Endodontics is the dental specialty concerned with the study and treatment of dental pulp. The most common endodontic treatment procedure is endodontic therapy, or more commonly called Root Canal Therapy.
First, Let’s Look at Our Teeth
Our teeth are like Ogres, or onions if you like, as in they have layers. The outer layer is the Enamel and we have spoken a lot about that part of the tooth. It’s the hard outer shell. Under the enamel is the Dentin layer which is made up of living cells that secrete a hard mineral substance (which becomes the enamel). Under the dentin layer is the Pulp Cavity where the pulp, nerves and blood vessels reside. It is the soft, living inner structure of the tooth. On the outside of the tooth, under the gum line around the roots of the tooth is a layer of connective tissue called Cementum. This tissue binds the roots of the tooth to the jawbone and gums. Finally, the Periodontal Ligament keeps the tooth tight against the jawbone. It is important to understand these layers in order to understand endodontic therapy.
When is Root Canal Therapy Considered the Right Treatment Option?
When a patient comes to their dentist with a toothache, a number of things are done to diagnose the problem. First an x-ray is taken to determine if there is any damage to the root of the tooth, if there is any decay that extends into the pulp or if there is an abscess infection. The dentist will do a limited exam on the specific problem tooth to determine what course of action best suits the tooth and the patient. If the dentist feels a root canal is the patients best course of action, due to severe decay or an infection, they will refer the patient to an endodontist to perform the root canal procedure.
The Root Canal Therapy Procedure
Once you are at the endodontist’s office and it is verified that you need endodontic therapy, the process begins. After numbing the patient a dental dam is fitted around the tooth to keep the tooth isolated, to keep saliva from interfering with the procedure and to keep the instruments and materials from being inhaled.
Upon placement of the dental dam, the endodontist starts working. First the endodontist will open up the tooth by drilling into the crown down towards the pulp chamber. The endodontist will try to limit the size of the hole drilled into the tooth so that it doesn’t affect the structure too much. After the tooth is opened and the pulp chamber is exposed, the endodontist uses a series of files–handheld needle-shaped instruments with tiny teeth wrapped around the head–to drill out the nerve from the root canal. The files start very thin and small and as the procedure progresses, so does the size of the file in order to widen the canals. The process of removing the infected tissue and debris from the root canal serves to facilitate greater penetration of an irrigation solution. Finally, after the tooth is opened up, the nerve is removed and the irrigation solution does its job, the endodontist will fill each of the root canals and the chamber with an inert material and seal the opening.
At the end of the procedure, the endodontist will discuss with you the final step of the root canal therapy- getting the crown for the tooth. He will send a correspondence of the treatment to your general dentist and advise you to make the appointment within the following weeks.
The Tools and Materials of the Trade
The Dental Dam
The dental dam is a thin rectangular piece of latex rubber used by many dental practitioners to isolate one or more teeth. Isolation of the tooth may be required to keep saliva from affecting the treatment procedure. But the dam serves to keep the instruments and materials from being inhaled. Consider it this way; the drill is breaking up the crown of your tooth like your Black and Decker hand drill does a piece of drywall. There is a lot of dust and debris stirred up by this one part. Then the files are stuck down into the pulp of the tooth, grabs the nerve and tissue and pulls it out. There is a lot of stuff being done to that one tooth you don’t want sitting around in your mouth. The dental dam is there as a “catcher” to ensure none of it can be breathed in or swallowed.
The Dental Drill
The dental drill is also referred to a dental hand piece, is a small high speed drill used for all sorts of dental procedures including the removal of decay and reshaping a tooth for a filling or crown. Modern drills can rotate up to 400,000 rpm and generally use hard metal alloy bits known as burrs. Dental burrs come in a variety of shapes and sizes designed for specific applications.
Endodontic files are surgical instruments commonly made from stainless steel or nickel titanium alloy with a spiral-toothed head designed to grab and remove nerves and tissue. Typical file lengths are 21mm, 25mm and 31mm with a taper from the handle to the tip.
Irrigation solutions are used to ensure all debris from the infected tissue and the procedure itself is removed from the root canal, leaving a clean, sterile tooth behind.
Standard Filling Material
Standard filling material for root canal therapy is gutta-percha, a natural polymer prepared from latex from the percha tree. The filling technique involves inserting a gutta-percha cone into the cleaned out root canal along with a sealing cement.
What’s the Fuss About Root Canals?
Root Canals are among the most feared treatments in dentistry. Many people can experience pain after the procedure, even though the tooth no longer has a nerve or blood supply. This can cause people to think the procedure did not work, which may cause them to panic about further treatments. But if you’ve had endodontic therapy, it is important to remember, though the one tooth no longer contains a nerve, there are still nerves in the jaw and gums around the tooth that may experience pain or sensitivity. And that is totally normal. But if you are worried, you should talk to your dentist. They will always do their very best to make sure you are comfortable and pain free.
As a Patient at Affiliated Dentists
Root Canals are referred out to an Endodontist as they are specialists and will take great care of you. Your crown work required post-root canal therapy can all be handled at Affiliated Dentists.