Demystifying
Root Canal Treatment.
By Dr. Anthony Druttman
Many people have a deep-seated fear of root canal (endodontic)
treatment. They will say “not as bad as a root
canal” – as if it is one of the worst human
experiences. Such fears are unfounded. In
professional hands, root canal treatment is the best
way to keep your natural teeth and preserve good
dental health. By having better information about
this treatment, you will understand why it is often
called ‘the tooth saver’, says endodontics
specialist Dr. Tony Druttman www.londonendo.co.uk
Life doesn’t always play us a fair hand. Most of us
try to keep our teeth in reasonable condition
because we know that long-term neglect can be
painful, both in the mouth and pocket. Yet there are
occasions when unnoticed changes take place to our
teeth. We only become aware of this when we have
dental pain or our dentist discovers an underlying
problem during a routine inspection. The following
advice about root canal treatment will help to put
your mind at ease.
A dental microscope allows precise
inspection of the tooth root
Should anecdotal evidence influence you?
Very often patients describe their root canal
experiences with terms like “it was very painful”
and “I had to go back six times”. That’s
unfortunate, but not the way things need to be. When
carried out correctly, the endodontics procedure is
no worse than having a normal filling, although it
may take a little longer. People often agree to root
canal treatment with reluctance, when there seems to
be little other choice. In fact it is the best
solution in cases of substantial dental damage or
decay. Advice by a dentist will give you a clearer
picture than advice by other patients.
Why do teeth need root treatment?
The nerve and blood vessels in the tooth (known as
‘dental pulp’) are there to help the tooth grow to
maturity. They protect against bacteria within the
body. Bacteria play a defensive role in the general
mouth area, but can become destructive when they
attack the body via the dental pulp or through gum
disease.
In fact, recent
research has found a correlation between gum disease
and coronary heart disease.
Bacteria cause decay in teeth. When the decay is
deep, it can allow bacteria to invade the dental
pulp – the living tissue inside your teeth. Your
dentist removes the decay in the tooth to protect
the pulp and to restore the function and appearance
of the tooth. However repeated bacterial attacks can
weaken the pulp to such an extent that the nerve can
no longer recover, and so the pulp dies.
How do you know if something is wrong?
The point is – you don’t always know. Different
nerve systems within the pulp will cause the tooth
to respond in different ways. The nerve may die
quietly and never cause any symptoms. It may be a
chance x-ray that alerts the dentist to a problem.
Alternatively the dying nerve may cause a great deal
of pain and be very difficult to locate. When the
nerve becomes irreversibly damaged, then either the
pulp or the tooth has to be removed.
Will a root-treated tooth feel different?
The treated tooth is referred to as being dead
because it has lost its internal nerve and blood
vessels. However there is still a nerve and blood
supply to the outside surface of the tooth, so the
successfully root-treated tooth should feel normal.
Is there an alternative to endodontic treatment?
If you choose not to have root treatment, your
affected tooth will be extracted. Should you fill
the space? That depends on functional and aesthetic
grounds. People today are aware of their mouth and
smile, so someone displaying unaesthetic black gaps
between their teeth may feel self-conscious about
speaking or smiling. Back teeth may not be
immediately noticed in a smile, but they are very
important in terms of chewing function. Every tooth
stabilizes the teeth adjacent to it and those
immediately above or below. If it is removed and not
replaced, other teeth may well shift from their
natural positions. This will stimulate problems with
gum disease, food packing (leading to further decay)
and bite problems.
If a tooth needs extracting, what next?
Teeth can be replaced with bridges, implants or
removable dentures and the possibilities should be
discussed with your own dentist. Implants have
revolutionized restorative dentistry and can be an
excellent substitute for the natural tooth. The
dental root has often been described as nature’s
implant, so wherever possible existing teeth should
be kept in place. However there are situations when
it is neither feasible nor cost-effective to keep
the tooth. The options have to be considered
carefully either by your general dental
practitioner, or by an endodontics specialist.
How successful is endodontic treatment?
Nobody can guarantee success. However when the
endodontic treatment and the restorative treatment
that follows it are both carried out to a high
standard, long-term success is very likely. Failure
would be caused by the leakage of bacteria into the
root canal system or by mechanical failure i.e.
fracture of the remaining tooth.
Should
endodontic treatment fail, it may be possible to
re-treat the tooth. If further treatment is
impossible, the tooth may require extraction.
Endodontic re-treatment may be carried by your own
dentist or by an endodontist, depending on the
particular problems and reasons for the failure.
General dentist or root canal specialist?
General dentist are trained to carry out root canal
treatment and many of them do this to a very high
standard. Whether root canal treatment is carried
out by your regular dentist or an endodontics
specialist will depend on many factors. Is your
dentist skilled, experienced and confident in
performing these kinds of procedures? Is it a
straightforward treatment or are there
complications? The molar teeth have a more
complicated root canal system than the front teeth
(incisors and canines), are harder to access and may
require more specialized equipment.
While endodontics specialists are usually more
expensive, their training and experience enable them
to deal more easily with complications. In many
cases, this involves re-treating teeth where the
original root treatment has failed.
Dr Anthony Druttman, Endodontics Specialist,
www.londonendo.co.uk
About the author:
Dr Anthony Druttman
is a specialist in Root Canal Treatment, operating
from two practices in Central London UK. He offers
Endodontics services to other dentists as well as
directly to patients.
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