Every tooth in our mouth has 3 main structures. First is the Enamel which is the hardest structure of our body & even harder than bone. Second is Dentin which is located beneath the Enamel & is less harder than it. Finally, the Pulp which has the nerves, blood vessels, & lymphatics. The pulp is the organ responsible for giving a life to the tooth. When any kind of harmful stimulus reaches it, it manifests itself as inflammation & pain.
A Root Canal Treatment a.k.a RCT is a procedure in which the dentist removes the irreversibly inflamed, infected & necrotic pulp in order to preserve the function of the tooth in the mouth. The dentist will be using his drill in order to get access to the pulp & remove it along with a preparation of the root canals for cleaning & filling.
After the development of the tooth, Odontoblast cells are those responsible for the formation of dentin & pulp. After the tooth is fully maturated & its in the anticipated position in the mouth, the odontoblast cells will be located in the periphery of the pulp, just beneath dentin. These cells has odontoblastic processes & they are extensions to which they fill the very small tubules that are radiated from the pulp periphery to Enamel periphery (they are entirely located in dentin). These tubules are called Dentinal Tubules & they contain the odontoblastic processes along with nerve endings of the pulp in some cases & filled also with fluid.
When caries invade enamel & reaches dentin, toxins & harmful chemicals travel through the dentinal tubules to irritate the pulp & subsequently leads to inflammation of the pulp known as Pulpitis of which then the patient will feel pain.
Root Canal Treatment will provide relief of pain by removing the pulp that is irreversibly damaged & a proper filling material will be used to seal the canal space.
Steps of Root Canal Treatment: –
- The dentist should take a good history of the condition including the characteristics of the pain, time, duration, & the condition of the tooth.
- The dentist will have to perform an X-Ray in order to aid in the diagnosis & to know much more about the condition. Pregnant women can wear a lead apron that will absorb the x-ray radiation thus minimizing the risk significantly to her child.
- An isolation of the tooth must be performed by the use of a rubber dam or a cotton rolls. Any single saliva drop in the tooth might lead to failure of the treatment.
- The dentist will establish an opening into the pulp & must remove all existing caries and defective tooth structure. The pulp has a roof & a floor just like your house. All roof should be removed to facilitate a straight line access to the root canal. Any roof present might lead to inability to remove the pulp or difficulty in the insertion of root canal instruments. Any pulp debris that has not been removed will eventually lead to staining to the crown of the tooth.
- After establishing access, the dentist will have to determine the correct length of the root canal by taking another x-ray with the files in the root canal.
- After establish the correct working length, the operator with the use of his files will remove the infected pulp & will prepare the root canal for the insertion of the proper filling material with thorough irrigation with Sodium Hypochlorite or any other suitable irrigant. The function of the irrigant is to chemically clean & kill as many bacteria as possible. In some cases, chelating agent might be used in a very narrow canals in order to facilitate insertion of the instruments, an example of a chelating agent is EDTA.
- Finally, a filling material commonly known as Gutta Percha (GP) will be used to seal the canal space & the tooth will be restored.
- A crown might be recommended in order to prevent longitudinal tooth fractures that will eventually require extraction.
- A follow-up to the case is necessary to ensure the success of the treatment.
This procedure is invasive to the tooth and thus prevention is better than treatment. That’s why dentists always say brush & floss your teeth everyday.
Do you have a tooth that has RCT performed? & how was your experience?
I would love to hear your stories & comments.
Haider Maitham, DDS