Dr. S.R. Kataria DDS Prosthodontics, Cosmetics and Implant Dentistry

Root Canal

From Wikipedia, the free encyclopedia
http://en.wikipedia.org/wiki/Root_canal

Root canals are the long passages full of soft tissue deep within the dentin of a tooth, adjoined the pulp chamber. In dentistry, a pulpectomy is an endodontic treatment to cure an infection of the root canal; informally a root canal. A root canal, coupled with internal tooth bleaching, is also used to fix teeth that have blackened due to infiltration of decayed soft tissue into the dentin in the teeth, most often seen in frontal incisors that have been injured through a sudden impact.

Tooth structure

At the center of a tooth is a hollow area that houses soft tissue, known as pulp. This hollow area contains a relatively wide space towards the chewing surface of the tooth called the pulp chamber. This pulp chamber is connected to the tip of the root of the tooth via thin hollow pipe-like canals—hence, the term "root canal". Human teeth normally have one to four canals; teeth toward the back have the most canals. These canals run through the centre of the roots like pencil lead runs through the length of a pencil. The tooth receives nutrition through the blood vessels and nerves traversing these canals. Occasionally, a cavity on the outside of the tooth may allow this soft tissue to become infected. If left untreated a serious jaw infection can result. The infection and inflammation is very painful in most cases. Ideally treatment should take place before this happens.

Root canal treatment

Sometimes a tooth is considered so threatened (due to internal cracking etc) that future infection is considered likely or inevitable, and a pulpectomy is advisable to prevent it. But usually some inflammation and/or infection is already present, within or below the tooth. To cure the infection and save the tooth, it is necessary for the dentist to drill into the pulp chamber, and remove the infected pulp by scraping it out of the root canals. Once that is done, the dentist fills the cavity with an inert material and seals up the opening. This procedure is known as root canal therapy. If enough of the tooth has been damaged, or removed as a result of the treatment, a crown may be required.

The standard filling material is Gutta-percha, a thermoplastic polymer of isoprene, which is melted and injected to fill the root canal passages. Barium is added to the isoprene so the material will be opaque to X-rays, allowing verification afterwards that the passages have been properly completely filled in, without voids.

For patients, root canal therapy is one of the most feared procedures in all of dentistry; contrary to popular belief, however, modern root canal treatment may be relatively painless due to effective pain control techniques. Lidocaine is a commonly used local anesthetic. Pain control medication may be used either before or after treatment. However, in some cases it may be very difficult to achieve pain control prior to performing a root canal. For example, if a patient has an abscessed tooth, with a swollen area or "fluid-filled gum blister" next to the tooth, the pus in the abscess may contain acids that inactivate any anesthetic injected around the tooth. In this case, it is best for the dentist to drain the abscess by cutting it to let the pus drain out. Releasing the pus releases pressure built up around the tooth; this pressure causes much pain. The dentist then prescribes a week of antibiotics such as penicillin, which will reduce the infection and pus, making it easier to anesthetize the tooth when the patient returns one week later. The dentist could also open up the tooth and let the pus drain through the tooth, and could leave the tooth open for a few days to help relieve pressure. At this first visit, the dentist must ensure that the patient is not biting into the tooth, which could also trigger pain. Sometimes the dentist performs preliminary treatment of the tooth by removing all of the infected pulp of the tooth and applying a dressing and temporary filling to the tooth. This is called a "pulpectomy." The dentist may also remove just the coronal portion of the dental pulp, which contains 90% of the nerve tissue, and leave intact the pulp in the canals. This procedure, called a "pulpotomy," tends to essentially eliminate all the pain. A "pulpotomy" may be a relatively definitive treatment for infected primary teeth. The pulpectomy and pulpotomy procedures eliminate most all pain until the follow-up visit for finishing the root canal. But if the pain returns, it means any of three things: the patient is biting into the tooth, there is still a significant amount of sensitive nerve material left in the tooth, or there is still more pus building up inside and around the infected tooth. All of these cause pain.

After removing as much of the internal pulp as possible, the root canals can be temporarily filled with calcium hydroxide paste. This strong alkaline base is left in for a week or more to disinfect and reduce inflammation in surrounding tissue.[1] Ibuprofen taken orally is commonly used before and/or after these procedures to reduce inflammation.

After receiving a root canal, the tooth should be protected with a crown that covers the cusps of the tooth. Otherwise, over the years the tooth will almost certainly fracture, since root canals remove tooth structure from the tooth and undermine the tooth's structural integrity. Also, root canal teeth tend to be more brittle than teeth not treated with a root canal. Placement of a crown or cusp-protecting cast gold covering is recommended also because these have the best ability to seal the root canaled tooth. If the tooth is not perfectly sealed, the root canal may leak, causing eventual failure of the root canal.

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