Treatment of dental root canals

When dental decay is not treated in time, the lesion penetrates deeper through hard tissues until it reaches the pulp. At this point, treatment of dental root canals is required.

Each tooth consists of the crown and one or several roots. A dental crown is the part which is visible in the mouth. It is made of enamel and deeper layers of dentine. The root is the part of the tooth located in the gums and bone. It is coated by a thin layer of cementum and dentine in the deeper layer. There is a cavity inside the tooth filled with soft tissues (nerves, blood vessels, lymph vessels) which is called the pulp (to put it simply – a dental nerve). When an inflammation affects the entire dental pulp, root canals become a reservoir of various microorganisms. If an inflammation is untreated, it may penetrate deeper into the bone and cause an inflammation of apical periodontium.

What are the causes of pulpitis, i.e. the inflammation of the dental nerve?

The major cause of pulpitis is bacteria. As dental decay advances, deeper hard dental tissues are affected and the gate to the very pulp is opened for oral bacteria. The lesion of the pulp may occur while polishing teeth, treating deep dental decay or in the event of a trauma (dental injury, cracked crown).

What are the symptoms of pulpitis?

Patients usually complain about a very severe spasmodic causeless pain. Often, pain spreads into the ear, temple, is more intense in the evening and at night. Pain killers are ineffective or only larger doses relieve pain. In some cases, pulpitis produces no symptoms but even then the infection spreads into the surrounding bone.

How is pulpitis diagnosed?

First, patient’s complaints are listened to. Then, teeth are examined, i.e. dental decay, large fillings under which decay may occur are searched for, cold sensitivity of teeth is checked. When looking for dental decay between teeth, under fillings, crowns, an X-ray picture may be required.

How is pulpitis treated?

The purpose of treatment of root canals or endodontic treatment is to remove tissues of the dental pulp affected by the inflammation and microorganisms. Normally, treatment is performed under anaesthesia. Upon drilling the dental crown, one or several root canals are found. Depending on the tooth, the number of root canals may vary from one to four or even more. The tissues affected by the inflammation in the canals are removed. Then, canals are disinfected. During other appointments, dental root canals are once again cleaned, disinfected and filled, i.e. filled with gutta-percha (produced from tropical trees growing in Asia and Australia) and special cement (sealer).

Having filled canals, the dental crown is also filled or a denture is made depending on the degree of lesion. After endodontic therapy, it is usually recommended to fabricate dentures for molar and pre-molar teeth because they fracture more frequently.

What is apical periodontitis?

When the inflammation of the dental pulp is untreated or is treated improperly, the infection penetrates through the apex of the root into the tissues surrounding the root, i.e. periodontium, bone.

How is apical periodontitis diagnosed?

Patients complain about an increased sensitivity of the tooth when biting, chewing, and a nagging, dull pain. Due to the spread of the inflammation into periodontium, the tooth feels “high”, gingival swollenness is likely. An X-ray picture shows a wider periodontal ligament gap around the root apex, bone destruction and abscess.

How is apical periodontitis treated?

Apical periodontitis is treated in a similar way as pulpitis but more visits to the clinic are required. First, the infected pulp or an old filling of the dental canal is removed. Canals are disinfected, they are filled with medicine (calcium hydroxide) to remove the inflammation focus. Canals are then filled with special substances and the dental crown is filled or a denture is made.
Generally, treatment of dental root canals is extremely complicated, requires great experience and thorough work. Very tiny instruments, occasionally special optical devices, are used. Most frequently, canal treatment is accomplished during several appointments, yet sometimes more appointments may be required. Quality endodontic treatment is more expensive in all senses. Therefore, prevention, i.e. good oral hygiene and regular visits to the dentist, always pay back.