Why Does My Tooth Need Root Canal Treatment?
A tooth generally needs a root canal procedure because the pulpal tissue inside the tooth has become irreversibly injured because of root canal disease.
The tooth pulp is composed of elements similar to any other tissue in the body and is susceptible to injury from bacterial decay, repeated or extensive dental procedures, traumatic accidents, or advanced periodontal disease. Pulpal disease occurs in an anatomically complex space termed the root canal system. When appropriate, root canal treatment is directed towards removing inflamed or abscessed tissue, disinfecting, and preparing this space to receive a biocompatible filling material. Once the root canal system has been sealed and a protective crown placed the tooth can be retained as a healthy and functional member of the dental arch.
Root canal disease can be caused by several different events and occurs when tooth pulp (the tissue inside a tooth) becomes injured. Generally, the affected tissue is removed during the root canal treatment and in many cases the affected tooth can be saved.
Some of these principles were unknown or misunderstood in the past and, consequently, many teeth have had endodontic treatment based on concepts, techniques, and materials that are not considered optimal by today's standards. Even so, some of these teeth have given and will continue to provide additional years of good service.
1. Root canal treatment has not always been as successful as it is today. Fortunately, the guiding principles of modern dentistry can now be utilized to deliver very predictable results over a patient's lifetime. Some of these principles were unknown or misunderstood in the past and, consequently, many teeth have had dentist treatment based on concepts, techniques, and materials that are not considered optimal by today's standards. Even so, some of these teeth have given, and will continue to give, additional years of good service. In other instances, previously treated teeth exhibit bacterial leakage that may or may not be accompanied by clinical symptoms. Failing endodontic treated teeth can generally be successfully re-treated by a dentist using modern biological concepts, technologies, and techniques.
2. Root canal treatment can be successful even if a tooth is severely damaged by decay, trauma, or other destructive events. In cases such as this, it may be necessary to reinforce the tooth by placing a post into the root before a crown can be placed. In these situations, the root canal dentist must weigh risks versus benefits during the treatment planning process.
3. The success of root canal treatment is greatly enhanced when the tooth receives a protective restoration after completion of the treatment. When a protective crown is not placed, the root canal filling may leak or the tooth may develop additional decay or even fracture. Once a root fracture has occurred, there is generally no predictable treatment or dental surgery to save the tooth.
4. For an endodontic treatment to be successful, the periodontal supporting structures of the tooth must be healthy or capable of being returned to a state of health with periodontal treatment. Other specialty consultations may also be necessary depending on the findings in a particular situation.
5. To insure that root canal treatment is working, the particular tooth should be evaluated over time. Teeth are subject to enormous shifts in temperature (such as hot coffee vs. ice cream), tremendous mechanical loads (in pounds per square inch), and constant exposure to the bacteria in saliva. Periodic re-evaluation allows the dentist to examine the results of past treatments and to intervene early if new damage or breakdown is occurring.
As with any human endeavor, there are certain clinical situations in which dental surgery does not work even with the best efforts that modern dentistry can offer.
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Dr. Christine Tenaglia
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