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Root Canals

 

What is a Root Canal Treatment?

Root Canal therapy refers to the process by which a dentist treats the inner aspects of a tooth, specifically that area inside a tooth that is occupied by its "pulp tissue." Most people would probably refer to a tooth's pulp tissue as its "nerve." While a tooth's pulp tissue does contain nerve fiber it is also composed of arteries, veins, lymph vessels, and connective tissue.

 

Diagram of a tooth's nerve area.

Root canal is the commonly used term for the main canals within the dentin of a tooth. These are part of the natural cavity within a tooth that consists of the dental pulp chamber, the main canals and more intricate anatomical branches, that may connect the root canals to each other or to the root surface of the tooth. Root canals are filled with a highly vascularized, dense connective tissue, the dental pulp inflammation or infection of the pulp tissue may occur. The most common reasons are caries and tooth fractures that allow microorganisms, mostly bacteria from the oral flora or their by products access to the pulp chamber or the root canals. If this process is irreversible, an endodontic treatments advised in most of the cases and a general dentist or specialist endodontist should be seen for advice and treatment.


Endodontic treatment coupled with internal tooth bleaching,  is also used to fix teeth that have blackened because of infiltration of decayed soft tissue into the dentin in the teeth, most often seen in incisors that have been injured through a sudden impact.

A tooth with completed root canal treatment. 

For the purposes of this discussion, so to use terminology that people seem to be most familiar with, we will use the terms "nerve" and "nerve tissue" to refer to a tooth's pulp tissue.


Where precisely in a tooth is its nerve?

Teeth are hard calcified objects but their inner aspects are not completely solid. Inside every tooth there lies a hollow space which, when a tooth is healthy, contains the tooth's nerve tissue. Dentists use the following terms to refer to various portions of this nerve area.

The pulp chamber


This is a hollow space that lies more or less in the center of the tooth.

The root canals


Each tooth's nerve enters the tooth, in general, at the very tip of its root(s). From this entry point the nerve then runs through the center of the root in small root canals which subsequently join up with the tooth's pulp chamber.


What is the function of a tooth's nerve tissue?

Initially a tooth's nerve tissue plays an important role in the formation and development of the tooth. Then, once the tooth has formed, the function of this tissue becomes one of helping to preserve the tooth's health and vitality. The nerve tissue keeps the organic components of the tooth's mineralized tissues (dentin and enamel) supplied with nutrients and moisture. The nerve tissue also produces new tooth structure (reparative dentin) as is needed so to help to wall off and protect the nerve from insult or injury (such as advancing tooth decay).


A tooth's nerve tissue does provide a sensory function but this role is probably different from what you expect. Under normal circumstances the nerves inside our teeth provide us with very little information. Yes, when activated by extremes in pressure, temperature, or severe insult (such as a cracked tooth or advancing tooth decay) teeth do respond with a painful sensation. But under normal circumstances the nerves inside our teeth remain relatively "quiet."


At this point you might be thinking that if you push on your tooth with a finger or close your teeth together you will feel a pressure sensation. Because of this you might assume that sensation must come from the nerve inside the tooth. Well, in reality, that sensation comes from the nerves found in the ligament that binds the tooth to the jawbone, not from inside the tooth itself. This implies then, from a standpoint of the normal functions we perform with our teeth, that the presence of a live nerve inside a tooth is somewhat academic. If a tooth's nerve tissue is present and healthy, wonderful. But if a tooth has had its nerve tissue removed as a part of the root canal treatment then that's fine too. You will never miss it.


How are Dental Root Canals Performed?

Depending on the number of teeth and severity affected, root canals usually require one to two visits not including any follow-up visits. Dr. Hernandez  will numb the area around the affected tooth, or may offer you the option of mild sedation. A rubber dental dam is placed and the tooth is then drilled to the pulp area either through the top or the back of the tooth. The actual root canals are measured after some of the pulp has been removed. This is done so that Dr. Hernandez an clean the entire canal, and so that enough of the filling material will be used to completely fill the canal. The actual measuring is done with either x-rays or electronic imaging devices.


All of the diseased pulp in the tooth is removed, and the canal is cleaned out thoroughly with an antiseptic solution. This solution will clean all of the canals within the tooth. The canals are then filled with gutta percha, a flexible plastic material. A temporary filling is then put on top of that. A crown or a permanent filling will be done after there has been no sign of infection. Crowns are most common since the root canal procedure weakens the tooth. The crown is usually placed as soon as possible, within a month or less.


Expect two to three days of soreness after the procedure, or longer if the infection in the root canal was severe.