Root Canal Treatment
Where indicated, we can provide root canal treatment for any tooth, including molars (back teeth), that can be restored predictably, provided the patient wishes to keep the tooth. The alternative would be to extract the tooth.
Modern root canal treatments, when carried out under ideal conditions (rubber dam isolation, microscope enhanced vision, modern obturating techniques ) have a very high success rate.
We also provide root canal treatment for patients who have been referred by their own dentist. Patients who have been referred for root canal treatment will return to their own dentist for any further treatment.
There are a number of reasons why you might need a root canal treatment.
The most likely reason is due to the presence of decay - either new decay, or in a filled tooth that previously had considerable decay. The bacteria in the decay cause inflammation in the pulp ( this is the soft tissue in the middle of the tooth and root, made up of nerves and blood vessels ) If the inflammation is reversible ( usually short stings, particularly to temperature sensation ) then the pulp can recover and all that may be required is a restoration (filling).
If the inflammation is irreversible (usually long stings as a response to temperature, particularly heat) then the pulp will not recover. It may become symptom free for some time, but it will not recover and the symptoms will recur. The pulp will then die.
The treatment for irreversible inflammation is to have a root canal treatment - or alternatively to extract the tooth.
Root canal treatment ( endodontics ) involves the removal of the dead, or irreversibly inflamed tissue in the tooth and root canal space. Some teeth have one canal (upper incisor and canine teeth, some lower incisor teeth). Some have 2 canals (first premolars and some second premolars, some lower incisor teeth) Some have 3 canals (upper premolars occasionally, some molar teeth) and some have four canals (upper first molar teeth, some upper second or third molar teeth and some lower molar teeth).
The tooth is anaesthetised as for a normal filling. Rubber dam is placed to isolate the tooth to prevent contamination of the tooth by saliva, which contains normal bacteria. The dam also allows the use of antibacterial chemicals to disinfect the canals and kill bacteria. Without the rubber dam it is not possible to use the chemicals safely in sufficient quantities.
The number of canals is identified from the xrays, from experience and by using an operating microscope, which affords a much greater image making it significantly easier to identify all the canals and tissue spaces which are harbouring bacteria.
When all the space inside the root canal has been shaped and cleaned this space is then sealed ( obturated ) with heated gutta percha, a natural material which is used to compact a sealer against the walls of the canals and spaces. This is sometimes done at the first treatment visit or alternatively if more time is required to better clean and disinfect the root canal, then the obturation is done at a subsequent visit.
There is no discomfort during this procedure as this is always done under local anaesthetic. After a root canal visit many patient s experience little or no discomfort. Those that do experience some discomfort should take anti-inflammatory medication such as Nurofen and/or painkillers such as Paracetamol. Only very rarely will a patient experience an increased inflammatory response, known as a flare up, and as well as significant discomfort there may also be some swelling. As stated, this is rare and the treatment is again anti-inflammatory medication (Nurofen +/- Paracetamol). If you should experience a flare-up you should contact the surgery and additional painkilling medication can be prescribed
Trauma to your tooth or teeth can lead to the need for root canal treatment. Not all teeth fractured as a result of trauma will need a root canal treatment. Occasionally where a tooth is fractured as a result of trauma, the adjacent tooth will have received much the same force and will subsequently die and need a root canal treatment, whereas the tooth that fractured may remain vital, as the act of fracturing dissipates the force on the tooth.
Trauma cases need to be monitored carefully and often no treatment is required. Where necessary, there are specific treatments based on the extent of the damage to the tooth and/or jaw, the age of the patient, whether the tooth remains alive or not.
If the tooth was avulsed, (knocked out completely) treatment and prognosis would depend on how long the tooth was out of the mouth and whether or not the tooth was kept moist (milk is the commonest readily available solution).
Wear and tear on teeth, from clenching or grinding can cause hairline cracks to occur in teeth. Over time these cracks can allow sufficient bacteria to contact the pulp, leading to reversible or irreversible inflammation. In the case of irreversible inflammation, a root canal treatment would be indicated. (in the case of reversible inflammation, a crown or occasionally a large filling can resolve the symptoms).
Dental procedures can exert an effect on your tooth. Over time, a tooth that has had significant treatment, maybe several fillings, possibly a crown, combined with wear and tear, is more likely to need a root canal treatment.
Remember, there is nothing as good as your own tooth. After root canal treatment, most back teeth will require a crown , to prevent chewing and grinding forces being transmitted directly to the root, which could cause the root to fracture vertically, leading to the loss of the tooth. Many front teeth can be restored with a large restoration (filling) after root canal treatment, as these teeth are less likely to fracture, being used for biting rather than chewing.
Some dead teeth, as well as requiring root canal treatment, will also require cosmetic treatment because they have darkened . This mainly applies to upper and lower front teeth. There are many options when it comes to cosmetically treating a darkened root treated tooth. The most conservative treatment Is to bleach the tooth internally. Alternatively a bonded restoration, a veneer or a crown may be used.
With their more sophisticated procedures, dentists are helping people keep their teeth longer. Because people are living longer and more stressful lives, they are exposing their teeth to many more years of crack-inducing habits, such as clenching, grinding, and chewing on hard objects. These habits make our teeth more susceptible to cracks.How do I know if my tooth is cracked?
Cracked teeth show a variety of symptoms, including erratic pain when chewing, possibly with release of biting pressure, or pain when your tooth is exposed to temperature extremes. In many cases, the pain may come and go, and your dentist may have difficulty locating which tooth is causing the discomfort.Why does a cracked tooth hurt?
To understand why a cracked tooth hurts, it helps to know something about the anatomy of the tooth. Inside the tooth, under the white enamel and a hard layer called the dentin, is the inner soft tissue called the pulp. The loose pulp is a connective tissue that contains cells, blood vessels and nerves.
When the outer hard tissues of the tooth are cracked, chewing can cause movement of the pieces, and the pulp can become irritated. When biting pressure is released, the crack can close quickly, resulting in a momentary, sharp pain. Irritation of the dental pulp can be repeated many times by chewing. Eventually, the pulp will become damaged to the point that it can no longer heal itself. The tooth will not only hurt when chewing but may also become sensitive to temperature extremes. In time, a cracked tooth may begin to hurt all by itself. Extensive cracks can lead to infection of the pulp tissue, which can spread to the bone and gum tissue surrounding the tooth.How will my cracked tooth be treated?
There are many different types of cracked teeth. The treatment and outcome for your tooth depends on the type, location, and extent of the crack.Craze Lines
Craze lines are tiny cracks that affect only the outer enamel. These cracks are extremely common in adult teeth. Craze lines are very shallow, cause no pain, and are of no concern beyond appearances.Fractured Cusp
When a cusp (the pointed part of the chewing surface) becomes weakened, a fracture sometimes results. The weakened cusp may break off by itself or may have to be removed by the dentist. When this happens, the pain will usually be relieved. A fractured cusp rarely damages the pulp, so root canal treatment is seldom needed. Your tooth will usually be restored with a full crown by your dentist.Cracked Tooth
This crack extends from the chewing surface of the tooth vertically towards the root. A cracked tooth is not completely separated into two distinct segments. Because of the position of the crack, damage to the pulp is common. Root canal treatment is frequently needed to treat the injured pulp. Your dentist will then restore your tooth with a crown to hold the pieces together and protect the cracked tooth. At times, the crack may extend below the gingival tissue line, requiring extraction. A nontreatable tooth is shown in the graphic above.
Early diagnosis is important. Even with high magnification and special lighting, it is sometimes difficult to determine the extent of a crack. A cracked tooth that is not treated will progressively worsen, eventually resulting in the loss of the tooth. Early diagnosis and treatment are essential in saving these teeth.Split Tooth
A split tooth is often the result of the long term progression of a cracked tooth. The split tooth is identified by a crack with distinct segments that can be separated. A split tooth cannot be saved intact. The position and extent of the crack, however, will determine whether any portion of the tooth can be saved. In rare instances, endodontic treatment and a crown or other restoration by your dentist may be used to save a portion of the tooth.Vertical Root Fracture
Vertical root fractures are cracks that begin in the root of the tooth and extend toward the chewing surface. They often show minimal signs and symptoms and may therefore go unnoticed for some time. Vertical root fractures are often discovered when the surrounding bone and gum become infected. Treatment may involve extraction of the tooth. However, endodontic surgery is sometimes appropriate if a portion of the tooth can be saved by removal of the fractured root.After treatment for a cracked tooth, will my tooth completely heal?
Unlike a broken bone, the fracture in a cracked tooth will not heal. In spite of treatment, some cracks may continue to progress and separate, resulting in loss of the tooth. Placement of a crown on a cracked tooth provides maximum protection but does not guarantee success in all cases.
The treatment you receive for your cracked tooth is important because it will relieve pain and reduce the likelihood that the crack will worsen. Once treated, most cracked teeth continue to function and provide years of comfortable chewing. Talk to your endodontist about your particular diagnosis and treatment recommendations. S/he will advise you on how to keep your natural teeth and achieve optimum dental health.What can I do to prevent my teeth from cracking?
While cracked teeth are not completely preventable, you can take some steps to make your teeth less susceptible to cracks.
- Don't chew on hard objects such as ice, unpopped popcorn kernels or pens.
- Don't clench or grind your teeth.
- If you clench or grind your teeth while you sleep, talk to your dentist about getting a retainer or other mouthguard to protect your teeth.