Root canal treatment without secrets

Proven content

Root canal treatment as a method of treating irreversible pulp inflammations – an interview with Andrzej Twardzik, a dentist with many years of professional experience, running a private dental practice.

– Endodontic treatment, called root canal treatment, is sometimes the only way to save a sick tooth.

— Yes, endodontic treatment consists in cleaning the root canals and the tooth chamber from the diseased pulp. After thorough cleansing of diseased tissue and processing, and then disinfecting, the free spaces in the canals are filled with a biocompatible material, most often gutta-percha. This method is used to treat irreversible pulpitis, also known as irreversible pulpopathies.

– Irreversible, i.e. where all the pulp is dead?

— Irreversible, i.e. those that cannot be cured by biological methods by indirect or direct covering of the tooth pulp.

– Toothache is an alarm signal and at the same time a message that treatment should be started as soon as possible to save the sick tooth. Meanwhile, pulp diseases are not always painful.

— True, not always. It all depends on the advancement of the disease process. It must be remembered that the pulp of the tooth is a living tissue, richly vascularized and innervated, showing exceptional sensitivity to pain stimuli. Pain, often sudden, very severe, which patients sometimes describe as unbearable, occurs in a tooth with a vital pulp in the initial stage of an inflammatory disease. Advanced inflammation, which has been going on in the tooth for some time, but covers the still living pulp, may either give no pain symptoms or, on the contrary, be characterized by long-term pain of considerable intensity. The dead pulp and the tissue in the decay stage of gangrene do not show any pain symptoms. The pain felt by the patient is the result of the increasing pressure inside the chamber and the root canals.

– Root canal treatment also hurts …

— Endodontic treatment is indeed not the most pleasant, but it does not have to be painful, as it is usually performed under local anesthesia. In people with whom contact is difficult or with classic dentophobia, i.e. panic fear of dental procedures, root canal treatment can be performed under general anesthesia. Patients do not like endodontic treatment. In the case of irreversible pulp inflammations, it is the only treatment method apart from extraction, thanks to which the disease focus and the potential risk of developing a serious infection that can spread to many organs are removed from the body.

– So, apart from root canal treatment, there is no other way to heal a tooth with irreversible pulpitis?

– Not. You should also know that endodontic treatment cannot always be performed. In a situation where there are obstacles, e.g. in the form of channels formed in such a way that they cannot be thoroughly cleaned of the diseased tissue and processed, the dentist may decide to remove the tooth. It can also act more economically and perform resection of the root apex containing the uncleaned pulp and unfilled canal fragment. In the event that there are changes in the periapical tissues of the root, the dentist may perform hemisection or radisection. Both procedures are performed on multi-rooted teeth, in which in the case of hemisection one or more tooth roots are removed together with a part of the crown, while during radisection only the root (one or more) is removed, leaving the entire tooth crown. It should be noted that the current dentistry aims at the maximum conservation of tooth tissues, so all removal or cutting procedures are performed only in cases justified by medical reasons.

– Does the patient have to be specially prepared for root canal treatment?

— Not. However, the dentist must have a radiograph of a given tooth in order to be able to assess the size, number and shape of the root canals of the tooth and its surroundings – I mean the periapical area. Before the root canal treatment, the dentist interviews the patient to find out about his general health and about any allergies. Only when endodontic treatment is to be performed under general anesthesia, it is necessary to provide up-to-date laboratory tests. And then the patient will also be interviewed by the anesthesiologist qualifying for the use of anesthesia.

– How does the dentist prepare for endodontic treatment?

— First of all, by conducting a medical interview, reading the results of laboratory tests and radiographs in indicated cases. And it is necessary to prepare tools and utensils with which the diseased pulp will be removed, as well as measures for maintaining the aseptic conditions of the working field and for rinsing the cleaned canals. Therefore, tools for determining the length of the root canals (endometer), for the preparation and widening of the canals and for introducing material filling the canals must be at hand. Endodontic treatment is often performed under a microscope – thanks to this, the dentist’s actions can be more precise and effective. It is necessary to take control radiographs, sometimes during the procedure, and obligatorily after filling the root canals. It is possible thanks to the use of modern, safe devices emitting low doses of radiation (radiovisiography). The patient must also be provided with a cofferdam, i.e. a saliva dam, thanks to which the operating field remains free of saliva.

– Standard root canal treatment consists of several stages. Which one is the hardest?

— For the patient or for the dentist? (laughs) First-time endodontic treatment begins with opening the tooth chamber. And if there is pulp in it in the state of decomposition of gangrene, then for the staff working in the office, due to the emitted very unpleasant and at the same time very intense smell, it will probably be one of the least pleasant moments to bear. Patients generally do not like the next stage the most, i.e. the chemical-mechanical preparation of dental canals with the use of tools. At this stage, also with the use of chemicals, pathogens in the dentinal tubules are eliminated. The channels prepared in this way are dried and then filled – usually with gutta-percha with a sealer. The final stage is the reconstruction of the tooth defect.

– Why do cleaned channels need to be filled?

— To create a barrier that prevents bacteria from penetrating from the periapical area or the oral cavity into the canals of the tooth, where they would find conditions conducive to re-infection. Filling the root canals is therefore a protection against the emergence of secondary infection in the area of ​​the treated tooth and even the spread of the infection to the adjacent teeth.

– Is root canal treatment always successful?

— The organism is a living structure and in the case of root canal treatment, as with any other medical intervention, complications can arise. The main causes are significantly curved root canals, their obliteration, i.e. the closure of their lumen (especially in old age), the presence of dentinomas and perforation of the bottom of the tooth chamber, lateral or apical. It also happens that the tip of the tool used by the dentist to prepare the canal breaks during work and it cannot be removed to prepare the canal to the end. Sometimes the cause of unsuccessful endodontic treatment is a mechanical trauma, which is difficult to assess on a picture before treatment begins.

– Teeth can be treated endodontically once again. How is the course of such treatment different from the first treatment?

– In re-endodontic treatment, it is necessary to remove the root canal filling that was inserted during the first treatment. The rest of the procedures are the same.

– Are there any age restrictions for endodontic treatment?

— No, age is not a contraindication to endodontic treatment, although in different age groups it may turn out that the end of treatment has to be postponed, e.g. in children due to incomplete formation of the root apex of the teeth with vital pulp. On the other hand, in older patients, the aforementioned complete obliteration occurs, i.e. the closure of the root canal lumen, which prevents its development.

– Endodontic treatment is also carried out in children.

— Yes; is a specific age group. In the case of teeth with dead pulp and unformed root tips or their partial resorption, problems may be encountered related to the precise and tight closure of a very wide, in this case, root tip. However, the currently used materials allow for effective treatment in such cases. Endodontic treatment of living teeth with incomplete apex development should be postponed.

– Is it worth root canal treatment despite the uncertainty of the result?

— Definitely yes. A properly treated endodontic tooth can be used for many years. Although implants and dentures are more and more modern, nothing can replace your own teeth. Even if the crown is broken as a result of some event (e.g. trauma), a properly endodontically treated tooth can be used as a so-called “Natural implant”, on the basis of which the tooth can be rebuilt through a crown-root inlay and a prosthetic crown. It is also worth remembering that endodontic intervention will not be necessary if the dentition is treated in advance and you remember about periodic check-ups.

– Thank you for the conversation.

Interviewer: Katarzyna Kieś-Kokocińska