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Dec 27, 2016

Root canal treatment (or not)

Toothaches can have many causes. You may experience pain even though the nerve of the tooth is gone (read more about pulp damage). But quite often the symptoms are obvious and a “root canal treatment” (root filling) is the best treatment. We gently remove the soft tissue inside the tooth (the pulp), clean it and seal it. Today this can be done completely pain-free. It is a common misconception that the best way to end toothaches is to remove the nerve. But without a nerve, the tooth loses its strength. At Snö, we believe it is always better to save the pulp, whenever possible.

There are basically four different scenarios depending how far the process has gone:

  • Pulp inflammation with chance for recovery
  • Pulp inflammation without chance for recovery
  • Pulp partially or fully infected with bacteria
  • Already root filled teeth with problems

Pulp inflammation with chance for recovery
If possible, we always begin by removing whatever causes trauma (eg caries) to the pulp. This is in order to save the pulp.

Above a schematic example of a healthy tooth (left) and one with a caries lesion (right) filled with bacteria that irritates the pulp.

The tooth is typically very sensitive, especially to cold. The inflammation creates pressure inside the pulp chamber making the nerve even more sensitive. The quick fix is to remove the pulp and do a root filling, but we do not believe that this is always necessary. In many cases, when most of the caries is removed and, more importantly, the cavity is sealed with a tight temporary filling, the pulp relaxes and the inflammation disappears. After a while (usually two months), if the tooth looks and feels better, it is an indication that we managed to save the pulp tissue. This also saves you the cost and trouble of a root filling. However, in some cases the inflammation is too widespread, making a root canal treatment necessary.

Unfortunately, dentists cannot easily tell which tooth will heal and which will not. Hence, many dentists play it safe by administering root canals. At Snö, we do not believe this is right, which is why we recommend a thorough exam (Snö Exam) and we carefully monitor your progress. 

Pulp inflammation without chance for recovery
When the symptoms are more severe and/or when we can diagnose an irreversibly damaged pulp, the two options are to remove the tooth, or try to save it with a root canal treatment. The latter is similar to the treatment for an infected tooth, but generally has a slightly better prognosis, and is sometimes faster.

Depending on the severity of your case, we will inform you of your prognosis and the alternatives.

Pulp partially or fully infected with bacteria
When bacteria gets into the pulp; eg, via a caries lesion, the infection spreads down through and out to the root canals, in close contact with the bone. Common symptoms at this stage are tenderness to touch and while chewing, discolouration of the tooth, swelling, pus drainage and tenderness in the lymph nodes, nearby bone and gum tissue. In some cases there may be no symptoms. To treat this, we remove the diseased and dead pulp tissue from the tooth with specially designed instruments.

This procedure is not painful as the area is numb and the tissue being removed is either dead or dying. Once the pulp, along with the nerves contained in it, is removed, the tooth itself can no longer feel pain. If there is an infection outside the root, it could cause some discomfort. But this will gradually dissipate. For particularly difficult cases we leave a special paste inside the tooth to fight bacterial build-up. But for most cases, we fill the tooth in the same session.

We then select root canal fillings (red above) that fit precisely into the freshly prepared canals. A rubber-like material called gutta-percha is used to fill the canal space. It is a thermoplastic material (“thermo” – heat; “plastic” – to shape) that is heated and then compressed into and against the walls of the root canals to seal it. Together with an adhesive cement (called sealant), the gutta-percha fills the prepared canal space. Sealing the canals is critically important to prevent them from becoming reinfected with bacteria. When the infection is gone, the bone will heal again (right), growing back into the cavity it created during the infection.

Your tooth will then need a permanent restoration — a filling or a crown — to replace lost tooth structure, and provide a complete seal for the top of the tooth. This step is of particular importance.

Already root filled teeth with problems
The prognosis for a root canal treatment depends on how thoroughly the treatment is carried out. If done quickly, without proper infection control and precision, the tooth could become reinfected. At Snö, we have the tools and expertise to guarantee thorough root canal treatments. 

However, some patients might have hidden canals or small fractures in the tooth/root leading to infections. In such cases, we can spot the problem and either do a cleaning/root filling procedure, or treat the root tip using microsurgery. The absolute last resort would be to remove the problematic tooth.

At Snö we prefer to give you pain-free options. You will always get all the information pertaining to your case, including all available scientifically proven techniques, alternatives, risks and prognoses. The Snö team is available to answer any questions you may have.