrounding
teeth to shift crookedly, resulting in a bad bite. Though
an extraction is cheaper, the space left behind will require an
implant or a bridge, which can be more expensive than root canal
therapy. If you have the choice, it's always best to keep your original
teeth.
What
is a periapical abscess?
Usually associated with facial pain and tenderness of the tooth,
this is an infection of the tooth due to decay or trauma to the
nerve of the tooth. The cells in the pulp of the tooth are
dying and bacteria and their waste products travel through the root
of the tooth to the apex (the end of the root), then a pocket fills
in the jaw bone with white blood cells (pus) putting pressure on
the bone and the tooth. Abscesses want to drain, sometime
the infection will travel to the sinuses (for upper teeth), out
through the gum or under the jaw out through the skin. It
is important to have treatment quickly because the travel of infection
can be dangerous depending upon the location of the abscess the
other nearby structures and the size of the infection.
What
is involved in root canal therapy?
Once Dr. McBride performs tests on the tooth and recommends therapy,
he can perform the treatment or refer you an endodontist (a pulp
specialist). Treatment usually involves one to three appointments.
First,
you will probably be given a local anesthetic to numb the area.
A rubber sheet called a rubber dam is then placed around the tooth
to isolate it. Next, a gap is drilled from the crown into
the pulp chamber, which, along with any infected root canal, is
cleaned of all diseased pulp and reshaped. Medication may
be inserted into the area to fight bacteria. Depending on
the condition of the tooth, the crown may then be sealed temporarily
to guard against recontamination, or the tooth may be left open
to drain, or the dentist may go right ahead and fill the canals.
If you're
given a temporary filling, usually on the next visit it's removed
and the pulp chamber and canal(s) are filled with rubberlike gutta
percha or another material to prevent recontamination. If
the tooth is still weak, a metal post may be inserted above the
canal filling to reinforce the tooth. Once filled, the area
is permanently sealed. Finally, a gold or porcelain crown is normally
placed over the tooth to strengthen its structure and improve appearance.
Remember this is the removal of all the components which make a
tooth vital (living), so after therapy the tooth becomes brittle.
If this is a back tooth, it will need a crown so as not to fracture;
if it's a front tooth, confirm with Dr. McBride what precautions
should be taken.
What
are the risks and complications?
More than 95 percent of root canal treatments are successful.
However, sometimes a case needs to be redone due to diseased canal
offshoots that went unnoticed or the fracturing of a canal filing
instrument used, both of which rarely occur. Occasionally,
a root canal therapy will have a return of pain, an endodontist
can access the root tip(s) of this tooth surgically and seal the
root canal(s) from this direction. This is called an apicoectomy.
Once this treatment has been performed the tooth surely has no vital
nerve endings inside it and should become comfortable.
What
happens after treatment?
Natural tissue inflammation may cause discomfort for a few days,
which can be controlled by an over-the-counter analgesic.
A follow-up exam can monitor tissue healing. From this point
on, brush and floss regularly, avoid chewing hard foods on the treated
tooth for a while, and see Dr. McBride regularly.
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