When a cavity passes all the way through the enamel and dentine of the tooth and into the pulp chamber (the areain the middle of the tooth where the nerve and blood supply sit), the bacteria quickly starts to spread. As the blood supply in the tooth is so small, the body can offer little resistance to the attack and the nerve and blood supply quickly dies, creating a reservoir of bacteria inside the tooth, which the body has no way to get to resolve. A root canal treatment is essentially the process of cleaning out all the bacteria in this space, and then filling it to prevent bacteria getting back in.
A root canal is usually done over a few visits. This is important as it allows time for the medicaments that we place in the tooth between visits, to kill all the bacteria and disinfect it thoroughly. The appointments for a root canal are usually as follows:
- This describes the process of removing the bulk of the dead material in the tooth, and putting in a antibacterial paste to start the disinfecting process. This is usually done at an emergency visit to address pain, or in combination with a filling, where the bacteria in other parts of the tooth are also cleaned out and sealed with a filling. It is important that the tooth is sealed so that no more bacteria can get into the tooth during the process, as complete disinfection is critical to long term success.
- The next step is to shape and prepare the long skinny canals in the tooth so that we are ready to fill up the space. The space within the middle of a tooth is usually very fine and irregular, and without filing and shaping these spaces, would be almost impossible to fill adequately. We usually take an xray during this appointment to make sure we’re filing the canals to the right length. This process also has the benefit of mechanically removing more bacteria and debris, as well as opening up the space to allow us to irrigate and medicate the whole space more effectively. The spaced is usually dressed with a paste and sealed off again at the end of this appointment.
- Obturation is just a fancy word for blocking or filling something, which is essentially what we’re doing when we fill this space up. We won’t do this unless the tooth has been pain free for a period of time, which indicates as much as we can tell, that the infection in the tooth has been completely removed. We fill the canal spaces with essentially a shaped rubber point, which matches the size of the files that were used to shape the canals. We compress the rubber in the space with a special glue that helps seal it off. We usually take an x-ray during after this appointment to ensure that we will and have filled the space appropriately. We then fill the tooth back up so it is ready for it’s final restoration.
In most situations, particularly back teeth, a crown is highly recommended on a tooth after it’s had a root canal treatment. This is recommended for a few reasons.
- Once the nerve and blood supply are gone, the tooth tends to become more brittle and is more susceptible to fractures.
- There is usually a considerable amount of tooth missing for it to have needed a root canal in the first place, and a crown will help to reinforce the remaining tooth.
- Keeping bacteria away from the middle of the tooth is critical for long term success. A crown will seal the tooth and keep the bacteria out of the repair much more effectively than a large filling will.
If you suspect you need to have a root canal treatment, or have had one and need to protect it with a crown, please don’t hesitate to give us a call on (07) 3379 1328