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Demystifying root canal
treatment
by Dr Anthony
Druttman
Demystifying root canal treatment
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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