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Root Canals: A Contemporary Point of View
Root canal treatment is an age old remedy for managing teeth with pulpal (nerve chamber) pathology. It dates all the way back to the early Egyptian civilization. Now, modern dental techniques afford dentists and endodontists (RCT specialists) the ability to save teeth once doomed for extraction.
Contrary to popular myth, a contemporary root canal is not a scary experience. New high-tech equipment, including sophisticated sonar-like instruments, makes the therapy a routine part of comprehensive dental care. Predictably effective local anesthetics, high torque handpieces, and titanium files make the procedure quick and painless with a high success rate.
When performed prior to (and preventing) an acute stage, root canals are commonplace and no more stressful than other aspects of clinical dentistry. Admittedly, in an acute phase, attaining complete anesthesia is more challenging, but it can be accomplished with no more than mild to moderate discomfort to the patient.
Many general dentists perform RCTs on anterior teeth, and some are skilled in treating posterior teeth. Dentists often refer a patient to an endodontist for more complex cases. As in all aspects of dental care, a general dentist is held to the same standard of care as is the specialist. In routine cases, general dentists are quite adept in RCT procedures.
Root Canal Procedures
Some dental experts have described the inside of a tooth as a tootsie pop, a rather ironic analogy. Within every tooth resides an internal compartment that extends into each of the roots. Important in the developmental stage of a tooth, the chamber, or pulp, contains formative cells, a blood supply and nerve fibers. Fortunately, once a tooth fully forms (usually within three years after its eruption), the pulpal contents are no longer necessary to a functional tooth. Otherwise, RCT would not be feasible.
The pulp chamber that extends into the root is called a canal. Anterior teeth commonly have one canal; pre-molars, one or two; and molars may have three, four, or more canals. After the administration of a local anesthetic, the dentist creates an access opening to gain entrance to the pulp chamber. Then each (root) canal is thoroughly cleansed, enlarged, and ultimately filled with an inert material to seal the canal(s). Since root canal-treated teeth usually become brittle, special considerations are necessary for complete restoration. Usually a tooth with RCT needs a full crown, possible a post, to restore its integrity. There are exceptions.
Root canal treatment does not always follow a predictable course. Even after appropriate initial therapy, a tooth may not heal in the expected manner. Antibiotics and possibly, anti-inflammatory medications, may then be necessary as an adjunct to the mechanical debridement of the pulp and its canals. Facial swelling from an infected tooth, a depressed immune system or other systemic factors can complicate root canal treatment. Suppuration (pus) around the infected root increases the acid concentration and it may create difficulties with anesthesia.
Occasionally, for less than 5 percent of teeth, conventional RCT may not be successful. Inaccessible canals, accessory canals, microscopic fractures and unusual dental anatomy interfere with treatment. Even then, other options to extraction are possible. This may seem like a lot of dental care for one tooth, yet saving a tooth is usually preferable to an extraction and placement of a bridge or an implant. The valuable lesson is that it is better to avoid needing a root canal by visiting the dentist regularly and finding problems before they require extensive and costly treatment.
Dental infections can harm the entire body, physically and emotionally. Needed root canal procedures are therefore important to overall health and well being. Pain is not always present with pulpal pathology. Regular dental visits can help detect infected teeth and serve to prevent unforeseen dental calamities.
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