Endodontics

WHAT IS ROOT CANAL TREATMENT (ENDODONTIC TREATMENT)?

Before the definition of endodontic treatment, we need to be familiar with the layers of teeth. On the outer part of a tooth is the solid tissue called, “enamel.” Beneath the enamel is dentin, the largest part of the tooth. On the innermost part, there is the pulp, which includes all nerves and veins of the tooth. When the decay reaches the dental pulp, or the dental pulp is infected or exposed due to a trauma, it becomes necessary to perform endodontic treatment. Endodontic treatment is the process of removing the whole dental pulp and maintaining the functioning of the tooth. The tooth will function for many years, provided that all steps of the treatment are properly performed.

WHEN IS THE ENDODONTIC TREATMENT APPLIED?

When the decay reaches the tissue of the pulp. . Decay is a chronic disease. It generally starts from a tiny point on the enamel. If it is not intervened, it advances and expands. It cannot be noticed by the patient when it advances without causing pain. The decay reaches the tissue of the pulp when it is ignored or not noticed. It causes severe toothaches that continue for a long time to a point where the patient wakes up at night. In these cases, a simple filling treatment will not be sufficient, and root canal treatment will be necessary.

When the dental pulp is dead (necrotic). Sometimes, the decay does not show any symptoms when it is advancing towards the dental pulp. It does not cause any pain or causes too little pain for the patient to notice, and it doesn’t last long. But it does not necessarily mean that the advancement of the decay has stopped. The decay goes on advancing, and the dental pulp starts to turn into a dead (necrotic) tissue. After a while, the pain completely stops. Moreover, in cases where there is a deep filling on the tooth, if the decay advances to the border of the filling or beneath the filling, or leaks out of the filling, the dental pulp begins to die. In these instances, the dead dental pulp is removed with endodontic treatment.

When an abscess is formed due to tooth decay. . When the dental pulp turns into dead tissue, an abscess starts to form on the tooth. The face swells. The swelling might travel towards the bottom of the jaw or towards the ear in cases where the abscess occurs on the teeth in the lower jaw. In some instances, there can be limitations in the mouth opening. If there are no limitations in the mouth opening, the tooth is cleaned, and the abscess is drained with emergency endodontic treatment. In such cases, endodontic treatment cannot be finished in a single session.

In the presence of a cyst or granuloma, associated with the tooth. Sometimes, abscess formation is not experienced when the dental pulp is dead, but the dead tissue continuously causes a toxic effect around the tooth. A chronic infection (granulation) of the tissue occurs around the bone at the edge of the root of the tooth, and osteolysis (bone loss) occurs. If it is not intervened, it might grow for years without showing any symptoms. In this situation, endodontic treatment is applied, and the shrinking of the lesion on the bone is monitored. The lesion on the bone, caused by endodontics, heals to a large extent without any surgical intervention.

When the trauma-related fracture or crack in the tooth reaches the pulp. . When the patient suffers from a tooth fracture due to an acute trauma (related to a fall) or from a crack due to chronic trauma (clenching of the teeth), the integrity of the tooth is compromised, and the tissue of the pulp is exposed. When the dental pulp is exposed in the mouth of adults (when the root of the tooth is closed), the whole pulp is generally needed to be removed with endodontic treatment. Otherwise, an infection will occur as the sterility of the tissue of the pulp has been compromised.

IS ROOT CANAL TREATMENT APPLIED ON AN INFECTED TOOTH OR IN THE CASE OF A SEVERE ACHE?

When there is a severe (similar to heart beat) toothache, the dental pulp should be removed immediately. The reason is that there is increased blood flow to the tooth in a lateral position and the substance, causing the ache, is produced in higher amounts at nights. In this case, emergency endodontic treatment is needed. Anti-inflammatory drugs are generally insufficient. The use of anti-biotics on its own is wrong. Anti-biotics do not stop the pain. The tooth needs to be cleaned to decrease the pressure. When regarded necessary, the treatment is reinforced with anti-biotics.
When there is a tooth abscess related to decay, emergency endodontic treatment should be applied when there is adequate opening of the mouth. Inside of the tooth should be cleaned, and the infected parts should be removed. The rule, “Infected tooth should not be interfered,” is only applicable to tooth extraction. Mechanical cleaning is necessary for a tooth abscess to heal, resulting from decay, and the treatment is reinforced with anti-biotics when regarded necessary.

HOW IS ENDODONTIC TREATMENT PERFORMED?

In endodontic treatment, the infected pulp and the decayed tissue are removed. The resulting gap is cleaned using anti-bacterial and antiseptic agents, followed by the filling of the tooth. The procedure generally takes a single session. The number of sessions might increase depending on the status of the infection.
The teeth, on which the endodontic treatment is performed, are not dead teeth; only the pulp tissue is removed. There is not much of a difference from other teeth in appearance. As there is a lot of tissue loss in teeth which require endodontic treatment, they need to be supported with prosthetic restorations.

IS THERE ANY PAIN DURING OR AFTER THE TREATMENT?

During the treatment, the patient does not feel any pain thanks to anesthesia. However, it is normal to feel pain up to a few days or a week after the treatment (decreasing over time). The post-treatment process is supported with anti-inflammatory drugs when regarded necessary. In some cases, antibiotics treatment is required between or after operations.

WHAT IS RETREATMENT (RENEWAL OF THE ROOT CANAL)?

When old root canal treatments are not sufficient, or an infection or abscess occurs in the bone on the root of the tooth, the retreatment procedure is performed. After the old filling is removed, the tooth is cleaned with antiseptic and anti-bacterial solutions. The treatment is supported with anti-biotics when regarded necessary. The functional period of the tooth is extended via the retreatment procedure.

ENDODONTIC TREATMENT IN THE PRESENCE OF A CYST OR GRANULAMA

When the tooth becomes necrosis, that is the pulp turns into dead tissue, a chronic infection can occur in the bone surrounding the tooth. When it is not intervened, this infection might turn into lesions that look like a granuloma or cyst. These cyst-like lesions can be receded, shrunk and healed with root canal treatment. After the treatment, the course of the lesion is checked once every three months. When regarded necessary, these lesions are surgically removed. Before (or during) the surgical procedure, endodontic treatment must be applied.

INTRACORONAL (WALKING) BLEACHING

After endodontic treatment, coloring might be experienced on the teeth based on the filling materials used in the procedure. In this case, intra-coronal bleaching treatment is applied. Before the application of this treatment, it is necessary to ensure that the older root canal treatment is not insufficient or that the tooth or the bone on the root of the tooth is not infected. In cases where root canal treatment is the ideal solution, the filling in the tooth is removed. Following that, the bleaching agent is applied on the root canal filling, and the tooth is left to wait for some time (for a few days) based on the intensity of the coloring. When decolorization (bleaching) is done, fixed restoration is performed on the tooth.

  1. Siqueira, J. F., & Rôças, I. N. (2013). Microbiology and treatment of acute apical abscesses. Clinical microbiology reviews26(2), 255-273.
  2. Saatchi, M. (2007). Healing of large periapical lesion: A non‐surgical endodontic treatment approach. Australian Endodontic Journal33(3), 136-140.