The pulp is the nerve- and blood supply of the tooth. The nerve- and blood vessel enter the tooth at the root apex and extends through the whole middle of the root ending up in a nerve chamber at the centre of the tooth crown. It is surrounded by hard tissue. Great decay, deep fillings, cracks, or serious damage to the tooth can cause infection in the pulp. This is called a pulpitis. In many cases this will cause extensive pain, but it can also be asymptomatic. Left untreated the nerve and blood supply will die and bacteria will spread through the nerve, to the apex and enter the bone tissue surrounding the tooth. Regardless of the cause of the infection, the exposed or infected pulp will need treatment in form of a root canal.
Root canal treatment
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A chronic pulp infection spread to the bone tissue from the tooth may be discovered on x-ray, regardless of symptoms. Acute infections will be very painful and persistent. It may start with tooth tenderness when biting and/or pain when exposed to hot and cold sensations. With time the pain can keep the patient awake at night and can be hard to reduce with pain killers. In some cases, the bacteria can produce a dental abscess. In serious cases or in advanced infection, this will be presented as swelling of the gum or even the face.
How is the treatment done?
Before treatment an x-ray is needed. Anaesthetic is given if necessary. If the nerve is dead anaesthetics is not called for. The dentist enters the nerve by drilling a hole at the top of the tooth. A rubber dam is placed over the tooth to prevent further bacteria from entering the nerve and to protect the patient. The nerve is removed with special tools and the canal is cleaned with different rinsing solutions. X-rays are needed together with a special measuring device to guide the dentist through the treatment. One or several visits may be necessary to finish the root canal. In some cases, a chemical treatment is put inside the root canal in between appointments. Gutta percha is the choice of material to seal the canal. This seal will prevent new bacteria from entering the tooth.
A tooth treated with a root canal must be protected from cracking. Because the tooth no longer has a blood supply it will dry out and be brittle. A crack in a root canal treated tooth may result in the extraction of the tooth. This may be prevented by placing an onlay or crown over the tooth.
Teeth have a complex root anatomy. In some cases, a regular root canal treatment is not enough to successfully combat the infection. If the tooth has a very complex structure or the dentist discovers an infection in a previously root canal treated tooth, we will refer you to an endodontic specialist. Sometimes it will be necessary to do an apicectomy. This is a surgical procedure where the oral surgeon removes the tip of the root and removes the infected tissue surrounding the apex of the tooth.
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