Published in Panorama
When Root Canal Treatment is Required
You could well be inviting trouble by ignoring the persistent ache in your tooth, actually allowing dental caries to progress to a point where extraction or root canal treatment may be your only solution options! Yes, if dental caries is allowed to progress beyond the enamel and dentine of your tooth and invade the tooth pulp, the most sensitive region of the teeth comprising nerves and blood vessels, root canal treatment may become inevitable says Dr.Shaheen M. Khokhawala, Aesthetic Dental Surgeon, Al Musalla Medical Centre, Dubai.
“Generally when you have irreversible pulpitis, that is infection of the pulp, the only way to save the tooth is either extraction or root canal treatment. In fact, tooth extraction is rather obsolete as per current practices in dentistry, unless of course, at the site of the pulpal condition, there is also damage to the supporting tooth structure - the gums and the bone, due to infection.
The indications for root canal treatment include pain while biting or chewing food, sensitivity to hot and cold food, spontaneous pain or throbbing and severe tooth decay or injury that causes the formation of abscess in the bone surrounding the tooth.
Root canal treatment involves treatment of the pulp space within a tooth, usually performed under local anesthesia. Before initiating the procedure, the oral cavity is thoroughly assessed. Dr.Shaheen explains, “An access opening is made through the crown of the tooth into the pulp cavity. Basically we drill the pulp and remove the infected pulp with the help of fine root canal instruments. Canals are cleaned with disinfectant irrigating solutions, enlarged and shaped using progressively larger endodontic files, that is, with root canal instruments. Once the cleaning and shaping of the root canal are completed, the root canal space is filled with a rubbery, plastic filling material called gutta-percha and a sealing cement. This will harden and seal the canal from bacterial invasion.”
A tooth that has undergone root canal treatment will always require some type of restorative treatment after the root canal is finished. Generally since so much cleaning and shaping occurs, the tooth is basically weakened. So we suggest a cap to be put after the filling is done, to restore the tooth. Many times this treatment will include a crown build-up, usually of gold or porcelain. Sometimes, a tooth that has not suffered extensive structural damage may be restored with a bonded composite resin filling or bonded inlay or onlay. The material used to fill the root canal space will probably last a lifetime, but eventually the filling or crown may required to be replaced.
The duration of the root canal treatment procedure may vary between half to one hour. Dr.Shaheen explains, “In fact, the first session is definitely longer and may take an hour or thereabout since we need to get the individual’s complete history and make an evaluation of the oral cavity. As regards the actual procedure, nowadays we do have bio-mechanical preparation and machine driven instruments which have speeded up the process. Yet the initial preparation to a certain extent, has to be done by hand since the canal is really very fine and narrow, we need to hacve the tactile sensation to exactly locate them. The second and third sessions may take only half an hour or so. This is so because in very severely infected teeth, more than one visit may be required to complete the procedure.”
What are the immediate after effects of root canal treatment? There may be some amount of soreness in the region on account of the anesthesia, explains Dr.Shaheen. “Bleeding happens only during the actual procedure. Thirdly, when we do the filling of the tooth, in very rare instances, some patients may show a reaction to the filling material by way of inflammation. So the patient may have some discomfort for 1 – 2 days following the treatment. Again, in very rare instances, if some amount of the infected tissue is left behind and the filling is closed, there may be an open pus drainage. In such a case we might have to give something called an open dressing, just for 24 hours. In that case, the patient may have pain for the first two days and the pain may not be less than what he came with, prior to the treatment.”
Root canal treatment is a completely safe procedure because there is no real risk except that associated with anesthesia. There is no complete contra-indication to the procedure. Even in the case of pregnant women in the first and last trimester of their pregnancy, where there is risk of the infection getting pushed into the foetus via the blood stream, root canal treatment can be safely undertaken under antibiotic coverage, reveals Dr.Shaheen.”
In the case of hypertensive, cardiac and diabetic patients, root canal treatment may be done after ensuring stability of these conditions, reveals Dr.Shaheen. “We have to ensure that patients’ blood pressure is under control. In the case of cardiac and diabetic patients, we have to put them under a high dose of prophylactic antibiotic and then do the procedure. Those patients who are on aspirin or an anticoagulant for cardiac problems, we have to stop this medication if tooth extraction is to be done.”
Once root canal treatment has been done, what are the chances of infection or any other problem occurring in that tooth again? Dr.Shaheen explains, “There would be no chances of re-infection if the procedure is done properly, unless there was already an existing periodontal problem. In that case, there would be some problem. But in that case, while we are doing the treatment itself, we will get to know the problem. So once the treatment is complete, chances of pain coming back, will not be there.”
While root canal treatment is associated with a very high rate of success, between 90% - 95%, However, where the treatment fails, re-treatment of the root canal may be done, but at higher cost, greater time and increase complications. Dr.Shaheen clarifies, “The only risk from the treatment is if the treatment itself is not done properly. This may happen when some amount of the infected tissue is left behind. In this case, the treatment itself would be seen as a failure and this may ultimately lead to the extraction of the tooth.”
The complications associated with root canal therapy include infection, discomfort and fracture of the tooth. The complications occur more often in teeth which have had severe symptoms prior to the treatment or where the teeth have had delayed diagnosis and treatment or where the patient had not strictly adhered to post-treatment care.
Alternative option to root canal treatment involves tooth extraction which while less expensive in the short term, is associated with bone loss, loss of chewing ability, loss of support of facial muscles and structures, difficulty in speaking and shifting of teeth in upper and lower jaws.