Endodontics is the branch of dentistry concerned with the morphology, physiology, and pathology of the human dental pulp and peri-radicular tissues. The study and practice of endodontics includes the biology of the normal pulp and peri-radicular tissues and the aetiology, prevention, diagnosis and treatment of diseases and injuries that affect these tissues.
Endodontic treatment is a specialised branch of dentistry known also as root canal therapy. Endodontics is carried out by general dentists and specialists endodontists to relieve dental pain and resolve infection or a disease process in teeth. The aim is to save teeth by locating the infected or irreversibly inflamed dental pulp in the root canals. The canals are thoroughly cleaned, then sealed to prevent re-infection.
Toothache can arise from a number of causes and appropriate treatment options can only be considered after a detailed mouth examination, x-rays and other tests in order to make a diagnosis. Factors such as a patient's medical history, oral cleanliness and health of the gums, and the amount of tooth and bone support remaining are important considerations in deciding whether a tooth has a reasonable long-term future or whether extraction should be considered. Replacement options for extracted teeth continue to improve but are generally much more expensive and less satisfactory than natural teeth.
The outermost layer of the tooth material is called "enamel", which is hard and solid. The inner layer of the tooth material is called "dentine". Both are hard and mineralised layers. Inside the tooth there is a small, delicate space called the "dental pulp" or what people normally refer to "tooth nerve". The dental pulp is a delicate structure that contains nerves and blood vessels that help nourishes the tooth and provides the tooth with sensation. The pulp is also responsible for most of the early growth and development of the tooth in childhood. See the illustration bellow which describes these structures.
Anatomy of a tooth
Endodontic treatment is a procedure carried out to preserve a tooth that may otherwise require extraction. There are many advantages of saving natural teeth including;
The most common cause of pulp damage is deep tooth decay. Other factors could also damage or expose the pulp to bacteria that cause pulp inflammation or infection. Among the other causes are tooth fracture, traumatic injury such as a blow to the mouth, a cracked or loose filling or repeated restorations, and less frequently periodontal (gum) disease.
Endodontic treatment is usually completed over two or three visits. In some cases it could be completed in one session.
With proper restoration and care endodontically treated teeth can last as long as any other tooth. There are many factors that determine the long-term survival of a root filled tooth including, but not limited to, the condition of the tooth before treatment, the type of tooth restoration following the treatment, the way teeth bite together and habits such as grinding or clenching teeth. Good oral hygiene, avoidance of a high sugar diet and periodic dental check-ups facilitate the long term survival of endodontically treated teeth.
Root canal procedure is usually carried out under local anaesthetic. The procedure should not be painful. However, when tissues are very inflamed causing severe toothache, this is the most difficult situation in which to achieve complete relief of pain. In these situations more than one method or technique for administering local anaesthetic may be required to achieve good pain control.
The majority of patients experience no or very minor discomfort. Sometimes teeth may be tender to bite on for 2-3 days after treatment. This is not uncommon and should be controlled by ordinary pain relief. Some teeth take more time to settle however, if the pain persists you should contact your dentist or endodontist.
The cost of root canal procedure can vary depending on several factors. The front teeth are usually easier to treat and therefore treatment may be less expensive than treatment of back teeth. The factors that determine the cost of the procedure are the difficulty of the treatment, complexity of procedure, time required for the treatment and the materials used for the procedure. You need to discuss cost with your dentist or endodontist. Generally, endodontic treatment is much less expensive than extraction and replacement of teeth with a bridge or an implant.
The alternative to endodontic treatment is usually tooth extraction. The options after extraction are to accept a gap or replace the tooth with an artificial replacement to restore function and aesthetics. The prosthetic or artificial replacement options include implant-supported crown, bridge restoration or removable partial denture (Plate). It may be important to confirm that a replacement option is possible before electing to have a tooth extracted.
With the recent advances in this field, endodontic treatment options can be offered for an increasing number of teeth that were traditionally considered not treatable. Even back teeth that are difficult to access can be effectively and satisfactorily treated. An individual assessment needs to include consideration of the medical history, acceptance/tolerance of the procedure itself, a detailed assessment of the tooth in question, the long-term outlook for the tooth and each individual patient's wishes.
Endodontic treatment has high success rate. The success rate of this procedure varies depending on several factors. Generally, and if performed to high standards, root canal procedure does enjoy high success rate in the long term. Problems, however, do occur with root filled teeth. If the root filled tooth develops decay or its restoration fails or leak it could lead to endodontic treatment failure. In some other cases and despite good care the tooth may not heal as expected. Further endodontic treatment or surgery may be indicated if appropriate to deal with the treatment failure. A tooth that develops vertical crack or fracture can also fail, which often require extraction.
It is usual for healing to be reviewed about 6 months after root canal treatment to determine whether healing has occurred. Sometimes, more than six to twelve months are required to confirm that healing has taken place. You may need to return back to your dentist for the permanent definitive crown restoration if healing has been confirmed and your tooth needs a crown.
If you have more questions before, during or after your treatment, your dentist will be happy to answer your questions.
Following your root canal treatment, the crown of the tooth should be restored with a permanent restoration which protects the remaining tooth from the risk of fracture. Your dentist may suggest you have a crown to protect a tooth where it has been heavily filled.