Dental Library- Root Canals

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Root canals often get an unwarranted reputation for being a painful and unpleasant experience. Root canals are only painful and unpleasant when the tooth has an active infection, an abscess, or when the tooth has been hypersensitive for a while. In the former case, root canals are uncomfortable because the infection does not allow for profound anesthesia. In the latter case, root canals are uncomfortable because the tooth's hypersensitivity does not allow for profound anesthesia. A way to minimize these two scenarios is to have regular dental examinations and radiographs (X-rays). In almost all other cases when profound anesthesia is achieved root canal treatment is comfortable and a very useful therapy. Root canals are a means of extending a tooth's useful life. Rater than extracting (pulling) a tooth that has been compromised by disease or trauma a root canal can often be done and the tooth saved allowing it to render decades more of useful service.

A root canal is always done by isolating the tooth under a rubber dam, creating an access opening to and then removing the pulpal tissue of the tooth. The pulp is the soft tissue located in the central part of the tooth and consists of nerve tissue, lymph tissue and the tooth's blood supply. Once the pulp is removed the tooth can no longer perceiving pain because it no longer contains any nerves. The area will still perceive pain because the jawbone and periodontal ligament that surround the tooth still have functioning nerve endings. In fact when a tooth is abscessed its nerve tissue is dead and therefore it cannot perceive pain and it is the jawbone and periodontal ligaments that are sending the pain signals to the brain. Most of this pain is from the excess pressure that the expanding infection puts on the surrounding tissues.

Once the pulp chamber, the part of the pulp that is located in the crown of the tooth, is accessed the bulk of the pulp is removed and access to the root canals, the space in the roots of the teeth that contain pulpal tissue, is achieved. As the root canal treatment proceeds the pulpal tissue in the root canal space is removed, the root canal space is enlarged mechanically and the root canals and pulp chamber are chemically disinfected and debrided. The use of small instruments and harsh chemicals emphasizes the need for rubber dam isolation. Exposure of oral tissues to or the possibility of swallowing or aspirating either of these would cause serious problems for the patient.

After the root canals and pulp chamber have been cleaned, shaped and disinfected a filling material is then placed in this space. The filling material seals the end of the root canals thus minimizing reinfection and ensuring the optimum health and longevity of the treated tooth. The filling materials of choice today are thermoplastic so they are placed into the root canal space and heated or are heated prior to placement into the root canal space. This thermoplastic quality allows the filling material to flow into all the minute nooks and crannies and affect the best possible seal of the root canals. This completes the root canal treatment but not all the treatment the tooth requires so that it can function properly.

Upon completion of root canal treatment a tooth needs to be restored to form, function and esthetics so that it can once again perform is proper functions in the patient's mouth. For most teeth a post and core are used to restore about one half the length of one root canal and the pulp chamber. Then a crown is often recommended to protect the root canal treated tooth. This is because root canal treatment eliminates the tooth's blood supply which in turn can cause the tooth to become brittle over time and therefore much more susceptible to fracture. The crown helps to reduce subsequent tooth fractures after root canal treatment. No one wants to spend all that time, money and apprehension on root canal treatment only to have the tooth break and be lost. Don't allow scary stories to stop you from getting the treatment that can save your teeth, so call immediately.

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