Caring for my teeth
Root treatment
Root treatment is a specialty of general dentistry, technically known as “endodontics”. General dentistry, also known as omnipractice, is practiced by all our dentists. It covers 3 categories:
- Conservative treatment (treatment of cavities): the least invasive and longest-lasting techniques for restoring the integrity of teeth
- Endodontics (root treatment): when the dental nerve is damaged, root treatment requires great finesse and state-of-the-art equipment.
- Pediatric dentistry (care of children): a specific, gentle approach to children’s care
What is endodontics?
Endodontics is a specialty of dentistry that involves the prevention, diagnosis and treatment of pathologies of the dental pulp. But what is the dental pulp?
Here’s a simple image to illustrate the dental pulp.
In a nutshell, the dental pulp, circulating in a canal system (canals located in the root(s)), ensures the innervation and vascularization of the tooth. It makes the tooth a living organ.
What is a root canal?
Endodontic treatment, commonly referred to as root canal treatment, is the removal of the tooth’s pulp. It is performed under local anaesthetic, using special instruments for optimal disinfection. Depending on the vitality of the dental pulp and the difficulty of the root canal system, it can be performed in one to three sessions, scheduled at regular intervals of one week to 10 days.
In detail, root canal treatment consists of:
- Placing a dental dam, which corresponds to an operating field to work under cover of saliva and limit the risk of ingesting instruments
- Remove any remnants of pulp tissue still alive in the tooth or already in the process of decomposition
- Scrupulously clean the inside of this tooth mechanically with manual or mechanical dental instruments (pins), but also chemically with abundant rinsing of the canal with sodium hypochlorite (dakin)
- Shape the dental canal up to the apex of the tooth (the end of the root in the bone) to allow this cleaning along the entire length of the root
- Dry the dental canal with specific, calibrated paper tips
- Obtain the dental canal with gutta-percha (heated or cold), which bonds to the canal walls thanks to the simultaneous application of cement.
Microscopes to improve chances of success...
The root canal system is not always easy to access, and is generally very small. It is therefore sometimes difficult to achieve working conditions with good vision. In our center, root canal treatment, like many other more conventional procedures, is generally carried out with optical magnification equipment: magnifying glasses or operating microscopes installed in every practice.
Please note! Root canal treatment can cause temporary pain, which usually disappears quickly!
What are the symptoms indicating that a root canal is necessary?
Intense, prolonged and spontaneous tooth pain is usually a sign that the pulp, the “nerve” of the tooth, is affected. That is the main indication for a root canal. But the absence of symptoms guarantees nothing: some complications appear only on X-rays, after years without the slightest sign.
The first signals: sensitivity to sweet, then to cold
As a cavity develops, sensitivity to sweet appears, then to cold. If it is not treated in time, bacterial toxins reach the pulp and the pain becomes more distinct: to sweet, to cold, sometimes even to chewing. This is the very last moment to treat the tooth while preserving its vitality.
When the pain sets in and wakes you at night
The hypersensitivity lasts longer and no longer passes quickly. The pulp is partly inflamed; treated early enough, the inflammation may still subside and the sensitivity return to normal. Without treatment, the pain becomes excruciating and spontaneous, by day and by night, with the sensation of a throbbing heartbeat in the tooth. Cold can sometimes make it worse, and nothing calms it. Only devitalising the tooth releases the internal pressure.
When the pulp is necrotic
The pulp eventually becomes necrotic: the tooth is “dead”. This time it is heat that brings the pain back. Pain on pressure and on chewing sets in, along with the feeling that the tooth sits slightly high, as if on a cushion. The inflammation reaches the tips of the roots: this is apical periodontitis. It can stay silent, then shift quite abruptly into an acute phase, with constant pain that nothing relieves, swelling, and heat that is at first local and can spread to half the face. You then need to see a dentist without delay. A fistula can also form along the tooth, with repeated discharge of pus and little pain: the infection is very much there.
The painless cases: a devitalised tooth, a crack
On a tooth that has already been devitalised, any new pain on chewing, even mild, should raise concern: repeating the treatment may be considered after examination and diagnosis. A crack can also reach the pulp and cause pain when chewing food that is hard, such as seeds, or dense, such as bread. The most common cracks are found in teeth carrying large fillings that are leaking or corroded. The root canal is then followed by a restoration that covers the tooth and spreads the chewing forces, to stop the crack reaching the roots.
In short, a root canal becomes necessary when a sensitivity that was trivial at first, having not been dealt with in time, intensifies, lingers with cold or heat, becomes spontaneous, prevents sleep and finally causes swelling.
When the dental pulp is dead or cannot be kept alive, root canal therapy becomes the only treatment option for keeping the tooth in the mouth. It prevents the onset or eliminates infection, the cause of which may be one of the following:
- A cavity
- A faulty root treatment
- A dental accident
- A severe periodontal (gum) problem
In cases where the prognosis for root treatment is too unfavorable, or root treatment is unsuccessful, replacement of the tooth to be extracted can be carried out by dental implant or removable appliance.
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3D Cone Beam CT radiography
