Endodontics: course of treatment
Although root canal treatments are sometimes feared by patients, they are not painful. You can rely on the expertise, empathy and experience of Dr Mehl.
If Dr Mehl can identify the tooth affected he will anaesthetise it and the surrounding area. Phobic patients can undergo this treatment under sedation or general anaesthetic. He will then cover the tooth and seal it to ensure that neither bacteria nor saliva can contaminate the area, and no disinfection solution is swallowed by the patient.
Then with the help of a microscope Dr Mehl gains access to the nerve system of the tooth. This is done by drilling a small hole into the chewing surface of the tooth. The root canal system is cleaned using rotating files and a tailor-made combination of disinfectants until the root tips, known as the apices, are reached.
How does a root canal treatment work?
This is a lengthy process but it is crucial to the success of the root treatment. To help avert boredom we provide video glasses so you can relax and watch a film or television show of your choice.
The length of the root canal is measured using an electronic gauge in a process known as endometrics, helping us avoid doing additional X-rays. Following preparatory treatment Dr Mehl will clean the nerve canals a second time by using a specially developed file (SAF system). This step is aimed at killing bacteria and removing tissue remnants.
Depending on the severity of the inflammation and the complexity of the patient’s root canal system, most treatments of this nature require only one visit to the dentist. After Dr Mehl has conscientiously and carefully prepared and disinfected the root canal, he seals it with a thick root filling to prevent bacteria entering. The material we use for this, gutta-percha, has proven to be very reliable.
For back teeth, crowns or partial crowns are used after this treatment to prevent tooth fractures or reinfection. The restoration stabilises the tooth in such a way that it will be twice as strong as a natural tooth free from decay.
How does tooth ache develop?
An example of a root canal treatment in pictures
When a dental nerves dies as a result of trauma, it is accompanied by inflammation in the root tips. This inflammation may affect your general health, not just your mouth. It is therefore vital that both the tooth and the root canals be disinfected up to the root tips. Here you can see a four-channelled back tooth with cleaned out canals.
The canals are sealed using cement and rubber-like pins made from gutta percha.
The tooth then receives a filling for restabilisation. In order to achieve long term stability, ceramic partial crowns or regular crowns are a suitable option.
Here is an X-ray showing a tooth with a root filling. The rubber tips fit perfectly into the tip of the dental root.
When might I experience toothache?
Toothache can happen because of one or more of the following: tooth decay, trauma from an impact, cracks in the tooth, loose fillings or crowns, differences in pressure (eg when flying or diving) and chemical or thermal stimuli (hot and cold). In rare cases toothache lasting for a week or two may be the result of a cold. Toothache caused by colds or changes in pressure initially only need to be observed. If needed we can cover sensitive tooth necks with small fillings. Root canal treatment should only be undergone when the tooth that is the source of the pain has been identified conclusively.
When the inflammation of the dental nerve (pulpitis) leads to uncontrolled dying off of the nerve, this inflammation may spread to the surrounding tissue and bone. Endodontists can see this in an X-ray — it usually shows as a dark spot at the tip of the root. This is because minerals such as calcium and magnesium are released from the bone as a result of the inflammation. In the more advanced stages of this condition the inflammation might break through the bone and an abscess could form. In this stage patients tend to suffer severe pain.
If the abscess empties through the membrane around the bone (the periosteum) and the gums into the oral cavity, this results in what is referred to as a dental fistula, at which point the pain stops. Once the inflammation reaches chronic stages dental cysts can form, which in most cases do not cause pain. However the tooth affected should be treated to prevent inflammation spreading.
What can I do if I have broken a tooth?
Dental trauma is most common among children and young people. Falling off a bicycle, slipping and tripping by the swimming pool or an impact from a hard object are among the most common causes. If a piece of the tooth breaks off or the tooth is knocked out altogether it is best to immediately see an endodontist. The tooth should be kept in a specially designed tooth rescue box, in saliva or in UHT milk. If the tooth can be treated your endodontist has three choices:
- If only part of the tooth is broken off without the dental nerve being affected, the fragment can be glued back on. Alternatively, the missing part of the tooth can be replaced using a filling or a veneer. Vitality of the tooth should be checked over the coming years.
- If a large chunk of the tooth has broken off and the dental nerve has been exposed, the endodontist will first of all perform root canal treatment. Depending on where the tooth is in terms of its growth stage, procedures may differ. In the early stages it may be possible to preserve the vitality of the tooth and to promote the natural conclusion of the growth of the dental root. The missing fragment can then be glued back on or the tooth can be sealed with a filling, a veneer or a crown.
- If the tooth has been knocked out and stored correctly it can be put back in place. In this case, too, an endodontist must first of all perform root canal treatment. This is because the dental nerve was most likely torn off as a result of the trauma, and the dental nerve may have died. The tooth will then, for a duration of three months, be aligned with the teeth on either side. It is vital to observe the tooth since root problems frequently occur in such cases.
For more information regarding this treatment
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