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Causes And Treatment Of Root Canal Disease

Why Does My Tooth Need Root Canal Treatment?

A tooth generally needs a root canal procedure because the pulpal tissue inside the tooth has become irreversibly injured because of root canal disease. The tooth pulp is composed of elements similar to any other tissue in the body and is susceptible to injury from bacterial decay, repeated or extensive dental procedures, traumatic accidents, or advanced periodontal disease. Pulpal disease occurs in an anatomically complex space termed the root canal system. When appropriate, root canal treatment is directed towards removing inflamed or abscessed tissue, disinfecting, and preparing this space to receive a biocompatible filling material. Once the root canal system has been sealed and a protective crown placed by an endodontist, the tooth can be retained as a healthy and functional member of the dental arch.

What Are the Usual Events That Trigger Root Canal Disease?

Events that may trigger root canal disease include:

• Decay: Dental decay contains bacteria that can infect the tooth pulp. Decay can progress through the outer enamel surface of the tooth into the underlying dentin, which is a hard, yet porous, structure. Ultimately, decay can invade the dental pulp and cause pulpal injury, which leads to an inflammatory condition that can potentially become an abscess. As dental decay and its associated bacteria invade the pulpal tissue, a patient may experience no discomfort or, in other instances, the pain may be acute.
• Traumatic events: The tooth pulp is vulnerable to trauma. A blow to the mouth may lead to a variety of dental injuries. A traumatized tooth may appear whole but exhibit root canal disease at a later date. A tooth may be only slightly chipped or it may be fractured to the extent that its clinical crown is broken off and the pulpal tissue is exposed. In severe situations, the root can be fractured within the bone or the tooth completely knocked out of the mouth, which is called an "avulsion." Frequently, these traumatic events will irreversibly damage the tooth pulp by causing bacterial contamination or by interfering with the tooth's blood supply and its ability to repair. Some teeth are traumatized to the extent that they are not treatable and must be removed.
• Repetitive or extensive dental procedures: The tooth pulp is also vulnerable to injury from repetitive or extensive dental procedures. Subjecting a previously injured pulp to the additional trauma of even the best planned and performed dental surgery may be enough to cause the pulpal tissue to become irreversibly inflamed and the tooth to require root canal treatment. The dentist may or may not be able to predict this outcome in advance. At times, based on the examination and treatment plan, the dentist may recommend the removal of the dental pulp before performing other planned dental procedures. In these situations, the tooth pulp is removed so that it will not become problematic at a later date under a new, and possibly complex, restoration. At times, initiating a root canal procedure through an existing restoration may compromise its integrity.
• Periodontal disease: Infection in the gum and bone around the tooth is referred to as periodontal or gum disease. Advanced periodontal disease may compromise the blood supply to the dental pulp and ultimately, bacteria may enter and infect the pulpal tissue in the root canal space.

By Clifford J. Ruddle, DDS, in collaboration with Philip M. Smith, DDS

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Root Canal Therapy- The Procedure To Relieve Your Pain

Many people flinch when their dentists tell them they need root canal therapy. While dentists are sympathetic to fears of pain, they also want patients to know that root canal procedure has three purposes:

• Stop the root canal symptoms of a toothache;
• Prevent bacteria and pain from spreading into the jaw; and
• Maintain the original tooth instead of replacing it with a denture or bridge.

Root canals are actually channels that run from the root of the tooth, which connects to the bone, up to the top surface of the tooth. The canal contains blood vessels, nerves and the complex cells that make up the living tissue inside the tooth. This lifeline inside the tooth is called the pulp.

When a tooth is decayed or cracked, bacteria can get to the pulp. The acid from the bacteria irritates the pulp and it becomes inflamed; it's the same process you watch when other parts of your body become infected. When the pulp tissue becomes inflamed, it's harder for blood to flow to the tissue, and the resulting pressure creates the pain symptoms inside your tooth.

There are two ways to get relief from root canal pain: perform the root canal procedure, or pull the tooth, clean the gum below, and replace the tooth with a denture or bridge. Dentists advise pulling teeth as a last resort because they know that your natural teeth are the ones best suited for your mouth.

It's important to have the root canal procedure done quickly. The bacteria will travel down the canal to the root and into the jawbone. If this happens, the pain of your toothache will spread to your jaw. Even more important, the infection can cause your jawbone to deteriorate and weaken the structure that holds your teeth.

The best way to avoid root canal therapy is to take good daily care of your teeth to prevent the growth and spread of bacteria. Brushing and flossing are important.

Just as important are regular trips to the dentist, to check for the first sign of decay or cracks that could eventually lead to an abscessed tooth. In this case, an ounce of prevention really is worth a pound of cure!

By Brian J. Gray, DDS, MAGD, FICO