Root Canal Therapy
One of the last lines of defense when it comes to preserving a tooth is root canal therapy (RCT). Some people seek care from Dr Timmerman after the problem has advanced so much that treatment is much more complicated (perhaps even more painful) than if care was sought at or before the first painful event (before meaning a cavity or abscess was seen on an x-ray at a routine visit, but there were no symptoms.) Root canals restore a tooth from the inside out, that is removing the infected nerve tissue and placing a filling material inside of the tooth. This removes the diseased tissues and infection, disinfects the tooth from internally, and prevents the tooth from eroding from the inside as well as recurrent infections.
Examples of When a Tooth Needs a Root Canal
Teeth typically need to be treated endodontically when:
- There is or has been an abscess on the tooth
- Trauma or injury has caused the tooth to die
- A large fracture or cavity is within close proximity of the nerve
- The patient experiences chronic pain caused by a crack in the tooth
Root Canal Treatment Process
Having a root canal is no different than most other dental treatment. It starts with a proper and complete diagnosis to determine which tooth is problematic (it isn’t always obvious) and the extent of the problem, as sometimes the damage is so significant that the tooth cannot be saved. The screening tests may include: percussion (tapping), palpation (lightly rubbing a gloved finger in the area), probing (pocket depth of the tissues surrounding the tooth), mobility (does it wiggle? adequate bone support to keep the tooth?), thermal tests (iced and/or heated instrument), and x-ray evaluation.
After the tooth has been identified, a small hole is created on top of the tooth to give direct access to the pulp/nerve. The pulp is unroofed enough to ensure complete removal of the pulp tissue and create a path to the canal system. A file is introduced to the canal to determine the length of the canal, often with the assistance of a device called an apex locator. This device is much more accurate in measuring canal length than just an x-ray, so if one is not used in your treatment, you should suspect inadequate care.
Cleaning and Shaping
After the length of the canal is learned, mechanical shaping of the canal is done. This is completed by using incrementally larger width files. Each file is the same length, but wider. Dr Timmerman uses a rotating file system so that the canal is cleaned and shaped precisely. In between each file, an antibacterial liquid is flushed into the system to wash away the bacteria and particles of shaped tooth. This helps to kill the infection.
Mechanical cleaning and shaping is very important, but chemical irrigation is key to disinfecting the tooth. There are many products that can be used, and Dr Timmerman prefers to use a combination of materials to make sure the tooth has been disinfected as much as possible. Some bacteria are killed with certain specific materials and others are not. By using a combination, the hope is that the entire spectrum is addressed.
After a canal has been cleaned, shaped, and disinfected, it must then be filled. The term dentists use is “obturation“. A sealer (imagine caulking) coats a gutta percha “cone”, a rubber-like material that is often used at the core of golf balls (fun fact). This sealer prevents re-infection of the root canal system by hermetically sealing the canal, as well as gives the root of the tooth increased strength.
If a tooth is treated with root canal therapy but NOT restored with a final restoration (crown, onlay, or whatever is determined as necessary), the tooth can still be lost. The hollowing out process of the therapy leaves a weaker tooth and it is prone to fracture. Fractures of teeth that have NOT had root canal therapy are often “chips” and are easily restored. Fractures of teeth that had RCT sometimes crack or break in such a way that the tooth must be extracted. Imagine “splitting wood” in lumberjack competitions. The fracture propagates the entire length of the tooth and is hopelessly unrestorable
—Dr. Lance Timmerman