Root canal treatment

Endodontic treatment (root canal treatment) is needed when microorganisms and their toxins reach the root canals andthe pulp – the soft tissue inside the root canals – becomes inflamed or infected. The inflammation of the pulp is called pulpitis. Also, pathological processes in the pulp can be triggered by other physical or chemical factors, such as traumas.

In the picture it can be seen how untreated caries damages the pulp over time.

The pulp is a part of the tooth comprised of blood vessels, nerves and lymphatic vessels. It is inside the tooth under the enamel and the dentine and supplies the hard tooth tissues with nutrients.

The treatment of pulpitis involves the removal of the damaged tissues and, in most cases, the pulp itself has to be removed. Then the root canal system is cleaned mechanically and chemically and finally the canals are filled and sealed.

The main factors causing pulpitis:

• caries which has been left untreated for a long time and as a result has reached the deeper dental tissues.
• the tooth has undergone a number of dental treatment procedures, extensive filings have been replaced a number of times
• the teeth are continuously being traumatised by a strong bite or teeth grinding (bruxism), etc.
• a dental trauma which disrupted the blood supply to the tooth nerve.

How would you know if you have pulpitis?

The main symptom of pulpitis is pain. Unlike any other parts of our body, where inflammation has room for swelling, the nerve inside the pulp chamber cannot swell up due to the hard and closed surroundings.Therefore, when the soft tissues inside get swollen, the tooth nerve is under growing pressure and increasing pain is felt. However, only the dentist during a thorough examination can provide you with a proper diagnosis. Pulpitis can be verified by using pulp vitality tests (sensitivity to heat, cold, electrometric tests). Sometimes an X-ray may be needed.

Reversible pulpitis

That is a mild inflammation of the pulp and, if treated in time, the pulp – the soft dental tissue – can be saved. The main symptom of reversible pulpitis is a short sharp pain while eating or drinking something cold or sweet. The pain lasts just as long as the food (drink) is in contact with the tooth and after 1-2 seconds the pain goes away.

Sometimes the symptoms of reversible pulpitis remain unnoticed and only when we get a toothache we become alert. To avoid a situation like that it is very important to pay regular visits to the dentist even if you have no toothache. The potential first symptoms of tooth nerve inflammation can be noticed during an examination or with the help of an X-ray. The earlier pulpitis gets diagnosed, the quicker, simpler and cheaper its treatment will be!

Irreversible pulpitis

It is a severe inflammation of the tooth nerve after which it does not recover and the tooth dies.

You can see a dead tooth on the right

Symptoms of irreversible pulpitis:

• Toothache which lasts up to an hour after the source of irritation has been removed (e.g. cold);

• Spontaneous pain appears without any reason, it does not need a trigger;

• The tooth becomes extremely sensitive to cold or hot foods or liquids;

• Spreading pain between the upper and lower jaws up to the ears;

• Toothache prevents you from sleeping or wakes you up in the middle of the night.

In case of irreversible pulpitis endodontic (root canal) treatment is necessary. Under some clinical circumstances the tooth may have to be removed.

It is important to remember that the symptoms of pulpitis vary greatly, frequently you cannot say for sure which tooth is painful, you may think that several teeth are painful. If the tooth is damaged by caries which has gone untreated for a while, it will always end up in developing pulpitis. Therefore, if you have any of the symptoms mentioned above, visit your doctor immediately. If you keep postponing your visit, you may have to have not only your tooth filled, but undergo root canal treatment as well or even have your tooth removed.

Why is root canal treatment necessary?

If the root canals are not treated, microorganisms inside the pulp leak out of the tip of the root and spread the infection into the surrounding tissues. As a result, this can lead to periodontitis, bone dissolution around the root and other complications.

When is endodontic retreatment needed?

If the endodontic treatment in the past was carried out improperly, or the crown is leaking or a new cavity appears, a secondary pulp inflammation may develop. Then the old filling material from the root canals must be removed, the canals are cleaned, shaped and refilled. The tooth crown is restored by placing either a filling or an artificial dental crown.