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ENDODONTICS - Root Canal Therapy

Root canal treatment is a dental procedure that replaces a tooth’s damaged or infected pulp with a filling. The pulp consists mainly of blood vessels, tissue fibres and some nerve fibres within the hollow centre of a tooth. The procedure is also known as endodontic treatment.

Success rates for endodontic treatment are generally good. About 90 to 95 per cent of patients who undergo root canal treatment can expect a functional tooth after the treatment. The treated tooth should last as long as the other teeth provided the person maintains good oral hygiene and generally looks after their teeth.

Endodontic Treatment: Preserving the Tooth

In the past, injured or diseased teeth frequently had to be removed. Today, they often can be saved through endodontic treatment. Also known as a root canal treatment, this procedure may be performed by a general dentist or a specialist called an endodontist. More than one practice visit usually is required.

Pulp Particulars

A root canal treatment generally involves the removal and replacement of a tooth’s pulp. The pulp is soft tissue containing blood vessels, nerves and connective tissue.
• The pulp is found in a canal that runs through the centre of the hard tissue on the inside of the tooth (the dentin).
• The pulp extends from the pulp chamber in the crown down through the root canal to the tip of the root in the jawbone.
• A tooth has only one pulp chamber but many have more than one root and several root canals.
If pulp becomes damaged through injury or disease and can not repair itself, bacteria and their products can leak into the pulp and cause the pulp to die. If a root canal procedure is not performed, an abscess can form at the tip of the root and cause considerable pain. Even if there is no pain, the bone anchoring the tooth in the jaw can be damaged. Without treatment, the tooth may have to be extracted.

Endodontic Treatment – What to Expect

Here is what you can expect when you schedule endodontic treatment.
On the initial visit:
• Local anesthetic usually is given to maintain patient comfort.
• The affected tooth is isolated from saliva with a rubber-like sheet called a dam.
• An opening is made through the crown of the tooth. The pulp is removed and then the root is cleaned and shaped. Medication may be added to the pulp chamber and root canal(s) to help eliminate bacteria.
• A temporary filling is placed in the crown opening to keep saliva out. Antibiotics may be prescribed if an infection is present and has spread beyond the end of the root(s).

On the next visit:

• The temporary filling is removed.
• The root canal is filled and permanently sealed. (A metal or plastic rod or post may be placed in the root canal for structural support.)
If an endodontist performs the procedure, he or she usually will send you back to your general dentist for preparation of a crown to be placed on the tooth. Crowns are made from a variety of materials, depending on the location of the tooth, the colour of the tooth and the amount of natural tooth remaining. Discuss with participating dentists which option is best for you.

The Rest is Up to You

The restored tooth can remain healthy as long as its roots are nourished by the surrounding tissues. Good oral hygiene at home and regular dental visits can help prevent tooth decay and gum disease. If you take good care of it, the restored tooth could last a lifetime.

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Tooth anatomy explained

A tooth is mainly made of a hard material called dentine. Enamel is the surface layer that protects the visible part of the tooth (crown). The part of the tooth that sits beneath the gum-line is called the root. The root is the ‘prong’ that helps anchor the tooth into the jaw. Generally, front teeth have only one root, while molars have several. There may be several root canals in one root.

The hollow centre of a tooth is called the pulp chamber. This area contains the blood vessels, nerves and pulp. The pulp is a sensitive tissue that provides oxygen, nutrients and feeling to the tooth. The main function of the dental pulp is to regulate the growth and development of the tooth during childhood. The pulp extends from the roof of the pulp chamber down into the bottom of each root canal.

Once the tooth is fully formed, nutrition for the tooth comes from the tissues surrounding the root. Therefore, a tooth can function without its pulp and, in the majority of cases, can be kept indefinitely. After endodontic treatment, the tooth is ‘pulpless’, but it is not a dead tooth.

Symptoms of damage

A diseased tooth pulp may cause inflammation or infection. The symptoms of a damaged or diseased tooth pulp may include:
• Sensitivity to hot and cold drinks and foods
• Pain when biting or chewing
• Loose tooth
• Swelling of the gum surrounding the affected tooth
• Oozing of pus surrounding the affected tooth
• Facial swelling.
Sometimes, tooth pulp may become damaged or diseased without presenting any symptoms. In these cases, the problem is usually diagnosed by x-rays during a dental check-up or treatment for other dental concerns.

A range of causes

Some of the events that can damage tooth pulp include:
• Deep-seated and untreated dental decay
• Decay beneath a filling
• Trauma to the face that damages a tooth
• Habitual tooth grinding (bruxism)
• Large and deep fillings
• Gum disease.

Research has also found a link between cigarette smoking and root canal treatment. A smoker is significantly more likely to need root canal treatment than a non-smoker, but the reason for the higher risk is unclear.

Possible complications

Without prompt dental treatment, complications could include:
• Spreading infection – once the pulp becomes infected, it loses its ability to fight the spread of the infection. If bacteria find their way into the pulp chamber, the bacteria will multiply unchecked. This can cause a severe infection or an endodontic abscess (a pocket or ‘blister’ of pus).
• Bone loss – the infection may spread around the tip of the infected root canal and cause bone loss in the jaw.
• Loss of tooth – the tooth may have to be removed, which interferes with the person’s ability to bite and chew. Tooth replacements such as dentures or dental implants often require a lot more work than root canal fillings.

Diagnosis methods

The dentist examines the tooth and takes x-rays. These x-rays also help the dentist to plan for the root canal treatment by revealing the number, size and depth of the roots.

Treatment options

You may need one or more visits to complete the endodontic treatment, depending on the complexity of the root canals in your tooth. The exact procedure chosen by your dentist may differ from the procedure outlined here. Ask your dentist for further information. Generally, the typical root canal treatment includes:
• The procedure can be performed using local anaesthetic. If the pulp is infected, anaesthesia may not always be necessary because the tooth no longer has any feeling.
• The affected tooth is wrapped in thin rubber (called a ‘rubber dam’) to keep the treatment area dry.
• The decayed portions of the tooth and any affected filling are removed.
• The pulp or pulp remnants are extracted.
• The dentist uses a drill and small files to thoroughly clean and shape the root canals to rid the canals of bacteria, pus and debris. The root canals may need to be shaped or hollowed out to ensure a smooth interior surface.
• The interior of the tooth is flushed with cleaning liquids and then dried.
• If infection is still present, the tooth is packed with special medications and sealed with a temporary filling. You may have to wait a few weeks, or even months, before the pulp canal is filled. If the dentist feels bacteria are still present at your next appointment, the cleaning procedure may be repeated and the tooth once again packed with medication. This stage will continue until the dentist feels the tooth is free from bacteria.
• The infection-free root canal is packed with a permanent filling made of various materials. This is usually a rubber-based material called ‘gutta percha’.
• The artificial biting surface of the tooth is fashioned out of regular filling material.
• In severe cases where considerable amounts of dentine are removed, the dentist may fit the tooth with a gold or porcelain crown to help prevent breakage or cracking.

Cosmetic issues

A tooth with a healthy pulp is yellowish-white in colour. A pulp-free tooth may, in time, turn grey. The dentist can advise you on appropriate cosmetic dentistry procedures.

All dentists can perform endodontic treatment

All dentists are trained to carry out endodontic treatment. Some dentists will refer complicated and emergency cases to an endodontist. Endodontists are dentists who are specialists in root canal treatment.

If specialist care is needed, your dentist will discuss this with you. If you would like a specialist opinion, ask your dentist for a referral to an endodontist.

 

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