How Do You Fix Infections INSIDE a Tooth?
Obviously this website isn?t about SAT vocab prep, but we?re still gonna answer that question with a word puzzle? If ?Endo? means ?inside? and ?Dontic? is a fancy way of saying tooth, then Endodontic Dentistry must treat the inside of a tooth, right? ?
Root canal Treatment is the most common type of endodontic treatment. An infected root canal is infected with many bad bugs (bacteria) and must be disinfected to cure the infection. Read more on Root Canal Treatment.
Are Tooth Infections Really Such A Big Deal?
These infections are a big deal if you care about toothaches and bone health. Once an infection reaches the nerve deep inside tooth?s pulp chamber, it?s only a matter of time until the infection causes a blazing toothache and pushes its way down the roots and into the surrounding bone. These are the infections that swell the face and keep you up at night with throbbing pain.
If the infection is allowed to progress into the bone, it can spread bacteria throughout the body and endanger your heart and brain. What starts as a tiny tooth infection can become life-threatening if not treated. It may sound crazy, but abscessed teeth were once a leading cause of death and they still cause brain infections, sepsis and death today when not treated promptly. Endodontic infections are definitely serious business and root canal treatment is the primary way I remove infections from teeth’s canals.
Root Canal Treatments: Relieving Toothaches One Root at a Time!
A root canal treatment stops a toothache by removing dead, dying and decayed tissue from the tooth?s center and roots and cleaning out any infected and inflamed pulp material. No more infection, no more nerve, no more pain. The roots? canals are then filled with a rubber-like material (called gutta-percha) and the tooth is restored appropriately.
But Don?t Root Canal Treatments Compromise Teeth?
Great question. Can we answer with a question? Compromised compared to what?
Without the root canal, the tooth is a goner. So are you comparing the strength of the root canal tooth to that same tooth if left alone with its infection, OR are you comparing it to a healthy tooth that never had an infection?
When a tooth is badly infected, keeping it requires a root canal treatment. Compared to an infected tooth or no tooth at all, a root canal tooth is strong and functional and can stay healthy for years. Compared to a healthy natural tooth, yes, root canal teeth fracture more easily.
Just like other natural teeth, root canal treated teeth need to be kept clean, and the filling or crown that seals the root canal needs to be carefully maintained to prevent future infections. Remember, the tooth can still decay and get re-infected. The fact that it has been treate once doesn?t mean that it cannot get infected again if bacteria gain access again.
Benefits of Root Canal Treatments:
- You keep your natural tooth.
- You preserve your gum tissue and bone around your tooth.
- From a cost perspective, a root canal is generally less expensive than a new implant tooth.
Are There Any Alternatives to Root Canal Treatment? Yes.
Root canal treatment is not the only way to treat infected teeth.
- Extractions: The least expensive way to fix an infected tooth is to extract it. Once the infected tooth is gone, the body can clear up any remaining infection with the help of antibiotics. This gets rid of the infection. However, missing teeth create cosmetic and functional problems of their own. Learn more about extractions here.
- Extraction and Bridge: Treating an infected tooth with an extraction and fabricating a bridge eliminates the infection, solves any cosmetic issues and stops teeth from shifting. However, a bridge cannot stop bone loss at the missing tooth spot. Bridges can also be more expensive than a root canal and require drilling down the neighboring teeth. Whether or not a bridge is the best solution for you depends on your exact situation. Learn more about bridges here.
- Dental Implants: Like a bridge, an implant is placed after the infected tooth is pulled. Implants are typically more expensive than a root canal treatment and crown. However, an implant can be more ideal than a root canal because it it is stronger and potentially much longer lasting. A dental implant treats the infection, solves cosmetic issues, stops shifting AND stops bone loss. Implants also have the advantage of never being able to get a cavity or decay. Learn more about dental implants here.
It?s Just an Infection, So Why Don?t Antibiotics Work?
Toothaches are like the Terminator – ?They?ll be BACK!? An antibiotic alone can make a toothache stop hurting, but it will not cure a toothache permanently. Why? A toothache infection has two parts: the infection inside the tooth and the infection in the surrounding bone and tissue.
The antibiotic gets to the infection riding in the blood. This means that the antibiotic can reach the bone and tissue around the tooth, but that it can?t really get inside the dead nerve. The pain will stop, but because the antibiotic can?t really penetrate the tooth with all that infection inside, the infection and the pain are going to come back.
Once a tooth has been infected inside, the infection must be cleaned out. The only options are root canal treatment and extraction.
When No More Pain is a Bad Sign: 4 Stages of Infection
Most people assume that no more pain is ALWAYS a good thing ? they assume that no more pain means that the infection is gone. Right? No. Sometimes this is wrong and that?s when it gets dangerous. When a terrible toothache magically ?goes away on its own? without treatment, the pain has stopped because the nerve has died. In spite of the fact that the pain is gone, the infection is continuing to grow, spread and damage surrounding tissues. You can?t feel it anymore because the nerve, the body?s emergency warning system, is dead. To understand how this happens, you need to know about the four basic stages of tooth infection.
Stage 1 (No Pain Cavity): Bacteria take up residence on a tooth and produce acid that starts the decay process in the tooth?s enamel. The outside of the tooth is infected with dental caries. Treatment: teeth filling.
Stage 2 (Sensitive Tooth with Cavity): Left untreated, the cavity decays through the tooth enamel and dentin to reach the nerve in the central pulp chamber. The tooth now has a large cavity and is sensitive but it?s not a full-on toothache. Treatment: teeth filling or crown, depending on the size of the cavity, along with tooth nerve insulation or liner.
Stage 3 (Tooth Ache): The infection is in full swing creating puss under intense pressure inside the tooth and on the nerve. The infection begins to seep out of the ends of the tooth roots creating an abscess and swelling in the jaw bone. Stage 3 infections hurt intensely with throbbing, untouchable pain. These are the toothaches that people dread. Treatment: root canal treatment.
Stage 4 (No Pain Dead Nerve Tooth): The nerve dies from the pressure and infection and the bacteria and inflammation spread to the surrounding tissues. The pain stops because the mechanism responsible for transmitting pain is destroyed. Without a live nerve in the area, the body only stops feeling pain until the infection spreads to another nerve and the toothache comes back with a vengeance. Treatment: still root canal treatment.
4 Key Factors for Successful Root Canals:
Talk about technique sensitive! In a root canal treatment, the operating dentist is working in tooth roots that are just fractions of a millimeter wide at the tip. Infected and dead tissue must be completely cleaned in order for the root canal to be successful.
Four tips to help choose a dentist when you need root canal treatment:
- Choose a dentist with a microscope: All endodontic specialists have microscopes that they can use to magnify the inside of the tooth and get a detailed view of all the cracks and crannies.
- Choose a dentist with root canal experience or a mentor: The only way a dentist can build experience is by working on patients. When I was gaining root canal experience after dental school, I partnered with a more senior dentist who would coach me through root canals, helping me prevent mistakes and successfully navigate the challenging parts of the procedure.
- Choose a dentist who is meticulous: Root canals are detailed work and you want a detailed dentist doing them. Root canals are not the job for anyone who ?paints with a broad brush.?
- Choose a dentist who knows his or her limits: I have lots of experience doing routine root canals. With the help of my microscope, I can even handle complex cases. However, I will refer cases with oddly curved roots or suspected root fractures. I won?t retreat a tooth myself if I can?t figure out why it failed. A dentist who knows their limits is a dentist who puts patients first.
Broken Down Tooth? Root Canal Treatment + Post & Core to the Rescue!
Sometimes cavities decay so much that there isn?t enough healthy tooth left to support a crown. In these cases, often the only way to save the natural tooth is to perform a root canal treatment, removing the nerve as well as all the decayed tooth so that the tooth can be fitted with a post & core that extends down the tooth roots and provides an anchor for a crown. Without proper support, crowns leak, loosen and fail leaving extraction as the only option. To place the crown on a severely decayed tooth without first performing a root canal treatment and placing a post & core would be to invest money in a guaranteed failure.
What! How Can I Need Another Root Canal Treatment on the Same Tooth?
Sometimes a root canal treated tooth gets re-infected and needs another root canal treatment or ?retreatment? to save it. An endodontic retreatment (or second root canal) goes over the inside of the tooth with the high powered microscope to insure that the tooth is crack-free, completely clean and properly re-filled.
Why would you need a second root canal treatment? Here are the most common reasons:
- Bacteria normally found in the mouth has found its way through the tooth.
- A tooth may also get re-infected if trauma or wear causes cracks that allow bacteria to get inside the tooth.
- Root canal treatments fail if the infection or any live material was not completely removed during the first attempt. This can happen due to hidden canals, tooth defects, calcified tooth roots or oddly curved tooth roots.
- Also, root canal treatments completed in foreign countries with generally lower skill and technology are at a higher risk for failure.
Endodontic Surgery: Healing Stubborn Bone Infections
Sometimes the bone around a tooth root remains stubbornly infected even after a root canal treatment. These ?periapical? infections (?peri? – around, and ?apical? – end of tooth, so periapical means ?around the tip?) are normally taken care of by the immune system after a root canal. When they persist, endodontic surgery is needed. Endodontic surgery is micro-surgery that goes into the bone and removes the infected bone as well as the affected end of the tooth root. The tooth root is then re-sealed with a small filling to prevent infection from going up into the tooth. With the infected bone removed, the area can heal and will re-grow healthy bone around the tooth root. Endodontic surgery can also detect and treat root fractures and damaged root surfaces. It can also remove calcium build up from canals. Endodontic micro-surgery is possible thanks to advances in digital imaging and operating microscopes. These surgical procedures cannot be easily performed in developing countries or rural areas that lack the technology.