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Roots Canal Treatment - Endodontic

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1. What is pulpitis or "toothache"?

Following the onset of a cavity, a trauma or a shock, the pulp can become inflamed. The nerve usually also becomes inflamed, which causes severe pain: this is pulpitis or "toothache".
Up to a certain point, pulpitis is, in principle, reversible and the vitality of the pulp is preserved. If left untreated, the inflammation develops into an infection: these complications require endodontic treatment or root canal treatment or even tooth extraction. The tooth must be devitalised, i.e. the pulp tissue remaining inside the tooth must be removed, the inside of the tooth must be disinfected, and the canal must be filled with a disinfectant paste.

2. Which technique to treat pulpitis: endodontics, root canal treatment?

Endodontics is the dental specialty that treats pathologies inside the tooth as indicated by its ethimology (from the Greek endo, inside and dontie, tooth). Endodontic treatment concerns the dental pulp inside the tooth and aims to prevent and treat infections such as pulpitis or its advanced state, periapical abscess. It is also called root canal treatment because it aims to clean and disinfect the roots in which the pulp is located.

3. What are the symptoms of dental nerve inflammation?

Inflammation of the nerve of the tooth (dental pulp) is called pulpitis, more commonly known as "toothache".

The inflammation causes the following typical symptoms:

  • Increased sensitivity to cold and heat.

  • Pulsating tooth pain aggravated by lying down.

  • Pain that can be referred to the head, temple or ear.

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When pulpitis is not treated, after a variable time, the nerve dies, the tooth is no longer painful. This is pulp necrosis. The colour of the tooth may turn grey. Your dentist will perform an endodontic treatment to clean and disinfect the root canals in order to preserve the tooth.
If a necrotic tooth is not treated, bacteria can migrate from the root tip into the surrounding bone, causing an abscess a few months or years later. Early intervention is required to prevent the spread of these bacteria into the bloodstream.

4. Tooth devitalization: how does a root canal treatment work?

When a pulpitis occurs, the patient usually consults his or her dentist in an emergency because of the intense pain (toothache). During this first appointment, your dentist will focus on relieving the patient by removing the inflamed pulp tissue. He will then disinfect the pulp chamber and the roots. If the pulp is bleeding, he will place a temporary clove dressing. On the other hand, if the pulp does not bleed, a sign of necrosis, the dentist will leave the tooth open.

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At a second appointment, the dentist will perform the actual endodontic treatment: 

  • numb the painfull tooth with a local anaesthesia

  • make an adequate opening to access the pulp,

  • remove the pulp tissue inside the tooth, thereby devitalizing the tooth,

  • clean the inside of the tooth thoroughly by mechanical and chemical action

  • shape the channel so that the filling solution penetrates everywhere,

  • dry out the canal system

  • fill the canal with antiseptic paste

 

In a third step, the dentist will propose to restore the tooth: the tooth is considered dead but the treatment of its root allows to avoid the need for an implant. Depending on the case, your dentist will place an inlay, an onlay or a crown, thus avoiding any recolonization by bacteria.

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5. When should you see a dentist if you have a toothache? 

It is recommended to consult your dentist if your tooth pain

  • lasts longer than 2 days

  • does not go away when you take painkillers

  • is accompanied by a high temperature, pain when biting, red gums or a bad taste in the mouth

  • if your cheek or jaw is swollen

6. What is a dental abscess (periapical abscess)?

Periapical abscesses occur when bacteria reach the root tip and can trigger the formation and accumulation of pus in the bone. 
To relieve the pain, consult your dentist as soon as possible.

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