root canal treatment


Root Canal Treatment

 

Definition

Root canal treatment, also known as endodontic treatment, is a dental procedure in which the diseased or damaged pulp (core) of a tooth is removed and the inside areas (the pulp chamber and root canals) are filled and sealed.Root canal treatment is a dental procedure in which the diseased pulp of a tooth is removed and the inside areas are filled and sealed. In figure A, the infection can be seen above the pulp cavity. The dentist drills into the enamel and the pulp cavity is extracted (figure B). Finally, the dentist fills the pulp cavity with antibiotic paste and a temporary filling (figure C).Root canal treatment is a dental procedure in which the diseased pulp of a tooth is removed and the inside areas are filled and sealed. In figure A, the infection can be seen above the pulp cavity. The dentist drills into the enamel and the pulp cavity is extracted (figure B). Finally, the dentist fills the pulp cavity with antibiotic paste and a temporary filling (figure C). (Illustration by Electronic Illustrators Group.)

Purpose

Inflamed or infected pulp (pulpitis) most often causes a toothache. To relieve the pain and prevent further complications, the tooth may be extracted (surgically removed) or saved by root canal treatment. Root canal treatment has become a common dental procedure; more than 14 million are performed every year, with a 95% success rate, according to the American Association of Endodontists.

Precautions

Once root canal treatment is performed, the patient must have a crown placed over the tooth to protect it. The cost of the treatment and the crown may be expensive. However, replacing an extracted tooth with a fixed bridge, a removable partial denture, or an implant to maintain the space and restore the chewing function is typically even more expensive.

Description

Root canal treatment may be performed by a general dentist or by an endodontist, a dentist who specializes in endodontic (literally "inside of the tooth") procedures. Inside the tooth, the pulp's soft tissue contains the blood supply, by which the tooth gets its nutrients, and the nerve, by which the tooth senses hot and cold. This tissue is vulnerable to damage from deep dental decay, accidental injury, tooth fracture, or trauma from repeated dental procedures (such as multiple fillings over time). If a tooth becomes diseased or injured, bacteria build up inside the pulp, spreading infection from the natural crown of the tooth to the root tips in the jawbone. Pus accumulates at the ends of the roots, forming a painful abscess which can damage the bone supporting the teeth. Such an infection may produce pain that is severe, constant, or throbbing, as well as prolonged sensitivity to heat or cold, swelling and tenderness in the surrounding gums, facial swelling, and discoloration of the tooth. However, in some cases, the pulp may die so gradually that there is little noticeable pain.Root canal treatment is performed under local anesthesia. A thin sheet of rubber, called a rubber dam, is placed in the mouth to isolate the tooth. The dentist removes any tooth decay and makes an opening through the natural crown of the tooth into the pulp chamber. Creating this access also relieves the pressure inside the tooth and can dramatically ease pain.The dentist determines the length of the root canals, usually with a series of x rays. Small wire-like files are then used to clean the entire canal space of diseased pulp tissue and bacteria. The debris is flushed out with large amounts of water (irrigation). The canals are also slightly enlarged and shaped to receive an inert (non-reactive) filling material called gutta percha. However, the tooth is not filled and permanently sealed until it is completely free of active infection. The dentist may place a temporary seal, or leave the tooth open to drain, and prescribe an antibiotic to counter any spread of infection from the tooth. This is why root canal treatment may require several visits to the dentist.Once the canals are completely clean, they are filled with gutta percha and a sealer cement to prevent bacteria from entering the tooth in the future. A metal post may be placed in the pulp chamber for added structural support and better retention of the crown restoration. The tooth is protected by a temporary filling or crown until a permanent restoration may be made. This restoration is usually a gold or porcelain crown, although it may be a gold inlay, or an amalgam or composite filling (paste fillings that harden).

Preparation

There is no typical preparation for root canal treatment. Once the tooth is opened to drain, the dentist may prescribe an antibiotic, then the patient should take the full prescribed course. With the infection under control, local anesthetic is more effective, so that the root canal procedure may be performed without discomfort.

Aftercare

The tooth may be sore for several days after filling. Pain relievers, such as ibuprofen (Advil, Motrin) may be taken to ease the soreness. The tissues around the tooth may also be irritated. Rinsing the mouth with hot salt water several times a day will help. Chewing on that side of the mouth should be avoided for the first few days following treatment. A follow-up appointment should be scheduled with the dentist for six months after treatment to make sure the tooth and surrounding structures are healthy.

Risks

There is a possibility that the root canal treatment will not be successful the first time. If infection and inflammation recur and an x ray indicates retreatment is feasible, the old filling material is removed and the canals are thoroughly cleaned out. The dentist will try to identify and correct problems with the first root canal treatment before filling and sealing the tooth a second time.In cases where an x ray indicates that retreatment cannot correct the problem, endodontic surgery may be performed. In a procedure called an apicoectomy, or root resectioning, the root end of the tooth is accessed in the bone, and a small amount is shaved away. The area is cleaned of diseased tissue and a filling is placed to reseal the canal.

Key terms

Abscess — A hole in the tooth or gum tissue filled with pus as the result of infection. Its swelling exerts pressure on the surrounding tissues, causing pain.Apicoectomy — Also called root resectioning. The root tip of a tooth is accessed in the bone and a small amount is shaved away. The diseased tissue is removed and a filling is placed to reseal the canal.Crown — The natural crown of a tooth is that part of the tooth covered by enamel. Also, a restorative crown is a protective shell that fits over a tooth.Endodontic — Pertaining to the inside structures of the tooth, including the dental pulp and tooth root, and the periapical tissue surrounding the root.Endodontist — A dentist who specializes in the diagnosis and treatment of disorders affecting the inside structures of the tooth.Extraction — The surgical removal of a tooth from its socket in the bone.Gutta percha — An inert latex-like substance used for filling root canals.Pulp — The soft innermost layer of a tooth, containing blood vessels and nerves.Pulp chamber — The area within the natural crown of the tooth occupied by dental pulp.Pulpitis — Inflammation of the pulp of a tooth involving the blood vessels and nerves.Root canal — The space within a tooth that runs from the pulp chamber to the tip of the root.Root canal treatment — The process of removing diseased or damaged pulp from a tooth, then filling and sealing the pulp chamber and root canals.In some cases, despite root canal treatment and endodontic surgery, the tooth dies anyway and must be extracted.

Normal results

With successful root canal treatment, the tooth will no longer cause pain. However, because it does not contain an internal nerve, it no longer has sensitivity to hot, cold, or sweets. These are signs of dental decay, so the patient must receive regular dental check-ups with periodic x rays to avoid further disease in the tooth. The restored tooth could last a lifetime; however, with routine wear, the filling or crown may eventually need to be replaced.

Resources

Organizations

American Association of Endodontists. 211 East Chicago Ave., Ste. 1100, Chicago, IL 60611-2691. (800) 872-3636. http://www.aae.org.American Dental Association. 211 E. Chicago Ave., Chicago, IL 60611. (312) 440-2500. http://www.ada.org.

Other

"Endodontic (Root Canal) Therapy." Tooth Talk and Your Health with Dr. Frank Gober. http://www.toothtalk.com."Root Canal Treatment." Annapolis Endodontics. http://users.erols.com/canals/index.html."Root Canal Treatment." Value Added Benefits. http://www.vab.com.Thivierge, Bethany. "What is the Value (and Cost) of a Root Canal?" A Healthy Me Page. http://www.ahealthyme.com/topic/rootcanal.

treatment

 [trēt´ment] 1. the management and care of a patient; see also care" >care.2. the combating of a disease or disorder; called also therapy. Schematic of the treatment planning process using occupational therapy as an example. From Pedretti and Early, 2001.active treatment treatment directed immediately to the cure of the disease or injury.causal treatment treatment directed against the cause of a disease.conservative treatment treatment designed to avoid radical medical therapeutic measures or operative procedures.empiric treatment treatment by means that experience has proved to be beneficial.expectant treatment treatment directed toward relief of untoward symptoms, leaving the cure of the disease to natural forces.extraordinary treatment a type of treatment that is usually highly invasive and might be considered burdensome to the patient; the effort to decide what is extraordinary raises numerous ethical questions.fever treatment in the nursing interventions classification, a intervention" >nursing intervention defined as management of a patient with hyperpyrexia" >hyperpyrexia caused by nonenvironmental factors. See also fever.heat exposure treatment in the nursing interventions classification, a intervention" >nursing intervention defined as management of a patient overcome by heat due to excessive environmental heat exposure. See also stroke" >heat stroke.hypothermia treatment in the nursing interventions classification, a intervention" >nursing intervention defined as rewarming and surveillance of a patient whose core body temperature is below 35°C. See also hypothermia.Kenny treatment a treatment formerly used for poliomyelitis, consisting of wrapping of the back and limbs in hot cloths, followed, after pain has subsided, by passive exercise and instruction of the patient in exercise of the muscles. It was named for Sister Elizabeth Kenny, an Australian nurse known for her care of polio patients during the first half of the 20th century.neurodevelopmental treatment Bobath method.palliative treatment care" >supportive care.preventive treatment prophylaxis.t's and procedures in the omaha system, a term used at the first level of the intervention scheme defined as technical nursing activities directed toward preventing signs and symptoms, identifying risk factors and early signs and symptoms, and decreasing or alleviating signs and symptoms.treatment and/or procedure a intervention" >nursing intervention in the nursing minimum data set; action prescribed to cure, relieve, control, or prevent a client problem.prophylactic treatment prophylaxis.rape-trauma treatment in the nursing interventions classification, a intervention" >nursing intervention defined as the provision of emotional and physical support immediately following a reported rape.rational treatment that based upon knowledge of disease and the action of the remedies given.refusal of treatment see under refusal.root canal treatment therapy" >root canal therapy.specific treatment treatment particularly adapted to the special disease being treated.substance use treatment in the nursing interventions classification, a intervention" >nursing intervention defined as supportive care of patient/family members with physical and psychosocial problems associated with the use of alcohol or drugs. See also abuse" >substance abuse.substance use treatment: alcohol withdrawal in the nursing interventions classification, a intervention" >nursing intervention defined as the care of the patient experiencing sudden cessation of alcohol consumption. See also alcoholism.substance use treatment: drug withdrawal in the nursing interventions classification, a intervention" >nursing intervention defined as the care of a patient experiencing drug detoxification. See also abuse" >substance abuse.substance use treatment: overdose in the nursing interventions classification, a intervention" >nursing intervention defined as monitoring, treatment, and emotional support of a patient who has ingested prescription or over-the-counter drugs beyond the therapeutic range. See also overdose.supporting treatment (supportive treatment) care" >supportive care.

root ca·nal treat·ment

1. the means by which painful or diseased teeth, in which the pulp is involved, are restored to a healthy state; 2. removal of a normal, diseased, or dead pulp by biochemical and mechanical means, enlargement and sterilization of the root canal, followed by filling the canal, to effect healing of diseased periapical tissues; 3. the diagnosis and treatment of diseases of the pulp and their sequelae. Synonym(s): endodontic treatment

root ca·nal treat·ment

(rūt kă-nal trētmĕnt) 1. Means by which painful or diseased teeth, in which pulp is involved, are restored to a healthy state. 2. Removal of a normal, diseased, or dead pulp by biochemical and mechanical means, enlargement and sterilization of the root canal, followed by filling the canal, to effect healing of diseased periapical tissues. 3. Diagnosis and treatment of diseases of dental pulp and their sequelae.
Synonym(s): endodontic treatment,, root canal therapy.