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© 2017 Care Endodontics Chicago/Julianne Carrara DMD MS LTD

Endodontic Therapy-Why

Why I may need treatment with or without discomfort?

After consultation/examination, we are able to discuss why you require endodontic treatment.

You may require endodontic treatment without any pain.  Pain is not always a determining factor-just the most popular.

The nerve inside the tooth is responsible for forming the tooth.  After maturity, it is a pain indicator. Some patients have trauma and are not aware the nerve is dying.  You may have cold sensitivity; pressure or constant aching- or you may miss these signs and live in ignorant bliss-that is lovely!

The nerve may be traumatized or damaged:

  • After new or repetitive restoration placement; 

  • Deep restoration into the nerve

  • Trauma from sports injury/Blunt trauma; Drunken falls

  • Orthodontic Movement

  • Periodontal issues

  • Habits- Bruxism or grinding; clenching; gum chewing; ice crunching; etc

  • Structural limitations.

You may have a high pain tolerance or on medications that mask pain.  Radiographs that capture the entire tooth are necessary.  Most Dentists take radiographs looking for decay and not evaluate the entire tooth.  We at Care Endodontics Chicago see less decay and more structural breakdown.  It is not related to brushing and flossing.  

The patients without pain require a consultation- more involved discussions.   Pain makes our job easier.  There may be a shadow or dark area around the root.  This is not always infection-bone marrow patterns or density may mimic infection.  It is always beneficial to obtain a baseline.

Root canal Treatment Explained

Advantages and Steps

Root Canals
What does root canal treatment entail? Learn more about this quick, comfortable procedure that can relieve your pain and save your natural tooth.  

Has your dentist or endodontist told you that you need root canal treatment? If so, you're not alone. Millions of teeth are treated and saved each year with root canal, or endodontic, treatment.   Remember, root canal treatment doesn't cause pain, it relieves it. 

Inside the tooth, under the white enamel and a hard layer called the dentin, is a soft tissue called the pulp. The pulp contains blood vessels, nerves and connective tissue, and helps to grow the root of your tooth during development. In a fully developed tooth, the tooth can survive without the pulp because the tooth continues to be nourished by the tissues surrounding it. 

Contrary to jokes about the matter, modern endodontic treatment is very similar to having a routine filling and usually can be completed in one or two appointments, depending on the condition of your tooth and your personal circumstances. You can expect a comfortable experience during and after your appointment.

How does endodontic treatment save the tooth?
  • Root canal or endodontic treatment—treatment done to the inside of the tooth—is necessary when the pulp becomes inflamed or infected.

  • The inflammation or infection can have a variety of causes:

    • deep decay,

    • repeated dental procedures on the tooth,

    • faulty crowns,

    • or a crack or chip in the tooth.

 

In addition, trauma to a tooth may cause pulp damage even if the tooth has no visible chips or cracks. If pulp inflammation or infection is left untreated, it can cause pain or lead to an abscess.

 

During root canal or endodontic treatment: 

  1. the inflamed or infected pulp is removed and the inside of the tooth is carefully cleaned and disinfected,

  2. then the canals are filled and sealed with a rubber-like material called gutta-percha.

  3. We. place a temporary restoration inside the tooth and often, we reduced the occlusion-the tooth is structurally weak.

  4. Afterwards, schedule an appointment with your dentist to restore the tooth with a crown or filling for protection.

  5. After restoration, the tooth continues to function like any other tooth.

Endodontic treatment helps you maintain your natural smile, continue eating the foods you love and limits the need for ongoing dental work. With proper care, most teeth that have had root canal treatment can last a lifetime

Endodontic Retreatment

Previously Treated Teeth

Endodontic Retreatment

With proper care, even teeth that have had root canal treatment can last a lifetime. But sometimes, a tooth that has been treated doesn't heal properly and can become painful or diseased months or even years after treatment. If your tooth failed to heal or develops new problems, you have a second chance. An additional procedure may be able to support healing and save your tooth. If you are experiencing dental pain or discomfort in a previously treated tooth, talk to an endodontist about retreatment.

 

As occasionally happens with any dental or medical procedure, a tooth may not heal as expected after initial treatment for a variety of reasons:

  • Narrow or curved canals were not treated during the initial procedure.

  • Complicated canal anatomy went undetected in the first procedure.

  • The placement of the crown or other restoration was delayed following the endodontic treatment.

  • The restoration did not prevent salivary contamination to the inside of the tooth.

 

In other cases, a new problem can jeopardize a tooth that was successfully treated. For example:

  • New decay can expose the root canal filling material to bacteria, causing a new infection in the tooth.

  • A loose, cracked or broken crown or filling can expose the tooth to new infection.

  • A tooth sustains a fracture.

 

During retreatment, the endodontist will reopen your tooth and remove the filling materials that were placed in the root canals during the first procedure. The endodontist then carefully examines the tooth, looking for additional canals or new infection. The endodontist then removes any infection, cleans and shapes the canals, and places new filling materials. The opening is then sealed with a temporary filling. Once the tooth heals, a new crown or other restoration is placed on the tooth to protect it. 

Endodontic Surgery

With Modern Technology, we can determine if this is the best Treatment Direction

Endodontic Surgery

Occasionally, a nonsurgical root canal procedure alone cannot save your tooth and your endodontist will recommend surgery.

 

Endodontic surgery can be used to locate small fractures or hidden canals that weren't detected on x-rays or during previous treatment. Surgery may also be needed to remove calcium deposits in root canals, or to treat damaged root surfaces or the surrounding bone of the tooth. Endodontists use advanced technologies like digital imaging and operating microscopes to perform surgeries quickly, comfortably and successfully.

What is an apicoectomy?

 

There are many surgical procedures that can be performed to save a tooth. The most common is called an apicoectomy, or root-end resection, which is occasionally needed when inflammation or infection persists in the bony area around the end of your tooth after a root canal procedure. In this microsurgical procedure, the endodontist opens the gum tissue near the tooth to see the underlying bone and to remove any inflamed or infected tissue. The very end of the root is also removed. A small filling may be placed to seal the end of the root canal and few stitches or sutures are placed to help the tissue heal. Over a period of months, the bone heals around the end of the root. Local anesthetics make the procedure comfortable, and most patients return to their normal activities the next day. Postsurgical discomfort is generally mild.

Are there other types of endodontic surgery?

Other surgeries endodontists might perform include dividing a tooth in half, repairing an injured root, or even removing one or more roots. Your endodontist will be happy to discuss the specific type of surgery your tooth requires.

Will the procedure hurt?

Local anesthetics make the procedure comfortable. Of course, you may feel some discomfort or experience slight swelling while the incision heals. This is normal for any surgical procedure. Your endodontist will recommend appropriate pain medication to alleviate your discomfort.

Your endodontist will give you specific postoperative instructions to follow. If you have questions after your procedure, or if you have pain that does not respond to medication, call your endodontist.

Can I drive myself home?

Often you can, but you should ask your endodontist before your appointment so that you can make transportation arrangements if necessary.

When can I return to my normal activities?

Most patients return to work or other routine activities the next day. Your endodontist will be happy to discuss your expected recovery time with you.

Does insurance cover endodontic surgery?

Each insurance plan is different. Check with your employer or insurance company prior to treatment.

How do I know the surgery will be successful?

Your dentist or endodontist is suggesting endodontic surgery because he or she believes it is the best option for saving your own natural tooth. Of course, there are no guarantees with any surgical procedure. Your endodontist will discuss your chances for success so that you can make an informed decision.

What are the alternatives to endodontic surgery?

Often, the only alternative to surgery is extraction of the tooth. The extracted tooth must then be replaced with an implant, bridge, or removable partial denture to restore chewing function and to prevent adjacent teeth from shifting. Because these alternatives require surgery or dental procedures on adjacent healthy teeth, endodontic surgery is usually the most biologic and cost-effective option for maintaining your oral health.

 

No matter how effective modern artificial tooth replacements are—and they can be very effective—nothing is as good as a natural tooth. You’ve already made an investment in saving your tooth. The pay-off for choosing endodontic surgery could be a healthy, functioning natural tooth for the rest of your life.

Post Treatment Care

What to expect after Endodontic Treatment

Post Treatment Care

It is normal to feel some tenderness in the area for a few days after your root canal treatment as your body undergoes the natural healing process. You may also feel some tenderness in your jaw from keeping it open for an extended period of time. These symptoms are temporary and usually respond very well to over-the-counter pain medications. It is important for you to follow the instructions on how to take these medications. Remember that narcotic medications, if prescribed, may make you drowsy, and caution should be exercised in operating dangerous machinery or driving a car after taking them.

Your tooth may continue to feel slightly different from your other teeth for some time after your root canal treatment has been completed. However, if you have severe pain or pressure that lasts more than a few days, contact your endodontist.

Guidelines for Post-Treatment Care

  • Do not eat anything until the numbness in your mouth wears off. This will prevent you from biting your cheek or tongue. 

  • Do not chew or bite on the treated tooth until you have had it restored by your dentist. 

  • Be sure to brush and floss your teeth as you normally would. 

  • If the opening in your tooth was restored with a temporary filling material, it is not unusual for a thin layer to wear off in-between appointments. However, if you think the entire filling has come out, contact your endodontist. 

  • Contact your endodontist right away if you develop any of the following:

    • a visible swelling inside or outside of your mouth;

    • an allergic reaction to medication, including rash, hives or itching (nausea is not an allergic reaction);

    • a return of original symptoms; or

    • your bite feels uneven.

     

Taking Care of Your Tooth

Root canal treatment is only one step in returning your tooth to full function. A proper final restoration of the tooth is extremely important in ensuring long-term success.

Contact your dentist as soon as possible to arrange your next appointment. If your tooth is being treated in more than one visit by an endodontist, do not return to your dentist for the final restoration until the root canal treatment is completed.

What the Future Holds

The tooth that has had appropriate endodontic treatment followed by a proper restoration can last as long as your other natural teeth. After the tooth has been restored, you need only practice good oral hygiene, including brushing, flossing, regular checkups and cleanings. 

Your dentist or endodontist may periodically x-ray the tooth to ensure that healing has occurred. Occasionally, a tooth that has undergone endodontic treatment does not heal or pain continues. At times, the tooth may become painful or diseased months or even years after successful treatment. Often when this occurs, repeating the endodontic procedure can save the tooth

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