Root canal treatment

Root canal treatment, also known as endodontic treatment, is a dental procedure in which the diseased or damaged pulp (central core) of a tooth is removed and the inside areas (the pulp chamber and root canals) are filled and sealed.

An inflamed or infected pulp is called pulpitis. It is the most common cause of a toothache. To relieve the pain and prevent further complications, the tooth may be extracted (surgically removed) or saved by root canal treatment.

Inside the tooth, the pulp of a tooth is comprised of soft tissue that contains the blood supply, by which the tooth receives its nutrients; and the nerve, by which the tooth senses hot and cold. This tissue is vulnerable to damage from deep dental decay, accidental injury, tooth fracture, or trauma from repeated dental procedures such as multiple fillings or restorations over time. If a tooth becomes diseased or injured, bacteria may build up inside the pulp, spreading infection from the natural crown of the tooth to the root tips in the jawbone.

Pus accumulating at the ends of the roots can form a painful abscess that can damage the bone supporting the teeth. Such an infection may produce pain that is severe, constant. It can also result in prolonged sensitivity to heat or cold, swelling, and tenderness in the surrounding gums, facial swelling, or discoloration of the tooth. In some cases, however, the pulp may die so gradually that there is little noticeable pain.

Root canal treatment is performed under local anesthesia. A thin sheet of rubber, called a rubber dam, is placed in the mouth and around the base of the tooth to isolate the tooth and help to keep the operative field dry. The dentist removes any tooth decay and makes an opening through the natural crown of the tooth into the pulp chamber. Creating this access also relieves the pressure inside the tooth and can dramatically ease pain. The dentist determines the length of the root canals, usually with a series of x rays. Small wire-like files are then used to clean the entire canal space of diseased pulp tissue and bacteria.

The debris is flushed out with large amounts of water (irrigation). The canals are also slightly enlarged and shaped to receive an inert (non-reactive) filling material called gutta percha. However, the tooth is not filled and permanently sealed until it is completely free of active infection. The dentist may place a temporary seal, or leave the tooth open to drain, and prescribe an antibiotic to counter any spread of infection from the tooth. This is why root canal treatment may require several visits to the dentist.

Once the canals are completely clean, they are filled with gutta percha and a sealer cement to prevent bacteria from entering the tooth in the future.

Signs that a root canal treatment is necessary include severe pain while chewing, prolonged sensitivity to heat or cold, or a darkening of the tooth. Swelling and tenderness of the gums or pimples appearing on the gums are also common symptoms. However, it is also possible that no symptoms will be noticed. The dentist will take an x ray of the tooth to determine if there is any sign of infection in the surrounding bone.

Once a root canal treatment is performed, the recipient must have a crown placed over the tooth to protect it.

During the time when antibiotics are being used, care should be taken to avoid using the tooth to chew food. The tooth has been structurally weakened and may break, or there is a possibility of the interior of the tooth becoming reinfected.

If the tooth feels sensitive following the procedure, a standard over-the-counter pain medication such as ibuprofen or naproxen may be taken. This sensitivity will fade after a few days. In most cases the patient can resume regular activity the following day.

There is a possibility that a root canal treatment will not be successful the first time. If infection and inflammation recur and an x ray indicates a repeat treatment is feasible, the old filling material is removed and the canals are thoroughly cleaned out. The dentist will try to identify and correct problems with the first root canal treatment before filling and sealing the tooth a second time.

In cases where an x ray indicates that another root canal treatment cannot correct the problem, endodontic surgery may be performed. In a procedure called an apicectomy, or root resectioning, the root end of the tooth is accessed in the bone, and a small amount is shaved away. The area is cleaned of diseased tissue and a filling is placed to reseal the canal.

With successful root canal treatment, the tooth will no longer cause pain. However, because it does not contain an internal nerve, it no longer has sensitivity to hot, cold, or sweets. Because these are signs of dental decay, the root canal recipient must receive regular dental check-ups with periodic x rays to avoid further disease in the tooth. The restored tooth may last a lifetime. However, with routine wear, the filling or crown may eventually need to be replaced.

In some cases, despite proper root canal treatment and endodontic surgery, the tooth dies and must be extracted. This is relatively uncommon.

The only alternative to performing a root canal procedure is to extract the diseased tooth. After restoration or extraction, the two main goals are to allow normal chewing and to maintain proper alignment band spacing between teeth. A fixed bridge, a removable partial denture or an implant will accomplish both goals.

Ex. 10. Translate the following words and word-combinations into your native language:

Successful; root; canal; treatment; cause; pain; nerve; sensitivity; signs; dental decay; root canal; recipient; regular; dental check-ups; periodic x rays; to avoid further disease; tooth; restored tooth; routine wear; filling; crown; to be replaced; endodontic surgery; the tooth dies; root canal procedure; to extract the diseased tooth; restoration; extraction; removable partial denture.

Ex. 11. Translate the text "Root canal treatment" into your native language.

Ex. 12. Answer the following questions:

1.What does endodontics include? 2. What does pulpitis lead to? 3. When is endodontis treatment required? 4. What is the basic object of endodontic treatment? 5. What is the commonest cause of pulpitis?

Ex. 13. Insert the missing words:

1. There is a possibility that a _ will not be successful the first time. 2.If infection and _ recur and an x ray indicates a repeat _is feasible, the old _ is removed and the canals are thoroughly cleaned out. 3.The _will try to identify and correct problems with the first root canal treatment before _ and _the _ a second time. 4.In cases where an _ indicates that another root canal _ cannot correct the problem, _ may be performed. 5.In a _ called an _, or root resectioning, the root end of the tooth is accessed in the bone, and a _ is shaved away. 6. The area is _ of diseased _ and a filling is placed to reseal the canal.

Ex. 14. Speak about Endodontics and possible ways to treat pulpitis.

Ex. 15. Look through the text, make a vocabulary, read it and translate.

In the situation that a tooth is considered so threatened (because of decay, cracking, etc.) that future infection is considered likely or inevitable, a pulpectomy, removal of the pulp tissue, is advisable to prevent such infection. Usually, some inflammation and/or infection is already present within or below the tooth. To cure the infection and save the tooth, the dentist drills into the pulp chamber and removes the infected pulp and then drills the nerve out of the root canal(s) with long needle-shaped drills. After this is done, the dentist fills each of the root canals and the chamber with an inert material and seals up the opening. This procedure is known as root canal therapy. With the removal of nerves and blood supply from the tooth, it is best that the tooth be fitted with a crown which increases the prognosis of the tooth by six times.

The standard filling material is gutta-percha, a natural non-elastic latex from the sap of the percha (Palaquium gutta) tree. The standard endodontic technique involves inserting a gutta-percha cone (a "point") into the cleaned-out root canal along with cement and a sealer.

Another technique uses melted or heat-softened gutta-percha which is then injected or pressed into the root canal passage(s). However, gutta-percha shrinks as it cools, so thermal techniques can be unreliable; sometimes a combination of techniques is used. In rare cases, the paste like any other material can be forced past the root tip into the surrounding bone. If this happens, the formaldehyde will immediately be transformed into a harmless substance. The blood normally contains 2 mg formaldehyde per liter and the body regulates this in seconds.

For some patients, root canal therapy is one of the most feared dental procedures, perhaps because of a painful abscess that necessitated the root canal procedure. However, dental professionals assert that modern root canal treatment is relatively painless because the pain can be controlled with a local anesthetic during the procedure and pain control medication can be used before and/or after treatment assuming that the dentist takes the time to administer one. However, in some cases it may be very difficult to achieve pain control before performing a root canal. For example, if a patient has an abscessed tooth, with a swollen area or "fluid-filled gum blister" next to the tooth, the pus in the abscess may contain acids that inactivate any anesthetic injected around the tooth. In this case, the dentist may drain the abscess by cutting it to let the pus drain out. Releasing the pus releases pressure built up around the tooth; this pressure causes the pain.