Treatment Focus: ENDODONTICS
Intro
Endodontics literally means "treatment within the tooth". It generally refers to dentistry which is performed on the canal system present in the the roots and crown. This canal system contains the nerves and blood vessels, ( known as the pupal tissue) which keep the dentine of the tooth alive. Accordingly endodontics is also refered to as root canal treatment (RCT), to be fair there is a lot more to endodontics than root canal treatment, although RCT does make up the bulk of endodontic work. When people say they have had a nerve removed from the tooth they are talking about endodontics although strictly speaking each root canal contains a complete plexus of nerves and blood vessels.
When is root canal treatment performed?
When the nerve and blood plexus (pulp) within the root canal system is irreversibly damaged it can become very painful and is known as "pulpitis". The pain may diminish with time but by removing the nerve plexus (pulp) during RCT the pain can be allieviated. The blood and nerve supply may die quietly or after a period of pain, these dying remnants may then cause an inflammatory response in the bone of the socket supporting the tooth and an abscess can form. The pain from the inflammation in the supporting socket can only resolve by removing the irritants causing the inflammation. This can be achieved by RCT or by extraction of the tooth itself.
How is root canal treatment performed?
After analgesia is obtained, generally by administring a local anaesthetic, access to the pulp is achieved by drilling into the tooth. The root canal system is cleaned mechanically by fine instruments, there are many different types of instruments but most are varieties of very fine files. The remains of the nerve and blood supply is cleaned away and the root canal system is enlarged. The debris is washed out using medicated solutions. Because it is impossible to effectively remove every piece of contaminated pulpal tissue and dentine, the root canal system is filled using a variety of methods the most commonest using a combination of dental cement and gutta percha rubber.
Problems with root canal treatment
When one looks at the structure of a tooth and the anatomy of the root canal system it is a wonder that RCT is successful at all. Each root has at least one large canal, but there will be many tiny side canals. The canal is itslf not a uniform tube but often elipitical in cross section, although treatment will tend to round the canals. The problems associated with RCT are: