Everything about Root Canal Treatment

A root canal is a treatment used to repair and save a tooth that is badly decayed or becomes infected.

Root canal procedures are performed when the nerve of the tooth becomes infected or the pulp becomes damaged. During a root canal procedure, the nerve and pulp is removed and the inside of the tooth is cleaned and sealed.

Root canal procedures have the reputation of being painful. Actually, most people report that the procedure itself is no more painful than having a filling placed.

History of Root Canal Treatment 

We can trace the history of root canal surgery (endodontic therapy) back to 1756, when Philip Pfaff published his work on gold as a filler material. A web page at the Oregon State School of Dentistry has a more complete account of the history of root canal surgery.

At the center of every tooth is a hollow area that houses soft tissues, such as the nerve, blood vessels, and connective tissue. This hollow area contains a relatively wide space in the coronal portion of the tooth called the pulp chamber. These canals run through the center of the roots, similar to the way pencil lead runs through a pencil. The pulp receives nutrition through the blood vessels, and sensory nerves carry signals back to the brain. A tooth can be relieved from pain if there is stoppage of root canal when there is pain in the tooth.

Procedures for root canal

The space inside the root canals is filled with a highly vascularized, loose connective tissue, the dental pulp. The dental pulp is the tissue of which the dentin portion of the tooth is composed. The dental pulp helps complete formation of the secondary teeth (adult teeth) one to two years after eruption into the mouth. The dental pulp also nourishes and hydrates the tooth structure, making the tooth more resilient, less brittle and less prone to fracture from chewing hard foods. Additionally, the dental pulp provides a hot and cold sensory function.

Root canal is also a colloquial term for a dental operation, endodontic therapy, wherein the pulp is cleaned out, the space disinfected and then filled

Root canal anatomy consists of the pulp chamber and root canals. Both contain the dental pulp. The smaller branches, referred to as accessory canals, are most frequently found near the root end (apex), but may be encountered anywhere along the root length. The total number of root canals per tooth depends on the number of the tooth roots ranging from one to four, five or more in some cases. Sometimes there are more than one root canal per root. Some teeth have a more variable internal anatomy than others. An unusual root canal shape, complex branching (especially the existence of horizontal branches), and multiple root canals are considered as the main causes of root canal treatment failures. (e.g. If a secondary root canal goes unnoticed by the dentist and is not cleaned and sealed, it will remain infected, causing the root canal therapy to fail).

Root canals presenting an oval cross-section are found in 50%-70% of root canals. In addition, canals with a "tear-shaped" cross section are common whenever a single root contains two canals (e.g., mesial roots of lower molars). Nevertheless, these aspects of root-canal anatomy are not seen or recognized in conventional 2D radiographs, as the long axis of their flat cross section is usually directed in parallel to the direction of the x-ray beam. With the increased use of Cone Beam Computerized Tomography (CBCT), these shapes are likely to be increasingly more often seen and recognized not only by endodontists but also in the clinical environment of general practice.

When rotary NiTi files are used in canals with flat-oval or tear-shaped cross sections, a circular bore is created, while the buccal and/or lingual recesses remain un-instrumented. It takes (a) the awareness that a given canal is flat and (b) expertise in creative use of hand instruments to try to overcome this problem.
Tissue or biofilm remnants along such un-instrumented recesses may lead to failure due to both inadequate disinfection and the inability to properly obturate the root-canal space.

Why Does the Pulp Need to Be Removed?

When nerve tissue or pulp is damaged, it breaks down and bacteria begin to multiply within the pulp chamber. The bacteria and other decayed debris can cause an infection or abscessed tooth. An abscess is a pus-filled pocket that forms at the end of the roots of the tooth. An abscess occurs when the infection spreads all the way past the ends of the roots of the tooth. In addition to an abscess, an infection in the root canal of a tooth can cause:

Swelling that may spread to other areas of the face, neck, or head
Bone loss around the tip of the root
Drainage problems extending outward from the root. A hole can occur through the side of the tooth with drainage into the gums or through the cheek with drainage into the skin.

What Are the Signs When Root Canal Treatment is needed?

Severe toothache pain upon chewing or application of pressure.
Prolonged sensitivity/pain to heat or cold temperatures (after the hot or cold has been removed).
Discoloration (a darkening) of the tooth.
Swelling and tenderness in the nearby gums.
A persistent or recurring pimple on the gums.