Endodontic therapy | Find Me A Cure

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Definition
A root canal is a dental procedure to remove dead or dying nerve tissue and bacteria from inside a tooth.
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The tooth pulp located in the centre of the tooth and in canals withen each tooth root. Pulp, consisting of connective tissue, nerves and blood vessels, nourishes the tooth when it first erupts (emerges through the gum). Once the tooth matures, the pulp can be removed safely from the pulp chamber and root canals and the tooth can be maintained. This is because the tooth also is nourished by a blood supply that surrounds the tooth. Removing the pulp is called endodontic treatment, but it is often referred to as root canal treatment or root canal therapy. Many people refer to this as “having a root canal.” Root canal treatments are quite common. This treatment saves about 24 million teeth every year in USA only.

Description
Why We Need Root Canal Treatment?
Root canal treatment is needed for two main reasons: infection or irreversible damage to the pulp. An untreated cavity is a common cause of pulp infection. The decay erodes the enamel and dentin of the tooth until it opens into the root canal system, allowing bacteria to infect the pulp. Infections inside teeth don’t respond to antibiotic treatment. The inflammation caused by the infection restricts the tooth’s blood supply, so antibiotics in the bloodstream can’t reach the infection very well. The reduced blood supply also limits the pulp’s ability to heal itself.

The pulp also can become damaged from trauma, a fracture or extensive restorative work, such as several fillings placed over a period of time. Sometimes, a common dental procedure can cause the pulp to become inflamed. For example, preparing a tooth for a crown sometimes leads to the need for root canal treatment.

In many cases, when the pulp is inflamed, but not infected, it will heal and return to normal. Your dentist may want to monitor the tooth to see if this happens before doing root canal treatment. Sometimes, though, the pulp remains inflamed, which can cause pain and may lead to infection.

Once the pulp becomes infected, the infection can affect the bone around the tooth, causing an abscess to form. The goal of root canal treatment is to save the tooth by removing the infected or damaged pulp, treating any infection, and filling the empty canals with an inert material. If root canal treatment is not done, the tooth may have to be extracted.

It is better to keep your natural teeth if at all possible. If a tooth is missing, neighboring teeth can drift out of line and can be overstressed. Keeping your natural teeth also helps you to avoid more expensive and extensive treatments, such as implants or bridges. If an infected or injured tooth that needs root canal treatment is ignored, not only can you lose the tooth, but also the infection can spread to other parts of your body.

Having endodontic treatment on a tooth does not mean that you’ll need to have it pulled out in a few years. The reason for doing root canal treatment is often a large cavity. The tooth often is weakened, but if the tooth is covered with a crown after the root canal or, in some cases, restored with tooth-colored composite filling material, the tooth can last the rest of your life.
You may click to see:->About Root Canal Treatment
.Signs and Symptoms
If you have an infection of the pulp, you may not feel any pain at first. But if left untreated, the infection will cause pain and swelling. In some cases, an abscess will form. Eventually, the tooth may need to be extracted. Some indications that a tooth may need a root canal are:

*A tooth that hurts significantly when you bite down on it, touch it or push on it
*Sensitivity to heat
*Sensitivity to cold that lasts longer than a couple of seconds
*Swelling near the affected tooth
*A discolored tooth, with or without pain
*A broken tooth

To determine whether your tooth needs root canal treatment, your dentist will place hot or cold substances against the tooth, feel surrounding tissues and gently tap on the tooth. He or she also will take X-rays.

If the condition of the pulp isn’t clear from these tests, your dentist may use an electric pulp tester. This hand-held device sends a small electric current through the tooth and helps your dentist evaluate whether the pulp is alive. This test does not cause pain or a shock, but a tingling sensation that stops immediately when the tester is removed from the tooth.

Caution: An electric pulp tester should not be used if you have a cardiac pacemaker or any other electronic life-support device.

Time takes to do the treatment:-
Root canal treatment can be done in one or more visits, depending on the situation. An infected tooth will need several appointments to make sure that the infection is eliminated. Some teeth may be more difficult to treat because of the position of the tooth, because they have many and curved root canals that are difficult to locate, or for other reasons. An uncomplicated root canal treatment often can be completed in one visit. Once the root canal treatment is finished, you will need to see your general dentist to have the tooth restored with a crown or filling.

Proceedure:
Measuring and Cleaning the Root Canals

Measuring
First, your dentist or endodontist will numb the area around the tooth. You also may receive sedation, such as nitrous oxide, or your dentist may offer other anxiety-reducing techniques if you feel you need them. He or she will make a hole in the top or back of your tooth to get to the pulp chamber. He or she will remove some of the diseased pulp. Then the root canals have to be measured.
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Your dentist needs to know how long the canals are so he or she can make sure all the diseased tissue is removed and the entire canal is cleaned. Also, the material used to fill the canal after it is cleaned needs to fill the entire canal.

Dentists use X-rays to determine the length of the canals or use an electric device called an apex locator. In the first procedure, your dentist will place a file into the canal he or she is measuring then take an X-ray to determine how close the file is to the end of the canal. An apex locator makes a calculation based on the resistance to a small electric current. This gives an accurate measurement of a root canal. Often, the two methods are combined.

Cleaning
After the canals have been measured, your dentist or endodontist will use the specially designed instruments to clean out the diseased pulp. After the pulp has been removed, the canal is cleaned with an antiseptic solution, which helps to treat the source of the infection.

For root canal treatment to be effective, all the canals within the tooth must be cleaned. Generally, the top front teeth have one canal, the bottom front teeth one or two canals, the premolars one or two, and the molars three or four canals. However, the location and shape of these canals can vary significantly. Some endodontists are now using a microscope to see inside the tooth to make sure all the canals have been located and all the pulp has been removed.

Once the canals have been thoroughly cleaned and the endodontist or dentist has made sure that the infection has been removed, the roots are filled. A temporary filling is then placed to cover the new root filling. The crown of the tooth should then be restored with a permanent filling or crown within a relatively short time.

In most cases, the tooth will need a crown, especially with molars that are under stress from chewing. A crown will help to restore the tooth’s strength and protect it from cracking. A crown should be placed as soon as possible, ideally within a month of the root canal. It’s important to get the tooth permanently restored to prevent damage to the tooth later. The temporary filling you receive is not meant to last.

The pulp that was removed during root canal treatment is the part that responds to temperature. The tissues and nerves surrounding your tooth remain, however, so your tooth will still respond to pressure and touch.

After Root Canal Treatment
Your tooth will be sore for two to three days after the procedure, and your dentist will tell you to avoid chewing on the affected side. The worse the infection and inflammation was prior to root canal treatment, the sorer the tooth will be after treatment. You can take over-the-counter pain relievers to ease the discomfort.

Risks Factors:-
•Abscess
•Nerve damage
•Loss of tooth

Complications that may arise sometimes:-

*Sometimes when a root canal is opened for treatment, the oxygen in the air will trigger some bacteria to start growing, causing inflammation and pain.

*Bacteria may get pushed out through the tips of the roots. Blood vessels enter the tooth through a small hole (the apex of the root) at the bottom of the root. Sometimes during a root canal procedure, bacteria are pushed out through this small hole into surrounding tissue. If this happens, the surrounding tissue will become inflamed and possibly infected. This can be treated with painkillers, and sometimes antibiotics, but the site could be painful until it clears up.

*A root canal treatment can puncture the side of the tooth. This can happen if the canal is curved or if the canal cannot be located. The instruments are flexible so that they bend as the canal curves, but sometimes the instrument makes a small hole in the side of the tooth. If saliva can get into the hole, the tooth will have to be treated further or extracted. If the hole is far enough under the gum line that saliva can’t reach it, it may heal.

*A root canal may be missed or an entire canal may not be fully cleaned out. Locating canals within the tooth can be difficult. If a canal or an offshoot of a canal isn’t located and cleaned out, the tooth can remain infected and the root canal procedure will have to be repeated. This also can happen if a canal isn’t measured correctly and pieces of infected or inflamed pulp are left near the bottom. Occasionally, root canals have branches that are not accessible to traditional treatment.

*A file may break. The tip of a file may break off inside the tooth. Usually, it’s possible to leave the piece in the tooth and finish the root canal. But if the cleaning of the canal has not been finished, the file piece may have to be removed. Sometimes this can be done from the top of the tooth. However, in some cases, the file can only be removed through a surgical procedure called an apicoectomy. A small incision is made in the gum to access the root of the tooth, and the portion of the root containing the file piece is removed.

Expectations after surgery
You will need to see your dentist after the procedure to make sure the infection is gone. A dental x-ray may be taken. Regular dental checkups are necessary. For adults, this usually means a visit twice a year.

Convalescence
You may have some pain or soreness after the procedure. An over-the-counter anti-inflammatory drug, such as ibuprofen or naproxen, can help relieve discomfort. Most people can return to their normal routine the next day. Until the tooth is permanently filled or covered with a crown, you should avoid rough chewing in the area.

You may click to see:->Myths About Root Canal Treatment

Resources:
http://www.healthprofessor.com/landers/root_canal.php?keywords=root+canals&referrer=Adwords&camp=HealthProfessor-RootCanal&group=root+canals&keyword=root+canals&traffictype=search&creativeid=2792829118&sourcesite=

http://www.colgate.com/app/Colgate/US/OC/Information/OralHealthBasics/CheckupsDentProc/RootCanalTreatments/RootCanalTreatment.cvsp

What is a Tooth Or Dental abscess?

A Tooth abscess or Dental abscess occurs when the nerve of a tooth has become infected. This is usually due to dental decay, but may also be caused by injury to the tooth. Pus is formed, which can only escape through the root of the tooth. This causes pressure under the tooth, which makes it painful if touched. The pain is intense and throbbing may affect the side of the face.

You may click to see pictures of different tooth abscess

An abscess usually develops as a complication of dental caries, which gradually destroys the layer of enamel on the outside of the tooth and the inner dentin, allowing bacteria to invade the soft central core, or pulp, of the tooth. Eventually, a dental abscess may form. the pulp may also become infected if a tooth is damaged by a blow to the mouth.

An abscess may also form as a result of certain forms of gum disease. Periodontitis is usually caused by a buildup of dental plaque in a pocket that forms between a tooth and gum.

Usually the abscess originates from a bacterial infection that has accumulated in the soft pulp of the tooth. This is usually but not always associated with what is commonly described as a dull throbbing excruciating ache.

A tooth abscess typically originates from dead pulp tissue, usually caused by untreated tooth decay, cracked teeth or extensive periodontal disease. A failed root canal treatment may also create a similar abscess.

There are two types of dental abscess. A periapical abscess starts in the dental pulp and is most common. A periodontal abscess begins in the supporting bone and tissue structures of the teeth.

A dental abscess can be extremely painful and may cause the affected tooth to loosen in its socket.

What are the symptoms?
Common symptoms of an acute tooth abscess is a toothache or a persistent, throbbing pain at the site of the infection.Putting pressure or warmth on the tooth can induce extreme pain.

In some cases, a tooth abscess may perforate bone and start draining into the surrounding tissues creating local facial swelling. The lymph glands in the neck in some cases will become swollen and tender in response to the infection.
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The main symptoms of a dental abscess develop gradually and may include:-

Â· Dull aching around either or both of the cheekbones.
Â· Severe pain on touching the affected tooth and on biting or chewing.
Â· Loosening of the affected tooth.
Â· Red, tender swelling of the gum over the root of the tooth.
Â· Release of pus into the mouth.

If the abscess is not treated, the infection may make a channel from the tooth to the surface of the gum, and a painful swelling, known as a gumboil, may form. If the gumboil bursts, foul-tasting pus is released and the pain decreases. In some cases, the channel may persist, leading to a chronic abscess that discharges pus periodically. If the infection spreads to surrounding tissues, your face may become swollen and painful, and you may also develop a fever. If you suspect that you have a dental abscess, you should consult your dentist as soon as possible.

What should you do if you get a dental abscess?

You should seek advice from a dentist urgently to get the abscess drained. It may be possible to drain the pus through the tooth itself so the tooth can be saved (root canal treatment). If not, the tooth will need to be extracted to prevent the abscess recurring.

Sometimes, a dental abscess may burst. This allows the pus to drain and can ease the pain. The process can be encouraged by using a hot salt-water mouthwash (a teaspoon of salt to a cup of water).

Do not apply any heat directly to the face – a hot-water bottle, for example – as this will make the swelling worse. However, something cold on the face may ease the swelling, while painkillers occasionally help reduce the pain. In severe cases, antibiotics may be necessary.

Treatment:
Your dentist will ask you about your symptoms and examine your teeth and gums. He or she may take an x-ray of your mouth to confirm the diagnosis.

One treatment for an abscessed tooth is to extract it, thereby removing the source of infection. However, in select cases a root filling or root canal therapy may be able to save the tooth by cleaning the source of infection in the pulp chamber and root canal system (for more information see Root canal therapy). Another possible treatment of an abscessed tooth is an invasive surgery through the cheek.The doctor will then remove the tooth, ridding the source of infection. Finally, the doctor will insert a tube through the cheek routing it the site of the tooth so any other pus may drain out through the tube in to either a Jackson-Pratt bulb or directly onto a surgical sponge.

If the abscess has been caused by decay, your dentist may try to save tooth. under local anesthesia, a hole is drilled through the top of the tooth to release the pus and relieve the pain. if there is a gumboil, a small cut may be made in the boil to drain the pus. The cavity is then cleaned with an antiseptic solution. a small tube may be left in place for a few days to allow any remaining pus to drain, and you will probably be given a course of antibiotics. Once the infection has cleared up, you will probably need root canal treatment. If it is not possible to save the tooth, it will be extracted.

To treat an abscess caused by gum disease, your dentist may use a probe to scrape out the plaque from the pocket between the affected tooth and gum. afterward, the pocket is washed out with an antiseptic solution. In severe cases, the tooth may be extracted.

What is the prognosis?
Most treatment is successful, but a small area of infection may persist and further treatment may be required.

Untreated Consequences:
An untreated severe tooth abscess may become large enough to perforate bone and extend into the soft tissue. From there it follows the path of least resistance. Largely dependent on the location of the infected tooth; the thickness of bone, muscle and fascia attachments, the infection then spreads either internally or externally.

External drainage may begin as a boil which bursts allowing pus drainage from the abscess, intraorally (usually through the gum) or extra orally. Chronic drainage will allow an epithelial lining to form in this communication to form a pus draining canal (fistula). Sometimes this type of drainage will immediately relieve some of the painful symptoms associated with the pressure.

Internal drainage is of more concern as growing infection makes space within the tissues surrounding the infection. Severe complications requiring immediate hospitalisation include Ludwig’s angina, which is a combination of growing infection and cellulitis which closes the airway space causing suffocation in extreme cases. Also infection can spread down the tissue spaces to the mediastinum which has significant consequences on the vital organs such as the heart. Another complication, usually from upper teeth, is a risk of septicaemia (infection of the blood), from connecting into blood vessels. Brain abscess, while extremely rare, is also a possibility.

Depending on the severity of the infection, the sufferer may feel only mildly ill, or may in extreme cases require hospital care.

How can a dental abscess be avoided?

Keeping your teeth healthy is the best way to prevent dental abscess.
Try to avoid cavities by reducing your intake of sugary foods and drinks – have them as an occasional treat, at mealtimes only. Brush your teeth twice daily using a toothpaste containing fluoride. To get the most benefit from the fluoride, do not rinse the toothpaste away after brushing.

Visit your dentist regularly, at agreed intervals. This way, problems can be diagnosed early and your treatment will be more straightforward.Remember that even if the abscess drains by itself, you should seek advice from your dentist for further assessment.

Disclaimer: This information is not meant to be a substitute for professional medical advise or help. It is always best to consult with a Physician about serious health concerns. This information is in no way intended to diagnose or prescribe remedies.This is purely for educational purpose
Resources:
http://www.charak.com/DiseasePage.asp?thx=1&id=68
http://en.wikipedia.org/wiki/Tooth_abscess
http://www.netdoctor.co.uk/diseases/facts/dentalabscess.htm
http://www.dentalgentlecare.com/decay_process.htm

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