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Root Canal Therapy

Who is an Endodontist?

What is Endodontic Treatment?

What are the symptoms for Endodontic (root canal) diseases?

How does Root Canal treatment work? Is it painful

What is root canal treatment?

Reasons for root canal treatment

Post-treatment care

What is tooth decay?

What is a cracked tooth and how to I prevent it?

What is an Abcessed tooth and how to I prevent it?

When to extract (remove) a tooth?

Who is an Endodontist?

Bellevue Dentist, Kirkland Dentist An endodontist is a specialized dentist with special training in diagnosing and treating problems associated with the inside of the tooth.

Endodontists complete four years of dental school and an additional two or more years of advanced training in endodontics. Endodontists are also licensed by the state in which they practice.

Endodontists primarily perform root canal therapies, including re-treatment of previous root canals that have not healed completely, but are also qualified in diagnosing and treating oral and facial pain, as well as treating dental emergencies, such as toothaches, oral trauma, and cracked or displaced teeth. Endodontists can also treat more complex conditions, such as extreme pain, medically compromised patients, and anatomic problems including tooth curvature and calcification. Endodontists also perform certain surgical procedures, most of which are required as an alternative to conventional root canal therapy.

Endodontists also routinely acquire continuing education to stay abreast of state-of-the-art research, clinical procedures, and technology, such as operating microscopes, ultrasonics and digital imaging.

What is Endodontic Treatment?

Endodontic treatment, commonly called "root canal treatment", is a common dental procedure that removes damaged tissue from inside the root canals of a tooth, thereby significantly lengthening the life of the tooth. Endodontic treatment significantly restores once damaged teeth and is a recognized and superior alternative to tooth extraction as a means of treating damaged interior structures such as pulp.

What are the symptoms for Endodontic (root canal) diseases?

Symptoms of endodontic disease include:

  • Hypersensitivity to hot or cold liquids and food

  • Hypersensitivity to touch

  • Pain - Any kind of pain that is spontaneous or throbbing, including pain not seemed to be caused by anything. Other kinds of pain may be related to exposure to hot or cold objects, an injury, or the pressure on a tooth caused by chewing or biting down.

  • Tenderness or swelling of the face, gums or lymph nodes

  • Tooth discoloration

How does Root Canal treatment work? Is it painful?

Endodontic treatments

Whether they are conventional root canal therapies or surgical procedures are designed to remove diseased tissue and restore teeth to a healthy state. Root canal treatment doesn't cause pain, it relieves it. In many cases, endodontic treatment relieves chronic pain from toothaches caused by pulp inflammation or infection.

Endodontic procedures are generally painless because sedatives and/or anesthetics are used to dull or eliminate nerve sensitivity. In most cases, an endodontic procedure is no less traumatic that a conventional filling.

Any mild discomfort you feel following an endodontic procedure can be minimized or eliminated by over-the-counter analgesics. If pain or undue pressure persists after a week or so, you should contact your endodontist.

What is root canal treatment?

Underneath each tooth's outer enamel is an area of soft tissue called the pulp, which carries the tooth's nerves, veins, and arteries. Root canals are very small, thin passageways that branch off from the top pulp chamber through the root tip. A tooth can have up to four root canals.

Sometimes, the pulp inside the tooth becomes infected by disease or bacteria, or damaged by a traumatic injury to the tooth. An infected and untreated root canal can allow bacteria in the mouth to enter the bloodstream and cause infections in other parts of the body. In addition to staving off potentially harmful infections in other parts of your body, root canal treatment can generally save your damaged tooth.

Root canal treatments typically affect the root tip or nerve of the tooth and the structures called the pulp chamber, pulp, and root canal. The procedure involves removal of diseased or damaged pulp inside the tooth, the cleaning, disinfection and reshaping of the inner canals beneath the tooth, and preparation of the tooth for later placement of a filling, and in most cases, an artificial crown made of porcelain or gold. The procedure enables you to keep most of your original tooth.

Root canal treatment usually takes one to three visits. Here is what normally occurs during a root canal procedure:

  • First, your gums are numbed with a topical substance and a local anesthetic is injected into the nearby area to completely numb your teeth, gums, tongue, and skin. For patients with an acute low tolerance for pain or anxiety, nitrous oxide gas may be used.

  • A small sheet of rubber is placed over the surrounding area of the affected tooth in order to isolate it from surrounding teeth and prevent you from swallowing debris.

  • A small hole is made in the top of the tooth in order to access the pulp chamber, pulp and root canals. The pulp is removed, the pulp chamber cleaned and the canals are cleared of debris and tissue. In most cases, the canals are first filled with antibiotic medications and temporary filling materials up to the gum line. Depending on the circumstances, the root canal may be left open for a few days in order to drain. In some cases, the canals may be filled right away with a final root canal filling.

  • If the canals are not permanently sealed, the temporary filling is removed and the pulp chamber and canal(s) are filled with a rubber-like material to prevent recontamination. If the tooth is still weak, a metal post may be inserted above the canal filling to reinforce the tooth.

  • Once filled, the area is permanently sealed, an impression of the tooth is made so an artificial crown can be made for placement over the affected tooth. In some cases, a temporary crown is placed over the tooth until the permanent gold or porcelain crown is made and cemented in, usually by your family dentist.

Reasons for root canal treatment

Root canal treatment is called for when the soft tissue inside the tooth's canals, also called the pulp, becomes inflamed or infected by bacteria. The most common cause of pulp death is a fractured tooth or a deep cavity, which can expose the pulp to the bacteria found in your saliva. A traumatic injury or blow to the tooth could cause swelling and inflammation of the tissues in and around the tooth, providing an opportunistic path, usually through a crack, for bacteria to collect. Repeated dental procedures on the same tooth could eventually weaken and compromise the original tooth, allowing pathogens to enter the inner canals. An infected pulp can lead to swelling and possibly fever; left untreated, infected pulp could leak harmful toxins from the root ends, leading to an abscess and erosion of the bone beneath the tooth.

Post-treatment care

A root canal procedure is designed to restore a damaged inner tooth, giving it the same lifespan as its original. With proper care following your procedure, your restored tooth should heal with about a 95% success rate. It is normal to feel some tenderness in the area over the next few days as your body undergoes the natural healing process. You may also feel some tenderness in your jaw from keeping it open for an extended period of time. These symptoms are temporary and usually respond very well to over-the-counter pain medications.

It is important for you to follow the instructions on how to take these medications. Remember that narcotic medications, if prescribed, may make you drowsy, and at least eight hours should pass prior to operating dangerous machinery or driving a car after taking them. Your tooth may continue to feel slightly different from your other teeth for some time after your root canal treatment has been completed. However, if you have severe pain or pressure that lasts more than a few days, contact our office.

What is tooth decay?

Tooth decay is another name for the disease known as "caries", or cavities. A cavity is the result of your tooth enamel, dentin, or cementum being destroyed over long-term exposure to harmful bacteria and other germs.

Cavities, while not life threatening and highly preventable, affect most people to some degree during their lifetime. Tooth decay is caused by your teeth being frequently exposed to foods rich in carbohydrates (starches and sugars) like soda pop, candy, ice cream, milk, and cakes. Ironically, even fruits, vegetables and juices can lead to tooth decay.

When these foods break down in your mouth, they release natural bacteria, which eventually turns into a colorless film on your teeth and gums called plaque. The plaque interacts with deposits left on your teeth from sugary and starchy foods to produce acids. These acids break down tooth enamel over time by dissolving, or demineralizing, the mineral structure of your teeth. This leads to tooth decay and weakening of the teeth.

Saliva is your body's best mechanism for fighting the destructive forces of acids formed by plaque. Saliva acts as a buffer and remineralizing agent. Sugarless gum is one way to stimulate the flow of saliva in your mouth in between brushings.

The best way to prevent cavities, however, is to brush and floss on a regular basis. Fluoride, a natural substance which also helps remineralize the tooth structure, is used in community water systems and is a main ingredient of many toothpastes. If you are at medium to high risk for cavities, your dentist may recommend special high concentration fluoride gels, mouth rinses, or dietary fluoride supplements. You may even receive a treatment of professional strength anti-cavity varnish, or sealants, which are thin, plastic coatings that provide an extra barrier against food and debris.

While everyone is susceptible to cavities, people with a lot of fillings have a higher chance of developing tooth decay. Children and senior citizens are the two groups at highest risk for cavities. Heredity may play a major role in how susceptible you are to the formation of a cavity. For example, tooth structure, size, and shape of the tooth, may be passed down through many generations. This includes deep pits and grooves which are ideal "plaque traps".

Many cavities originate in the hard-to-clean areas between teeth, like fissures and pits, the edges in the tooth crown and gaps between teeth.

Children under the age of 6 should only use a pea-sized dab of toothpaste on their brush and should spit out as much as possible. The reason for this is that children are most sensitive to higher levels of fluoride.

Common symptoms of a possible cavity may include:

  • A painful toothache

  • Higher sensitivity in your teeth to hot or cold temperatures, liquids, or foods

  • The presence of decay such as white spots

  • Tooth discolorations

Often, people develop cavities without any pain or other symptoms. That's why it's so important to schedule regular, routine visits with your dentist.

Left untreated, cavities can lead to more serious problems such as infection of the core of your tooth (pulp) or root canal, permanent deterioration, and even loss of the tooth itself.

Avoid frequent consumption of high sugar foods, especially sticky foods because the longer the food stays on your teeth and gums, the greater the likelihood a cavity will form. Healthy snacks that are low in sugar include white milk, fresh fruits, raw vegetables, dark breads, whole grain and enriched cereals, sugar free candies, gum and other snacks. High sugar foods are best eaten with a regular meal.

What is a cracked tooth and how do I prevent it?

A cracked tooth can be caused by a number of things: a traumatic injury such as that incurred in a sports-related activity; grinding teeth or jaws (which apply undue pressure on the top and side surfaces of the tooth and surrounding gum tissue); biting down or chewing hard objects such as ice or hard candy.

In many cases, you may not even realize you have a cracked tooth until is too late. Here are the symptoms to watch for: erratic pain when chewing food, exposure to hot or cold objects, or even brushing.

What causes the pain from a cracked tooth? Inside the tooth is soft connective tissue called pulp, which contains blood vessels and nerves. When the outer surface of the tooth becomes cracked, the inner pulp shifts and moves around, causing irritation of the tissue and nerves. When biting pressure is removed, sometimes the crack closes on itself, leading to sharp pain. Left untreated, the crack becomes larger and the inner pulp can become damaged beyond repair, leading to serious infections called abscesses.

Here are some general prevention tips:

  • Avoid chewing or biting down on hard things such as ice, candy, pens and pencils, or popcorn kernels

  • Avoid grinding your teeth of clenching your jaw. (Special mouth appliances are available to mitigate this problem if you can't stop on your own.)

  • Don't ignore mild or occasional pain in your tooth, because pain almost always is a sign that something is wrong. Keep in mind that pain from a cracked tooth is deceptive; it usually is not severe in nature and may be mistaken for something else such as chewing or exposing your tooth to something cold or hot.

  • Wear mouth guards when participating in sports, especially contact sports. Types and treatment of cracked teeth

Here are the most common types of tooth cracks and how they are treated:

  • Cracked tooth
    A fully cracked tooth usually involves a crack extending from the chewing surface down to the root. Pulp damage is common in an untreated cracked tooth. Root canal therapy, followed by crown replacement, is performed to repair the damaged pulp and restore the tooth. If a crack extends beyond the gum line, the tooth may need to be pulled.

  • Craze lines
    These are tiny cracks on the outer enamel and generally minor in nature. They usually do not require any treatment and are only cosmetic.

  • Fractured cusps
    Fractured cusps are small cracks on the pointed part of a tooths chewing surface. This weakens the structure, and often leads to pain, tooth fracture, and in rare cases, damage to the pulp. A weakened cusp may break off by itself or have to be removed. A replacement crown normally resolves the problem and root canal therapy is usually not required.

  • Split tooth
    An untreated cracked tooth sometimes splits a tooth into two or more pieces. In many cases, a portion of the tooth can be saved by endodontic treatment and general dental restorative procedures.

  • Vertical root fractures
    These are cracks that originate in the tooths root and extend upward to the tooths chewing surface, and because they often do not cause pain they are hard to spot. Vertical root fractures can sometimes lead to more serious problems. They often are spotted after surrounding bone and gum tissues become infected and inflamed. Removal of the fractured root through endodontic surgery may save the tooth, but often, the tooth may have to be extracted.

  • Long-term viability of a cracked tooth
    Unlike bones, the fractures in a cracked tooth do not heal, and may continue to progress even after endodontic treatment. While endodontic treatment and crown restoration will prolong the life of the tooth, in time, the tooth may eventually have to be extracted.

What is an Abcessed tooth and how do I prevent it?

Treatment of an abscessed tooth

An abscessed tooth is a pocket of pus, usually caused by some kind of infection and the spread of bacteria from the root of the tooth to the tissue just below or near the tooth.

In general, a tooth that has become abscessed is one whose underlying pulp (the tooth's soft core) has become infected or swollen. The pulp contains nerves, blood vessels and connective tissue, and lies within the tooth. It extends from the crown of the tooth, to the tip of the root, in the bone of the jaws.

An abscessed tooth can be an extremely painful condition.

In some cases, antibiotics are administered in an attempt to kill an infection. If antibiotics are ineffective and an abscess is shown to be damaging the pulp or lower bony structures, a root canal procedure may be needed to remove the dead pulp and restore the tooth to a healthy state.

When to extract (remove) a tooth?

Alternatives to root canal or endodontic surgery

Often, the only alternative to a root canal or endodontic surgery is extraction. In some cases, a weakened tooth may be replaced with a bridge, implant, or partial denture to restore chewing function and prevent shifting of your adjacent teeth.

The type, location, and extent of a crack in a tooth will determine which kind of treatment is most effective.

 
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