Tooth Pulps & Root Canals
“Root canal? Ouch!” That is what most of my Portland patients tell me, but luckily root canal treatments take away toothaches to make you feel better.
Usually dentists prefer to treat infected root canal pulps before they start to hurt because this is the most comfortable way to go. Waiting for a tooth to hurt before starting root canal treatment is usually less comfortable.
Permanent teeth are alive with nerves and blood vessels located in the middle of the tooth in the area called the pulp. Bacteria infected pulps or teeth that have been traumatized may have damaged pulps that cannot heal. If the pulp cannot heal, the tooth will become painful and may cause serious health problems. To avoid these problems, the tooth must be extracted or receive root canal treatment.
The steps of permanent tooth root canal treatment:
|•||Numb the tooth with local anesthetic, usually 4% articaine or 2% lidocaine (usually with 1:100,000 epinephrine).
|•||Stretch a rubber dam over the tooth to keep bacteria in saliva from re-infecting the cleaned root canal.
|•||Remove any decay with a handpiece drill and remove the infected pulp.
|•||Use extremely small wire files to scrape the tissue from the canals in the roots.
|•||Measure the length of the files to know exactly how far it is to the end of the root.
|•||Rinse the infected material from the root canals with disinfectants, often sodium hypochlorite.
|•||Soak triple antibiotics in the cleaned, shaped, and smooth canals to fight infection.
|•||Pack pink, rubbery gutta percha into the root canals all the way to the tip, with runny sealer to fill in any gaps.
|•||Place a filling in the hole and plan on a crown to hold the weakened tooth together.|
Primary teeth with infected pulps are treated differently than permanent teeth.
Primary molars last until about age 11 or 12 so we like to save them with root canal treatment, if we can, instead of pulling them out and placing a space maintainer.
Because primary teeth roots need to dissolve away when the permanent teeth start to grow in, the root canal material used for baby teeth should be dissolvable or not go all the way down the root canals.
Most of the time, primary teeth with infected pulps are treated with a partial pulp removal called a pulpotomy.
The steps of primary (deciduous or baby) tooth pulpotomy procedure:
|•||Numb the tooth with 4% articaine or 2% lidocaine (usually with 1:100,000 epinephrine).
|•||Stretch the rubber dam around the infected tooth to seal out infected saliva.
|•||Use a handpiece to drill away infected tooth and cut the infected tooth pulp in the top coronal pulp chamber.
|•||Stop any bleeding with ferric sulfate, then swab out the chamber with diluted formocresol.
|•||The infection is often only in the top of the tooth so using medicines like formocresol or ferric sulfate will treat painful nerves and kill the germs in the remaining pulp tissue.
|•||Fill the pulp chamber with zinc oxide and eugenol filling to form a tight seal and prevent bacterial entry.
|•||Place a tightly fitting stainless steel crown or a composite filling.|
These pulpotomies are very successful for teeth that have not infected the bone supporting the tooth. If the bone around a tooth gets infected, then all the pulp tissue must be removed, even the root canal tissue. This complete pulp removal is called a pulpectomy.
A pulpectomy procedure is similar to the adult root canal treatment in that files are used to clean and shape but the material we use to fill the root canals is much different because the roots are supposed to be dissolved away as the permanent teeth erupt.
The root canal filling material for primary teeth must be resorbable or dissolvable. I use a material called Vitapex (a mixture of calcium hydroxide, iodoform, and silicone lubricant) with great success healing abscessed teeth.
Pulpectomy treatment for primary teeth is mostly reserved for only the most important teeth: the second primary molars before the eruption of the permanent molars.
When faced with the options of a painful toothache, a root canal, or an extraction, most people will be pleasantly surprised that those root canals are the best option and not an “OUCH!” after all.