RCT (Root Canal Therapy)

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If the nerves and blood vessels of a tooth have been irreparably damaged, rather than extracting the tooth, we may attempt to save it by undertaking root canal therapy. At ‘The Dentist’ each decision on whether or not to do root canal treatment is made on an individual basis. This takes into account the patients’ general health status at the time, reviewing that decision at each check up and deciding what the implications are of the alternatives to RCT. If we have suggested root canal therapy, then it is important to have the treatment started as soon as possible. An infection that is allowed to continue, will likely result in the formation of an abscess. This will lead to the destruction of the underlying bone tissue and may make it impossible to save the tooth. In addition, the infection can spread to the adjacent teeth and could result in blood poisoning, fever, facial and neck swelling and a general feeling of unwell.

Inside every tooth is the dental pulp, which consists of nerves and blood supply. Its main role is in the growth of the tooth. It also helps detect changes in temperature. The pulp may become inflamed and die. This usually occurs as a result of decay and/or trauma. This can sometimes be painful (acute pulpitis or abscess) or can occur without any pain at all and go on for years undetected (chronic periapical abscess) until it becomes painful or is detected from X-ray examination. When the pulp dies, dead tissue sits inside the tooth (gangrene) and because there is no blood supply to fight the bacteria and toxins, this reservoir of infection remains inside the tooth. A root canal treatment attempts to clean out the inside of the tooth.

Root canal therapy involves the various procedures used by us to save the tooth from having to be pulled, by removing the infected or diseased pulp from the tooth. In simple terms, the pulp chamber and root canals of the tooth are cleaned, sterilized, and sealed to prevent recontamination of the root canal system.

The tooth is not removed leaving an empty space, which if left empty would cause teeth next to or opposite the empty space to begin shifting from their normal position. Shifting can cause teeth to become crooked or crowded, causing alignment problems that may eventually result in even more teeth being lost. Your natural tooth has been retained maintaining the normal cosmetic appearance of your teeth. Eliminates the need to have a replacement tooth (bridge) put in place of the removed tooth. Bridges are normally expensive and may also require extensive work on adjacent teeth for retention of the bridge.

Root canal therapy typically requires a series of appointments. At the first appointment, we drill a small hole through the top of the tooth, and remove the infected pulp tissue. The pulp chamber and the root canals are then cleaned out and sterilized to remove all of the bacteria and infection products. If there is an abscess, then we may place a temporary seal on the tooth, provide you with antibiotics and schedule a follow-up appointment. During the next appointment, we use small instruments to clean any remaining bacteria and widen the canals of the tooth and prepare them for the final stage of the root canal therapy. Finally the canals are filled and obturated with a plastic material and sealant cement.

A tooth without nerve and blood supply dries out and becomes brittle and needs to be strengthened. The tooth often requires a crown for strength.

Individuals undergoing root canal therapy for the first time usually have great apprehension and many concerns: Is the procedure painful, will this tooth have to be extracted later, how long will the tooth last, will it turn black etc. From the patient's standpoint, it is easy to see how these concerns would exist. Normally the procedure is painless; we will use local anesthesia prior to starting to work on the tooth. Most restored teeth will last as long as your natural vital teeth. The reason for this is that as long as the roots of the endodontically treated tooth are properly nourished by the surrounding tissues, your tooth will remain healthy. It is somewhat of a paradox in that most people think that a root canalled tooth is a dead tooth. However, it is not a "dead tooth" as long as the roots of the tooth are embedded in healthy surrounding tissues that bathe the external surface and offer it nutrition. For this same reason, it is seldom that a tooth will turn black. If appearance does become a prime concern, the tooth may be bleached or veneered (having a porcelain or composite facing placed over it). Most often, retention of the tooth and bleaching, veneering, or crowning are preferable to extraction and replacement with a prosthetic appliance (artificial tooth).

The alternative to root canal treatment is to extract the tooth and thoroughly curette the extraction site. When a tooth is extracted it should be replaced to maintain the harmony and balance of the teeth and jaw. The alternatives have there own potential problems and often may involve more extensive and expensive treatments. These include removable partial dentures, fixed bridge work and dental implants.