Information about root canal therapy

Some background information

Dr William Myers

Years ago, diseased or damaged teeth were almost always removed. Today, modern dental techniques often make it possible to save the damaged teeth. One of the most common techniques is Root Canal Therapy, or in dental terminology, endodontic treatment.
 Root canal therapy is generally necessary when the pulp, which contains the nerves and blood supply of the tooth, is diseased or damaged. This may be caused by a number of situations. For example, bacteria from a deep cavity can enter the pulp and cause infection. Or the tooth may be injured in such a way that the blood supply is ruptured or the nerve damaged. A third possibility is a fracture of the tooth itself, which exposes the pulp to bacteria normally found in the mouth. Severe gum (periodontal) disease can cause infection of the pulp too. All of these conditions can cause severe toothache or deterioration of the pulp may happen so gradually that it is nearly painless. In any event, when this situation exists the tooth should be treated by root canal therapy or it will be lost.

What is involved in root canal therapy?
The first step is to remove the pulp tissue and carefully clean the pulp chamber and root canals. This is done through a small opening in the crown of the tooth. (If you are experiencing severe pain from the tooth, this will usually provide dramatic relief).  

Root canal therapy is generally necessary when the pulp, which contains the nerves and blood supply of the tooth, is diseased or damaged.

Once the area has been cleaned, medicine is then placed in the tooth and it is temporarily sealed. However if a severe infection is present your dentist may leave the tooth open for a few days to promote drainage. He may also choose to prescribe an antibiotic to help control the infection. If a cyst or large area of infection is present at the tip of the root, it may be necessary to remove it surgically. This is called periapical surgery (or an apicoectomy) and is done through the gum. The treatment program usually takes between two and five appointments. When the dentist is certain that the tooth is free of infection, he will fill and seal the canals and pulp chamber with a material, which will prevent bacteria from reentering the tooth. Then the outer portion of the tooth must be restored. However it may first be necessary to strengthen the tooth with a "post and core" buildup. Then the crown of the tooth will be restored with a plastic filling, gold inlay, or a porcelain or gold crown.

Will the treatment be painful?
Many of the procedures can be done without local anesthesia. However, if your dentist anticipates any discomfort, a local anesthetic will be given. Sometimes there may be temporary irritation of the tissues surrounding the tooth following treatment. This is usually so slight that it can be controlled with a simple remedy such as aspirin. Should you develop any severe swelling, or increasing pain, you should contact your dentist at once.

Is it expensive?
The cost of root canal therapy and filling is usually less than the cost of removing the tooth and replacing it with an artificial one. Also no replacement will ever be as satisfactory as your natural tooth. The fee is usually determined by the complexity of the condition and the number of root canals involved. Restoring the crown after treatment is not usually included in the root canal therapy fee.
 
Why do I need a dental exam?
Your dentist performs a dental exam to gather information about your oral health. Checking for dental decay is only a small part of a complete oral exam. Your dentist checks for gum disease and also examines the health of your entire mouth surrounding soft tissues, which includes checking for such things as pre-cancerous or cancerous lesions; oral sores or irritations to gum tissue; fit of dentures or bridges and proper bite. Medical and dental histories are usually obtained, along with diagnostic information from X-rays, laboratory test or other tests.

Oral health is integrally connected with your general health. Check-ups are important because some diseases or medical conditions have signs that can appear in the mouth.  Diabetes, nutritional and vitamin deficiencies and hormonal irregularities are some examples. The extent of the exam you'll receive depends upon the number of factors. If you're a new patient for example, you'll receive much more thorough exam than if you've recently been to the dentist and are returning to have a specific dental condition checked.

I've heard about a new screening for gum disease. What is it?
Periodontal Screening or Periodontal charting is a simple new screening that helps your dentist "keep score" of your gum health. It is designed for early detection of gum disease. Because periodontal disease is a major cause of tooth loss in adults, early detection is important. Using a special periodontal probe screens the mouth. The rounded tip of the probe is gently inserted between the tooth and the gum to measure the depth of the tissue at this spot.

This measurement helps the dentist to assess the health of the gums. A series of six codes or scores for the six sections of the upper and lower teeth are assigned following the screening. The dentist can then determine whether or not a more complete periodontal exam is needed.  

What is periodontal disease?
Almost half of American adults have some form of periodontal disease. However the majority of these people do not even realize they have it. Periodontal disease (also known as gum and bone disease) is a bacterial infection of the gums, bone and periodontal ligament (attachment fibres that support the teeth and hold them in the jaw). Periodontal disease is usually painless and silent, until its advanced stages. If left untreated, symptoms can include:

Persistent bad breath Gums that bleed when you brush your teeth
Red, swollen and tender gums n    Gums that have pulled away from the teeth
Loose or separating teeth
Pus between the gum and tooth
A change in the way your teeth fit together when you bite
Periodontal disease can be diagnosed and treated by your dentist and/or periodontist. A periodontist is a specialist with advanced training in the prevention, diagnosis and treatment of diseases affecting the gums and supporting structures of the teeth.
Why should I be aware of the link between heart disease and periodontal disease?
 Healthy hearts and healthy gums play vital roles in maintaining a healthy body. Because periodontal disease is a bacterial infection, periodontal bacteria can enter the blood stream and travel to major organs and begin new infections. The heart is one of the most susceptible organs.  

Heart disease (or cardiovascular disease) affects more than 60 million Americans. It is the leading cause of death in the United States. Yet many types of heart disease may be prevented. Taking care of your periodontal health may be one important step toward prevention, along with controlling the well-known risk factors for heart disease.

How does periodontal disease increase my risk of heart disease?
Several theories exist to explain the link between periodontal disease and heart disease. One theory is that oral bacteria can affect the heart when they enter the blood stream, attaching to fatty plaques in the coronary arteries (heart blood vessels) and contributing to clot formation. Coronary artery disease is characterized by a thickening of the walls of the coronary arteries due to the buildup of fatty proteins. Blood clots can obstruct normal blood flow, restricting the amount of nutrients and oxygen required for the heart to function properly. This may lead to heart attacks.

What precautions should be taken before dental treatments?
 Periodontal disease can affect the heart in other ways. Some existing heart conditions can put people at risk for infective endocarditis. Infective endocarditis is characterized by inflammation of the lining of the heart and heart valves. Those patients with a history of rheumatic fever, mitral valve prolapse or heart murmur may require antibiotics prior to dental procedures. Your periodontist and cardiologist will be able to determine if your heart condition requires use of antibiotics prior to dental appointments.

The American Heart Association has identified guidelines to help protect patients most at risk for infective endocarditis. These people may be especially prone to problems with their heart following a dental procedure. If you are at risk for infective endocarditis, your dentist and/or periodontist may take steps to help limit the entry of bacteria into the blood stream during dental procedures, including:

Treatment of any existing periodontal infection
Prescribing antibiotics prior to the procedure
Asking you to make more regular maintenance visits
Helping you to prevent periodontal disease by reviewing proper home care for your teeth
If you know that you have heart disease or currently receive treatment for a cardiovascular complication, it is especially important for you to have good periodontal health. See your dentist for a periodontal evaluation. Periodontal disease also has been linked to other significant health problems, including respiratory diseases, diabetes, osteoporosis and premature and underweight births. It is very important that you always provide your dentist with a comprehensive and accurate medical history, including any problems you are aware of with your heart. Your dentist and physician can work together to help you protect both your gums and your overall health. As former Surgeon General C. Everett Koop said, "A person is not healthy without good oral health."

Risks for heart disease include smoking, being overweight and having high cholesterol or high blood pressure levels. Now evidence is mounting that suggests having periodontal disease may increase your risk for heart disease. For example, recent studies suggest that people with periodontal disease may have nearly twice the risk of having a fatal heart attack as those without periodontal disease.

What to expect from dentures?
Dentures are not as satisfactory as one’s natural teeth. They rest on top of the jawbone as opposed to being anchored into the jaw like natural teeth. One of the primary objectives of dentures is to preserve the supporting tissues within physiologic limitations. The majority of patients do not know what to expect from dentures. Unfortunately, well-wishing friends may tell the patient, "My dentures are as good as or better than my natural teeth, and I've never had a minute's trouble." Although this is possible, it is usually not true. As a result, a disappointed patient must learn for himself what he may realistically expect.

  Patients rarely expect to see with an artificial eye or to have natural use of an artificial hand or leg, yet they frequently expect the artificial teeth to duplicate the natural teeth in form and function. Dentists have contributed to this mistaken belief. The dentist should neither oversimplify nor over-complicate the procedure. He should be frank and honest in evaluating the situation and instructing the patient. Dentures are artificial substitutes and have limitations. It is perfectly normal to feel awkward with new dentures. The appearance has undergone a slight change; speech may seem altered and a feeling of mouth fullness may be present. Time, patience, and cooperation in following instructions will bring about a relaxation of the muscles of the lips, tongue, and cheeks. Eventually the slight change in appearance becomes a pleasant change; Speech will be normal, and eating will be less difficult.
 
What do implants have to offer?
 Whether you have full or partial dentures or have recently lost a tooth, implants may be an option for you. Implants attach artificial teeth directly to the jaw. There are three components of an implant: the anchor, which may be surgically embedded into the bone, a post to which the tooth attaches and the artificial tooth. Implants can replace one or more teeth, provide support for a denture, or are used to attach a full denture. Implants are not an option for everyone. Because implants require extensive surgery, patients must be in good health, have healthy gums, have adequate bone to support the implant and be committed to meticulous oral hygiene and regular dental visits.

How do I know if implants are right for me?
If you are considering implants, a thorough evaluation by your dentist will help determine if you would be a good candidate. This evaluation includes a clinical examination and a complete dental and medical history to gather information about any dental or medical conditions that you have, such as diabetes, heart problems or any condition that interferes with normal healing. Be sure to tell the dentist about allergies you have or any prescription or over-the-counter medications that you take. If necessary, the dentist may request a consultation with a physician.
During the dental examination, the dentist will check the condition of your mouth, the supporting bone in your jaws and the way your upper and lower teeth fit together. The dentist may gather additional information by taking X-rays and by making models (cast) of your teeth. This information will help your dentist determine if you are a good candidate for an implant and decide which implant to use and exactly where to place it.

What is involved in placing implants?
 Implants cost significantly more than dentures or bridges and require a considerable investment of time. The implant process involves several steps and may take up to nine months to complete.  First surgery is preformed to place the anchor. Surgery can take up to several hours and up to six months may be required for the bone to grow around the anchor and firmly hold it in place. Some implants require a second surgery in which a post is attached to connect the anchor to the replacement teeth. With other implants, the anchor and post are already attached and are placed at the same time.  After the gums have had several weeks to heal, the next step is begun. The restorative teeth are made and fitted to the post portion of the anchor. Because several fittings may be required, this step can take one or two months to complete.
 Implant surgery can be done in either a dental office or in a hospital, depending upon the type of implant, the patient's health and the dentist's preference. A local or general anesthetic may be used. Usually pain medications and, when necessary, antibiotics are prescribed. Your dentist will give you careful instruction on diet and oral hygiene.

What are the benefits and risks?
 Implants provide artificial teeth that look more natural. Many people also report that when they chew, the implants feel more secure than natural teeth. People who cannot successfully use conventional dentures may be candidates for implants.
Sometimes using implants can cause "stress" to the bones in the jaw. If bone loss occurs as a result, the implant may loosen. If the implant fails and needs to be replaced with a conventional denture, there may be problems in getting the denture to fit. Other possible complications include improper alignment, cosmetic problems, implant break-down, inadequate healing or damage to the adjacent teeth.

Ask us about white fillings?
Composites are fillings that are designed to match the color of your teeth. They may be used to restore a decayed tooth or repair a defect. A composite can be prepared and placed in one visit. After the decayed part of the tooth is removed, the dentist uses a very mild acid solution to "etch" the tooth surface. A bonding agent is brushed onto the prepared tooth. The dentist then applies several thin layers of the tooth-colored composite. Once the composite filling is placed, the material is chemically hardened, or cured with a special light, and polished.

Information about root canal therapy

Some background information

Dr William Myers Years ago, diseased or damaged teeth were almost always removed. Today, modern dental techniques often make it possible to save the damaged teeth. One of the most common techniques is Root Canal Therapy, or in dental terminology, endodontic treatment. Root canal therapy is generally necessary when the pulp, which contains the nerves and blood supply of the tooth, is diseased or damaged. This may be caused by a number of situations. For example, bacteria from a deep cavity can enter the pulp and cause infection. Or the tooth may be injured in such a way that the blood supply is ruptured or the nerve damaged. A third possibility is a fracture of the tooth itself, which exposes the pulp to bacteria normally found in the mouth. Severe gum (periodontal) disease can cause infection of the pulp too. All of these conditions can cause severe toothache or deterioration of the pulp may happen so gradually that it is nearly painless. In any event, when this situation exists the tooth should be treated by root canal therapy or it will be lost. What is involved in root canal therapy? The first step is to remove the pulp tissue and carefully clean the pulp chamber and root canals. This is done through a small opening in the crown of the tooth. (If you are experiencing severe pain from the tooth, this will usually provide dramatic relief). Root canal therapy is generally necessary when the pulp, which contains the nerves and blood supply of the tooth, is diseased or damaged. Once the area has been cleaned, medicine is then placed in the tooth and it is temporarily sealed. However if a severe infection is present your dentist may leave the tooth open for a few days to promote drainage. He may also choose to prescribe an antibiotic to help control the infection. If a cyst or large area of infection is present at the tip of the root, it may be necessary to remove it surgically. This is called periapical surgery (or an apicoectomy) and is done through the gum. The treatment program usually takes between two and five appointments. When the dentist is certain that the tooth is free of infection, he will fill and seal the canals and pulp chamber with a material, which will prevent bacteria from reentering the tooth. Then the outer portion of the tooth must be restored. However it may first be necessary to strengthen the tooth with a post and core buildup. Then the crown of the tooth will be restored with a plastic filling, gold inlay, or a porcelain or gold crown. Will the treatment be painful? Many of the procedures can be done without local anesthesia. However, if your dentist anticipates any discomfort, a local anesthetic will be given. Sometimes there may be temporary irritation of the tissues surrounding the tooth following treatment. This is usually so slight that it can be controlled with a simple remedy such as aspirin. Should you develop any severe swelling, or increasing pain, you should contact your dentist at once. Is it expensive? The cost of root canal therapy and filling is usually less than the cost of removing the tooth and replacing it with an artificial one. Also no replacement will ever be as satisfactory as your natural tooth. The fee is usually determined by the complexity of the condition and the number of root canals involved. Restoring the crown after treatment is not usually included in the root canal therapy fee. Why do I need a dental exam? Your dentist performs a dental exam to gather information about your oral health. Checking for dental decay is only a small part of a complete oral exam. Your dentist checks for gum disease and also examines the health of your entire mouth surrounding soft tissues, which includes checking for such things as pre-cancerous or cancerous lesions; oral sores or irritations to gum tissue; fit of dentures or bridges and proper bite. Medical and dental histories are usually obtained, along with diagnostic information from X-rays, laboratory test or other tests. Oral health is integrally connected with your general health. Check-ups are important because some diseases or medical conditions have signs that can appear in the mouth. Diabetes, nutritional and vitamin deficiencies and hormonal irregularities are some examples. The extent of the exam youll receive depends upon the number of factors. If youre a new patient for example, youll receive much more thorough exam than if youve recently been to the dentist and are returning to have a specific dental condition checked. Ive heard about a new screening for gum disease. What is it? Periodontal Screening or Periodontal charting is a simple new screening that helps your dentist keep score of your gum health. It is designed for early detection of gum disease. Because periodontal disease is a major cause of tooth loss in adults, early detection is important. Using a special periodontal probe screens the mouth. The rounded tip of the probe is gently inserted between the tooth and the gum to measure the depth of the tissue at this spot. This measurement helps the dentist to assess the health of the gums. A series of six codes or scores for the six sections of the upper and lower teeth are assigned following the screening. The dentist can then determine whether or not a more complete periodontal exam is needed. What is periodontal disease? Almost half of American adults have some form of periodontal disease. However the majority of these people do not even realize they have it. Periodontal disease (also known as gum and bone disease) is a bacterial infection of the gums, bone and periodontal ligament (attachment fibres that support the teeth and hold them in the jaw). Periodontal disease is usually painless and silent, until its advanced stages. If left untreated, symptoms can include: Persistent bad breath Gums that bleed when you brush your teeth Red, swollen and tender gums n Gums that have pulled away from the teeth Loose or separating teeth Pus between the gum and tooth A change in the way your teeth fit together when you bite Periodontal disease can be diagnosed and treated by your dentist and/or periodontist. A periodontist is a specialist with advanced training in the prevention, diagnosis and treatment of diseases affecting the gums and supporting structures of the teeth. Why should I be aware of the link between heart disease and periodontal disease? Healthy hearts and healthy gums play vital roles in maintaining a healthy body. Because periodontal disease is a bacterial infection, periodontal bacteria can enter the blood stream and travel to major organs and begin new infections. The heart is one of the most susceptible organs. Heart disease (or cardiovascular disease) affects more than 60 million Americans. It is the leading cause of death in the United States. Yet many types of heart disease may be prevented. Taking care of your periodontal health may be one important step toward prevention, along with controlling the well-known risk factors for heart disease. How does periodontal disease increase my risk of heart disease? Several theories exist to explain the link between periodontal disease and heart disease. One theory is that oral bacteria can affect the heart when they enter the blood stream, attaching to fatty plaques in the coronary arteries (heart blood vessels) and contributing to clot formation. Coronary artery disease is characterized by a thickening of the walls of the coronary arteries due to the buildup of fatty proteins. Blood clots can obstruct normal blood flow, restricting the amount of nutrients and oxygen required for the heart to function properly. This may lead to heart attacks. What precautions should be taken before dental treatments? Periodontal disease can affect the heart in other ways. Some existing heart conditions can put people at risk for infective endocarditis. Infective endocarditis is characterized by inflammation of the lining of the heart and heart valves. Those patients with a history of rheumatic fever, mitral valve prolapse or heart murmur may require antibiotics prior to dental procedures. Your periodontist and cardiologist will be able to determine if your heart condition requires use of antibiotics prior to dental appointments. The American Heart Association has identified guidelines to help protect patients most at risk for infective endocarditis. These people may be especially prone to problems with their heart following a dental procedure. If you are at risk for infective endocarditis, your dentist and/or periodontist may take steps to help limit the entry of bacteria into the blood stream during dental procedures, including: Treatment of any existing periodontal infection Prescribing antibiotics prior to the procedure Asking you to make more regular maintenance visits Helping you to prevent periodontal disease by reviewing proper home care for your teeth If you know that you have heart disease or currently receive treatment for a cardiovascular complication, it is especially important for you to have good periodontal health. See your dentist for a periodontal evaluation. Periodontal disease also has been linked to other significant health problems, including respiratory diseases, diabetes, osteoporosis and premature and underweight births. It is very important that you always provide your dentist with a comprehensive and accurate medical history, including any problems you are aware of with your heart. Your dentist and physician can work together to help you protect both your gums and your overall health. As former Surgeon General C. Everett Koop said, A person is not healthy without good oral health. Risks for heart disease include smoking, being overweight and having high cholesterol or high blood pressure levels. Now evidence is mounting that suggests having periodontal disease may increase your risk for heart disease. For example, recent studies suggest that people with periodontal disease may have nearly twice the risk of having a fatal heart attack as those without periodontal disease. What to expect from dentures? Dentures are not as satisfactory as ones natural teeth. They rest on top of the jawbone as opposed to being anchored into the jaw like natural teeth. One of the primary objectives of dentures is to preserve the supporting tissues within physiologic limitations. The majority of patients do not know what to expect from dentures. Unfortunately, well-wishing friends may tell the patient, My dentures are as good as or better than my natural teeth, and Ive never had a minutes trouble. Although this is possible, it is usually not true. As a result, a disappointed patient must learn for himself what he may realistically expect. Patients rarely expect to see with an artificial eye or to have natural use of an artificial hand or leg, yet they frequently expect the artificial teeth to duplicate the natural teeth in form and function. Dentists have contributed to this mistaken belief. The dentist should neither oversimplify nor over-complicate the procedure. He should be frank and honest in evaluating the situation and instructing the patient. Dentures are artificial substitutes and have limitations. It is perfectly normal to feel awkward with new dentures. The appearance has undergone a slight change; speech may seem altered and a feeling of mouth fullness may be present. Time, patience, and cooperation in following instructions will bring about a relaxation of the muscles of the lips, tongue, and cheeks. Eventually the slight change in appearance becomes a pleasant change; Speech will be normal, and eating will be less difficult. What do implants have to offer? Whether you have full or partial dentures or have recently lost a tooth, implants may be an option for you. Implants attach artificial teeth directly to the jaw. There are three components of an implant: the anchor, which may be surgically embedded into the bone, a post to which the tooth attaches and the artificial tooth. Implants can replace one or more teeth, provide support for a denture, or are used to attach a full denture. Implants are not an option for everyone. Because implants require extensive surgery, patients must be in good health, have healthy gums, have adequate bone to support the implant and be committed to meticulous oral hygiene and regular dental visits. How do I know if implants are right for me? If you are considering implants, a thorough evaluation by your dentist will help determine if you would be a good candidate. This evaluation includes a clinical examination and a complete dental and medical history to gather information about any dental or medical conditions that you have, such as diabetes, heart problems or any condition that interferes with normal healing. Be sure to tell the dentist about allergies you have or any prescription or over-the-counter medications that you take. If necessary, the dentist may request a consultation with a physician. During the dental examination, the dentist will check the condition of your mouth, the supporting bone in your jaws and the way your upper and lower teeth fit together. The dentist may gather additional information by taking X-rays and by making models (cast) of your teeth. This information will help your dentist determine if you are a good candidate for an implant and decide which implant to use and exactly where to place it. What is involved in placing implants? Implants cost significantly more than dentures or bridges and require a considerable investment of time. The implant process involves several steps and may take up to nine months to complete. First surgery is preformed to place the anchor. Surgery can take up to several hours and up to six months may be required for the bone to grow around the anchor and firmly hold it in place. Some implants require a second surgery in which a post is attached to connect the anchor to the replacement teeth. With other implants, the anchor and post are already attached and are placed at the same time. After the gums have had several weeks to heal, the next step is begun. The restorative teeth are made and fitted to the post portion of the anchor. Because several fittings may be required, this step can take one or two months to complete. Implant surgery can be done in either a dental office or in a hospital, depending upon the type of implant, the patients health and the dentists preference. A local or general anesthetic may be used. Usually pain medications and, when necessary, antibiotics are prescribed. Your dentist will give you careful instruction on diet and oral hygiene. What are the benefits and risks? Implants provide artificial teeth that look more natural. Many people also report that when they chew, the implants feel more secure than natural teeth. People who cannot successfully use conventional dentures may be candidates for implants. Sometimes using implants can cause stress to the bones in the jaw. If bone loss occurs as a result, the implant may loosen. If the implant fails and needs to be replaced with a conventional denture, there may be problems in getting the denture to fit. Other possible complications include improper alignment, cosmetic problems, implant break-down, inadequate healing or damage to the adjacent teeth. Ask us about white fillings? Composites are fillings that are designed to match the color of your teeth. They may be used to restore a decayed tooth or repair a defect. A composite can be prepared and placed in one visit. After the decayed part of the tooth is removed, the dentist uses a very mild acid solution to etch the tooth surface. A bonding agent is brushed onto the prepared tooth. The dentist then applies several thin layers of the tooth-colored composite. Once the composite filling is placed, the material is chemically hardened, or cured with a special light, and polished.