March 12, 2013
Tags: dentist, london dentist, nhs, whitening, inman aligner, cosmetic dentist, checkup, dental, anish, anish dentist, london hygienist, dental hygiene, root canal.
Decay left untreated can progress to irreversibly damage the nerves of teeth and cause infection. The infection will not go away with antibiotics or a simple filling, and a little more has to be done to remove the decay in the roots of the tooth.
Root canal treatment aims to clean the inside of the tooth and fill the resultant void, by doing so we can prevent further infection. In some cases we can root canal teeth that have developed into an abscess,however the success rates are decreased if they have.
Whatever the cause you must seek advice to have the area drained and relieve the swelling. We will normally try and drain the swelling from inside the tooth. Occasioanlly, if extensive, we will make a small incision into the affected area to drain the swelling directly. Once drained and the pressure is releived, the pain associated with often go away as well.
The most common causes of pulpal inflammation (pulpitis) and root infection (periapcial periodontitis) is extensive decay of the tooth. The decay once deep enough, will eventually enter the pulp (nerves and blood vessels) of the tooth. Here, they cause a local inflammatory reaction breaking down the pulp, which when allowed to continue causes pressure to build-up inside the tooth. It is this pressure exerted on the nerves of the tooth that causes the characteristic dental pain. Once the decay has reached the pulp, a simple filling will no longer help. We need to clean and shape the inside of the roots to prevent recurrent infection.
The swelling inside your mouth is due to the infection spreading outside the tooth, and into the bone and gums. If the infection has somewhere to exit (e.g gum boil) it has a point of release and it is likely you will not feel alot of discomfort, apart from a foul taste in you mouth. If the infection is contained, pressure builds up, and you will experience varying symptoms associated with a localised infection.
The less common cause is severe gum disease. Severe gum disease leads to bone loss around the tooth, and bacteria can enter along the sides of the tooth and in via the root tips, with similar consquences as above.
Even though it may sound scary, I assure you that it involves many of the steps of a normal filling. You will be completely numb, and will not feel a thing. It is done at the practice many times a week and is a perfected routine procedure. Root canal treatment can be done over a longer 1 visit or two separate appointments.
1st Visit- 30-45 Minutes (Less time for front teeth and more for back)
1. We will place numbing gel where we plan to place the anaesthetic, so you are less likely to feel the small pinch. We then wait a minimum of 10 minutes for it to work.
2. While we wait- We may be busy around you getting the rubber guard ready to place over your tooth. This protects you from swallowing any material we use and makes for a clean, infection free environment for us to work in.
3. Only when you feel ready do we proceed. I will check that you feel numb by asking you and sometimes checking that one side of your tongue and lower lip have lost sensation.
4. We start to remove the decay from the top part of the tooth and the root canal. You will see us stop occasionally and wash the tooth out with disinfectant.
5. Once cleaned we will switch to our small instrument to clean right down to the bottom of the tooth roots. If having NHS root treatment we will use hand files, and a rotary drill for Private Root canal treatment.
6. The next step is to take an x-ray of the tooth and check how long the roots are. You will see me measuring with a small ruler and placing mini instrument inside the tooth before we take the x-ray.
7. The next step is place antibiotic and anti-inflammatory paste inside the root and place a temporary filling on-top. We then wait at least a week for everything to settle down.
2nd Visit (30-45min (Less time for front teeth and more for back)
1. The same applies for this visit and we will place numbing gel followed by the anaesthetic. We will then wait until you are ready to proceed.
2. The temporary filling will be removed along with the paste that we place inside. We will clean the tooth again with same disinfectant used last visit.
3. The root canals will be shaped and cleaned with small instruments (again depending on option taken NHS or private- please ask me if you are unsure which option is better for you by emailing me directly).
4. The roots are dried and filled with multiple rubber points (NHS) or one exactly matched point (Private) and sealed. This will prevent any infection from getting down the root canal.
5. The tooth can then be filled with a simple filling (metal or white) or a crown if advised by myself.
This may look overwhelming, however root canal treatment is a routine procedure and done many times a week. A lot of the steps above are done simultaneously without you knowing! As mentioned above we can sometimes compress these two sessions into one!
After root canal treatment, your lips and gums may remain numb for a few hours until the anesthetic wears off. Later you may have throbbing pain, which you can treat with pain medicines, such as ibuprofen, paracetamol, or a stronger prescription painkiller with supplemental antibiotics. The pain usually lasts only a day or two.
The major risk of not having treatment is progression of the swelling and infection to areas that may restrict swallowing and breathing. Therefore, no matter how large or small it is important you have a medical professional check it and treat urgently.
With any root canal procedure there are associated risks, albeit small and unlikely, it is something everyone should know. They include: prolonged numbness and altered sensation, fracture of the tooth or instruments, recurrent infections despite treatment, jaw ache (due to keeping mouth open for a long time), and extraction of tooth is root canal fails.
Once the swelling and infection is controlled you can have the tooth extracted if you wish. Removing the source of infection (the tooth) will have the same effect as root treatment. The obvious difference is the lack of tooth to chew with, aswell as the remaining teeth tilting and shifting and moving into the space left.
After a tooth has been root filled it becomes brittle, and is more prone to breaking. A crown is advised to protect the tooth from this by surrounding all remaining cusps and holding the crown together. Crowns are also better at preventing re-infection from bacteria than a conventional filling.
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