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The Endodontist and a Successful Root Canal Treatment

Many international scientific studies demonstrate that root canal treatment is generally successful and provides an excellent long-term prognosis when the dental surgery is properly performed utilizing sound biological and mechanical concepts. As with any clinical situation, there are factors that must be considered when discussing root canal procedure outcomes with your dentist or endodontist:

1. Root canal treatment has not always been as successful as it is today. Fortunately, the guiding principles of modern endodontics can now be utilized to deliver very predictable results over a patient's lifetime. Some of these principles were unknown or misunderstood in the past and, consequently, many teeth have had endodontics treatment based on concepts, techniques, and materials that are not considered optimal by today's standards. Even so, some of these teeth have given, and will continue to give, additional years of good service. In other instances, previously treated teeth exhibit bacterial leakage that may or may not be accompanied by clinical symptoms. Failing endodontically treated teeth can generally be successfully retreated by an endodontist using modern biological concepts, technologies, and techniques.
2. Root canal treatment can be successful even if a tooth is severely damaged by decay, trauma, or other destructive events. In cases such as this, it may be necessary to reinforce the tooth by placing a post into the root before a crown can be placed. In these situations, the root canal dentist must weigh risks versus benefits during the treatment planning process.
3. The success of root canal treatment is greatly enhanced when the tooth receives a protective restoration after completion of the treatment. When a protective crown is not placed, the root canal filling may leak or the tooth may develop additional decay or even fracture. Once a root fracture has occurred, there is generally no predictable treatment or dental surgery to save the tooth.
4. For an endodontic treatment to be successful, the periodontal supporting structures of the tooth must be healthy or capable of being returned to a state of health with periodontal treatment. Other specialty consultations may also be necessary depending on the findings in a particular situation.
5. To insure that root canal treatment is working, the particular tooth should be evaluated over time. Teeth are subject to enormous shifts in temperature (such as hot coffee vs. ice cream), tremendous mechanical loads (in pounds per square inch), and constant exposure to the bacteria in saliva. Periodic re-evaluation allows the dentist to examine the results of past treatments and to intervene early if new damage or breakdown is occurring.

As with any human endeavor, there are certain clinical situations in which dental surgery does not work even with the best efforts that modern dentistry can offer. Fortunately, these cases are infrequent and, if they occur, many of the teeth can be successfully retreated by an endodontist. A root canal procedure, when appropriately planned and well-performed by your dentist or endodontist, is the most cost-effective and predictable treatment alternative in most clinical situations.

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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