Endodontics

Endodontics
Understanding Disease & Treatment
Root Canal Treatment
Retreatment
Dental Trauma


Endodontics

Endodontics was recognized as a dental speciality in the 1960’s. An Endodontist completes at least 4 years of dental training and Speciality training in Endodontics (Root Canal Treatment) requires a further 3 years of formal postgraduate training. Endodontists are also licensed by the Dental Board of Australia. You can check the specialist registration of a dentist on the AHPRA website.

Endodontists deal with the tooth pulp and the tissues surrounding the root of a tooth. Endodontists perform a variety of procedures including root canal therapy, endodontic retreatment, surgery, treating cracked teeth, and treating dental trauma. Root canal therapy is one of the most common procedures. If the pulp becomes diseased or injured, endodontic treatment is required to save the tooth.

Endodontics Treatment

A complex root canal system where 4 canals are located under the microscope.
A situation with 3 extra canals requires an operating microscope and specialist training to locate the canals.

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Understanding Disease & Treatment

To better understand endodontic disease and its treatment, a quick review of tooth anatomy is helpful.  “Endon” is Greek for “inside” and “odous” means “tooth.”  Endodontic treatment involves disinfecting damaged tissues located inside the tooth.


Reproduced with permission from the
American Association of Endodontists

Nerves and blood vessels in the centre of your tooth form a soft tissue called the dental pulp.  During tooth development, this soft pulp tissue creates the hard tissues of the tooth— the dentin and enamel.  After a tooth is completely formed, the pulp remains in tunnels or canals located in the very centre of the tooth and root.

Throughout your life, dental pulp serves two important functions:

 

1. It enables you to feel stimulus to the tooth caused by heat, cold, decay, or cracks;

2. It senses when bacteria from your mouth invade the tooth and it coordinates a defensive response against those invaders.

Bacteria are normally present in your mouth and teeth at all times, even in teeth that have never had a cavity, trauma, or root canal treatment.

Reproduced with permission from the
American Association of Endodontists

Normally, the pulp defends itself against bacteria to prevent them from reaching the center of the tooth where the pulp lives.  If the pulp is damaged by trauma or if too many bacteria penetrate into the center of your tooth (usually from a deep cavity, repeated dental procedures, or a crack), the pulp becomes inflamed and eventually dies as bacteria infect the canals in the center of your tooth.  Your body then creates an abscess— a hole in the bone around the tooth root where cells from your immune system kill bacteria as they exit the root.

Root canal treatment removes the inflamed or infected tissues from the center of your tooth, allowing you to keep a tooth that would otherwise need to be removed from your jaw. If root canal treatment or removal of the tooth is not performed, the infected tooth presents a significant risk to your health caused by spreading infection. Although you may experience pain, swelling, or other signs of infection at any point during this disease process, it is more common that a person does not know this chronic disease is occurring until a problem is found during a checkup by a dentist.

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Root Canal Treatment

Why would I need endodontic treatment?

Reproduced with permission from the American Association of Endodontists

Once bacteria cause extensive inflammation or infection of pulp tissue, this diseased tissue must be removed and the canals in the center of the tooth must be disinfected. Taking antibiotics or other medications cannot remove this diseased tissue nor can these medications disinfect root canals because the blood vessels that would deliver those medications to the site of infection are destroyed when bacteria infect the root canal.

What happens during endodontic treatment?

Reproduced with permission from the American Association of Endodontists

  • After numbing the tooth, the problem that allowed bacteria to enter the center of the tooth is corrected by removing tooth decay or cracks. If enough healthy tooth remains after this process to allow your dentist to rebuild the missing tooth structure, root canal treatment begins. An opening is made through the chewing surface of your tooth to enter the pulp chamber— the center portion of the tooth where pulp tissues from different root canals merge together. The pulp chamber and root canals are then shaped with small instruments to allow disinfectants to reach to the very tip of your root.

Reproduced with permission from the American Association of Endodontists

Once the canals and chamber are cleaned and dried, the root canals are filled with a rubber-like material and adhesive cement.  The pulp chamber and opening in the chewing surface of your tooth are then filled with a temporary filling material to protect the root canal treatment until your dentist can rebuild your tooth.

Reproduced with permission from the American Association of Endodontists

Properly performed root canal treatment decreases the number of bacteria in infected roots by more than 99% and promotes healing of infected tissues surrounding teeth that could cause serious health problems if left untreated.

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Retreatment

Why would I need endodontic retreatment?

  • With appropriate care, most endodontically-treated teeth that are properly restored (usually with a core foundation and crown) can last as long as your other natural teeth.  In some cases, however, the disease may not heal and might not be detected for months or even years after the initial treatment.  Lack of healing is caused by bacteria that contaminate the previously-treated root canals.

Reproduced with permission from the
American Association of Endodontists

Bacterial contamination usually occurs because of a problem that developed after the initial root canal treatment:  new tooth decay, a cracked tooth, delay in properly restoring the tooth, or a broken filling.


Reproduced with permission from the
American Association of Endodontists

Bacteria can also contaminate root canals that have very complex anatomy or calcifications that were inadequately treated during the previous root canal treatment.  Due to scientific advances, an endodontist can often give your tooth a second chance by using technology and techniques that may not have been available when you had your first root canal treatment.

What happens during endodontic retreatment?

Reproduced with permission from the
American Association of Endodontists

After numbing the tooth, the problem that allowed bacteria to enter the center of the tooth is corrected by removing tooth decay or cracks.  If enough healthy tooth remains after this process to allow your dentist to rebuild the missing tooth structure, root canal treatment begins.  An opening is made through the chewing surface of your tooth to enter the pulp chamber— the center portion of the tooth where pulp tissues from different root canals merge together.


Reproduced with permission from the
American Association of Endodontists

Once the canals and chamber are cleaned and dried, the root canals are filled with a rubber-like material and adhesive cement.  The pulp chamber and opening in the chewing surface of your tooth are then filled with a temporary filling material to protect the root canal treatment until your dentist can rebuild your tooth.

Reproduced with permission from the
American Association of Endodontists

Properly performed root canal treatment decreases the number of bacteria in infected roots by more than 99% and promotes healing of infected tissues surrounding teeth that could cause serious health problems if left untreated

 

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Dental Trauma
Treatment and proper care for dental traumatic injuries varies depending on the type of injury. Please see The Dental Trauma Guide at www.dentaltraumaguide.org for specific information. The Trauma Pathfinder section provides a very easy way to understand dental traumatic injuries and treatment. For baby teeth, follow the section for “Primary Teeth.” For permanent teeth, select the section for “Permanent Teeth.”

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