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ROOT CANAL: Why is it so common and can it be avoided?

“You need a root canal for the tooth”

A statement said and heard too often at a dental clinic.

Root canals are so common at a dental clinic that people believe that dentistry is all about filling teeth, root canals or removal of teeth if the above two cannot be done.

Although this couldn’t be more further from the truth, it is considered so because dental cavities are the second most disease on the planet after common cold.

Why are root canals so common?

Well, anyone who has a cavity is a potential patient for root canal treatment.

It starts with a small black discoloration and if ignored (which it generally is, as there are no symptoms at this time), it gradually progresses deeper and deeper into the tooth, finally reaching the innermost and the living portion of the tooth, known as the pulp.

Thus, although very common, for the most part, root canals are required because the small black spot that formed on your tooth was ignored.

When would I require a root canal?

Root canal is required when the bacteria causing the cavity reach the innermost layer of the tooth known as pulp. This layer is very rich in blood supply and nerves. Once the bacteria reach this layer they cause swelling, resulting in pain which especially increases while lying down in the initial phase.

The ways that are used to determine that you need a root canal treatment for your tooth involve

·         A detailed history about the symptoms: The type of pain, triggering factors of pain and the presence of a swelling help in determining if the pulp is involved.

·         An x-ray: A small x-ray involving the region is used to determine the extent bacteria have caused damage.

The other reasons requiring a root canal could be

·         Improper brushing technique

·         Severely misaligned teeth

·         Broken tooth due to a fall or a hit

When should a root canal be done?

You would generally approach the dentist when there is tooth pain/swelling. During this phase there is an active infection in the tooth.

IT is advised NOT to start the root canal treatment at this time.

The active infection causing the pain/swelling needs to be brought under control by proper medication before any treatment is started.

It is so because

·         Drilling of the tooth that is required to create an access for the root canal would be extremely painful.

·         Any surgical process during full blown infection will increase the bacterial count in the blood which might not be compensated by the body immunity, resulting in various illnesses including infection of the heart valves.

·         The anaesthesia isn’t effective in relieving pain while there is a swelling as the pus in the swelling chemically inactivates the anaesthesia.

Thus, getting a root canal while you have a swelling it would be extremely painful and has potential risks.

The first step when you have a tooth pain is to get it evaluated and get the complete proper prescription and medication to combat the infection.

Only after the infection is under control and the tooth is evaluated for the treatment of root canal should the process be undertaken.

If you do not have an active infection, or the root canal has been advised for reasons other than a tooth cavity the process can be started immediately without any antibiotics.

 What is a root canal?

It is a process of removing all the dead tissue and bacteria from inside the tooth while maintaining the framework of the tooth so that it functions adequately for chewing food.

Root canal involves the following steps

1.      Access to the pulp inside the tooth: This is the first step and involves drilling so the cavity (the black area of the infected tooth) is removed. The drilling is continued further till the canals (small chambers where the pulp is present) is reached

2.      Removing the bacteria and the dead pulp tissue:  Once the bacteria enters the pulp, it causes it to swell and finally kills the tissue. The next step involves removal of this tissue. The removal is done both mechanically (by using small stainless steel instruments) called files and chemically (by a biocompatible bleaching agent) in order to effectively remove the bacteria and dead tissue from even the smallest crevices. This is the most important step of root canal and if not done properly can lead to failure and re-treatment.

3.      Filling of the canal: After effective mechanical and chemical cleaning of the canal, it is filled with a rubber based material called Gutta Percha. This material provides a seal to the canal and disconnects it from the underlying bone, thus preventing future infections.

4.      Build up: As an extensive amount of tooth structure is lost due to the cavity and the drilling, a build-up is required over the Gutta Percha filling in order to reinforce the lost tooth structure.

 

How long would a root canal survive?

 A good root canal with a proper crown should survive a minimum of 10 years or longer.

Do I ALWAYS need a crown after a root canal?

Although not ALWAYS, a crown after a root canal is generally recommended. The reason is the extensive loss of tooth structure. A crown over a build-up is important in providing structural strength to the root canal treated tooth so that it performs the functions similar to a normal healthy tooth.

Avoiding a crown over a root canal treated tooth can result in its fracture and then depending on the line of fracture would require either extensive reinforcement using a post and core or the extraction of the tooth.  

Can a root canal be avoided?

Generally, a root canal is planned only when it is evident that the pulp (the living and the innermost layer of the tooth) has been irreversibly damaged.

In borderline cases where the cavity might be extremely close to the pulp but isn’t involving the pulp another procedure, which involves placement of medicines at this area to improve the calicification is undertaken.

This procedure preserves the tooth as a living structure as the nerves and the blood vessels inside the tooth are left intact.

Root canal is generally undertaken when there is irreversible damage and thus no medication (as of now) can be used to reverse and regrow the nerves and the blood vessels inside the tooth

Is removing a tooth and replacing it with a bridge/implant better than a root canal?

Root canal and an implant or bridge are two separate procedures. They cannot be interchanged and the treatment option suited depends on multiple factors like the amount of tooth affected by cavity and the health of the surrounding bone.

A proper and complete evaluation of the tooth and its surrounding structures is required before starting a root canal for its success.

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