Endodontics

Root canals are the space inside the hard layers of each of your teeth.

Within each canal, there is a bundle of nerves, blood vessels, and connective tissue that help the teeth to grow and develop. This bundle, called pulp, can become inflamed or infected leading to pain and sensitivity to biting and temperature changes.

Normally, the dental pulp is protected by hard layers of dentin and enamel, but deep decay or fractures due to biting or other trauma can injure the pulp and allow bacteria to enter the chamber.

A “root canal” treats infection inside a tooth. Symptoms of the infection can be identified as visible injury or swelling of the tooth, sensitivity to temperature or pain in the tooth and gums. During this procedure, the crown of the tooth is opened, allowing the doctor to access the root canal. The pulp tissue in the infected root canal is removed and the canals cleaned. A series of files is used to remove any remaining tissue, slightly enlarge the canals, and smooth the walls of the canals. The root canals are sealed with a material called gutta percha to prevent bacteria or debris from entering the root canals and causing further infection. Finally, the crown of the tooth is restored with a filling or crown.

A dentist may recommend a root canal to a patient after weighing different treatment options. Sometimes, there’s no way around a root canal when it comes to the damaged dental pulp and ignoring the problem will only result in pain and potential worsening of tooth decay or infection.

Root canal treatment is typically more cost-effective than tooth removal, followed by a crown procedure

Symptoms of a cracked tooth are varied and may include pain when chewing, temperature sensitivity or pressure sensitivity or a combination of these. Because the pain often comes and goes, it can be very difficult to recognize what is causing the problem. It can sometimes even be difficult to pinpoint exactly which tooth is causing the discomfort.

Even small movement of the cracked tooth pieces during chewing can cause irritation to the tooth’s pulp, which causes pain. Similarly, when the bite is released, the crack can close quickly, causing sharp pain. Over time, the pulp will become damaged. As this happens, the tooth will hurt more consistently. Cracks can sometimes lead to infections in the pulp tissue and spread to the surrounding gum and bone.

Occasionally a tooth that was treated months or even years ago may develop new problems. In some cases, a tooth that has received endodontic treatment fails to heal or continues to have pain. The need to retreat is generally due to

• Curved or narrow canals that were not treated during the initial treatment.
• Complicated canals that went undetected during the initial treatment.
• The crown or restoration was not placed within the appropriate amount of time following the procedure.
• New decay can expose a root canal filling material, causing infection.
• A cracked or loose filling or crown can expose the tooth to new infection.

In some cases, it may be necessary to remove the infected root tips. This is known as apical surgery or an apicoectomy. An incision is made in the gum tissue to expose the bone and surrounding inflamed tissue. The damaged tissue is removed along with the end of the root tip. A root-end filling is placed to prevent reinfection of the root and the gum is sutured. The bone naturally heals around the root over a period of months restoring full function.

Root resorption is the process in which the body breaks down and absorbs tissue surrounding a tooth. Although this is a rare phenomenon in adults, root resorption in children is natural and enables the roots of baby teeth to dissolve so that permanent teeth can serve as replacements. Pressure and tension are normal stressors that can lead to breakdown in tissue, sometimes past trauma to a tooth may damage gum ligaments, resulting in the beginning of resorption. Extreme teeth grinding has been found to initiate resorption as well.