Root Canal Treatment

The outside of your tooth is made up of 2 hard substances: the outer, harder layer called enamel and the inner softer layer called dentin. Under the dentin exists the dental pulp. Here are the blood vessels and nerves needed to help form the tooth when it is developing. The dental pulp extends into each individual root sometimes there can be more than one root canal in a root. Once a tooth is fully formed and mature, the dental pulp is not needed anymore. The tooth receives nourishment from the surrounding gum and bone tissue

There are many reasons why a tooth may need a root canal. One of the most common reasons is when a cavity in a tooth forms that is very large and deep into the tooth. When it reaches the dental pulp, the bacteria then can penetrate the soft tissue and can fester. Often, a patient perceives this as pain but can be exasperated by hot or cold temperatures or sweet foods. Other reasons for root canal treatment include repeated traumatic procedures on a tooth (multiple fillings, crown preparations, heavy bite due to work in the area) and direct trauma to the tooth from a direct blow with or without tooth breakage. All of these can cause inflammation and infection in pulp and if not addressed could lead to pain and an abscess.

1) First and foremost, an appropriate diagnosis of the problem must be made. Careful examination of the mouth (both extraorally and intraorally), surrounding structures, X-rays and patient symptoms will help Dr. Vlahos make the diagnosis. Once the offending tooth has been identified, a local anesthetic will be administrated. It is crucial to achieving adequate anesthesia so the root canal procedure will be relatively uneventful. A dental dam (usually made of vinyl) will be placed over the tooth to isolate the tooth from the rest of the mouth and protect the tooth from saliva. Once the treatment has begun, it is very important to try to keep the tooth as sterile as possible.

2) An access opening will be created through the top part of the tooth in order to get at the infected part of the tooth. Once accessed, each individual root canal will be located and accessed. Typically teeth can have anywhere between 1-5 root canals (but it depends on the kind tooth we are dealing with; front teeth usually one, molars 3-5). Initially, small files will be inserted into each canal to remove any infection and debris. Then, the exact length of the root canal will be determined through a device called an apex locator. Once the exact length is known, each canal will be shaped and clean with rotary instruments to idealize the shape of each canal. A disinfectant irrigant will be used to further flush out the canals and debris. The cleaned canals are then dried and ready to be filled. With adequate local anesthesia, this and the remaining steps of the procedure should be painless.

3) The root canals are ready to be filled. A biocompatible filling material called gutta percha and cement is used to seal each individual root canal. This material is inert and will provide a good seal to prevent any further infection from getting into the root canal system. Usually, once the canals are sealed, a temporary filling is placed in the access opening until the tooth can be restored permanently.

4) Depending on the degree of your tooth’s structurally integrity either a simple filling or a core filling with a permanent crown will have to placed on your tooth. Root canal teeth tend to be brittle and broken down. The incidence of tooth fracture can be significantly increased after root canal treatment. It is also very important to ensure that the tooth has a good seal from the oral environment to prevent bacterial infection again.