Root Canal Therapy

Dental Infection And Treatment

  • Dental emergency such as dental infection is caused by bacterial infection to the dental nervous tissue, in which usually began from a small dental cavity.  The bacteria can travel from the dental pulp to the surrounding bone tissue and may spread to various facial planes.
Dental Infection Spreads to Facial Tissue and Causes Facial Swelling.

Dental Infection Spreads to Facial Tissue and Causes Facial Swelling.

 

The cause of dental infection is from untreated dental cavity which has progressed to affect the dental nerve pulp.

The cause of dental infection is from untreated dental cavity which has progressed to affect the dental nerve pulp within the dental nerve canal.

 

The treatment involves incision and drainage of the affected intraoral tissues.  A small incision is made on the intraoral tissue containing the abscess.  Pus is then drained.  If the dental pulp is infected, the root canal therapy is to be initiated.  Patient is usually put on a course of antibiotics, usually Penicillin VK, which is effective in killing bacteria in dental origin.  Then the patient is to be returned to have the root canal therapy completed and the tooth is to be sealed and crowned for full coverage protection.

 

Written by Daniel Tee, DDS, MS

Emergency Dentist Office in Tempe AZ

Serving the city of Tempe, Chandler, Phoenix, Gilbert, and Mesa in Arizona. Practicing General Dentist

Does “Root Canal” Hurt?

The short answer to the question “Does Root Canal Therapy Hurt” is absolutely No.  The procedure itself should not hurt if performed under anesthesia.  The patient may not be able to get numb for the procedure because of bacteria secreting toxins that changes the chemistry in the tissue that prevent the proper action from the anesthetics.

For a longer answer, we can look into what kind of discomfort might be experienced by the patient and the cause of those discomfort.  My goal of this article is to educate the public about this common dental emergency procedure and to help people to cope with the fear of going to the dentist.

There are two major sources of discomfort experienced by the patient during the root canal therapy procedure.  One kind of discomfort is of nervous origin.  It can be the pain/discomfort from not having enough anesthesia.  Another kind of discomfort comes from the physical distress from undergoing the procedure, such as from opening the jaw for an extended time, stretching of the cheek and retracting of the tongue.

The nervous pain is due to the problem of patient not being able to get enough anesthesia from the injected anesthetics.  There are many possibilities of why patient cannot get numb.  It can be due to the anesthetics not penetrating to the location where the nerve is located or there is not enough anesthetics to sufficiently numb the nerve.  This usually can be easily corrected by letting the dentist to readjust the site of injection so that the anesthetics can get to the right place or, if there is not enough anesthetics, dentist can give additional anesthetics to the area.  However, there are times that the patient might still not be able to get numb even after the dentist does the necessary steps of injecting the anesthetics.  The chemistry of the body tissue might have changed due to the presence of bacteria when the patient is having dental infection.  Sometimes the infection might affect only one smallest part of the nerve within the tooth and the dentist won’t be able to find out until the tooth has been worked on in the middle of the treatment.  Most of the time, the tooth can be anesthetized if the dentist administers additional anesthetics, but in some rare instances if the patient still cannot get numb, the dentist might tell the patient to come back after a week of taking the antibiotics.

During the root canal therapy procedure, the patient might have physical distress from the technical aspect of the procedure.  The patient’s jaw might get tired from opening wide for extended time.  Or patient might have discomfort from having the cheek stretched.  Most of this is due to the technical aspect of the root canal therapy.  The patient might need to open for extended time because root canal therapy consists of multiple steps which requires the most concentration from the dentist and it takes time to thorough treat the infection within the infected nerve canal in the tooth.  Sometimes if the patient cannot open wide enough, it might add difficulty for the dentist to be able to see and reach the nerve canals in the tooth.  And also, sometimes the patient would express their distress in their body movement.  So even though we cannot change the technical aspect of the procedure and we cannot change how wide the patient can open their mouth, we can educate patient about the procedure and let them more tolerable to the procedure.  A calm patient will definitely contribute to the outcome of the root canal therapy.

In summary, the root canal therapy is not a painful procedure.  Under proper anesthesia and proper physical coping, the patient should have a pleasant experience of undergoing the dental procedure.  The fear of going to the dentist is due to the lack of understanding of the dental problems and the dental procedures.  I hope people to find that the root canal therapy is not “scary” so they can get the necessary dental treatment to save their teeth.

 

Written by Daniel Tee, DDS, MS

Practicing Emergency Dentist Serving the city of Tempe, Chandler, Phoenix, Gilbert, and Mesa in Arizona.

Root Canal Therapy — For Treating Dental Infection

To effectively perform root canal, a dentist must understand the anatomy of a tooth.  Our tooth is constructed with multple layers: the outer most layer is enamel; the middle layer is dentin; and the innermost layer is the pulp chamber.  The enamel and dentin are harden mineralized tooth structure.

Pulp is made of nerve and blood vessels.  Generally, when a person experiences pain, it is because the tooth is under external stimulation.  These stimulation can be due to bacterial infection or damage to tooth structure which compromises the protection of the tooth.  The tooth in compromised condition is more easily stimulated.  Tooth cavity,crack and damage to tooth structure can decrease the self-defense ability of the tooth.

Under mild stimulation, the tooth would generally recover itself upon the removal of stimulus.  For example, if the tooth filling is to repair the cavity, the tooth will no longer experience pain.

However, under some conditions, the tooth may never recover.  Or if the tooth has become dead, the tooth might not cause any pain.  A necrotic tissue within the pulp of the tooth may cause more severe infection.  Often the antibiotics would not be able to penetrate to the inner portion of tooth and antibiotics may not be effective against the dental infection.  Thus, the necrotic tissue in the pulp must be removed by performing the root canal therapy by the dentist.

Root canal therapy is to remove the necrotic tissue in the tooth.  The tissue within the pulp chamber and the nerve canals within the tooth is thoroughly cleaned out.  The empty canal space will then be filled with medication so to prevent bacteria from re-entering into the pulp chamber to cause infection.

There is a misconception that after the root canal therapy, the tooth would become dead and become useless.  Well, this is incorrect.  The treated tooth can still be preserved and function just like any other teeth.

Generally, it is recommended that a crown is put on the tooth after the root canal therapy.

 

Written by Daniel Tee, DDS, MS

Practicing Dentist Serving the city of Tempe, Chandler, Phoenix, Gilbert, and Mesa in Arizona.

Dental Avulsion — Immediate Treatment

Dental Avuslion, Hanks Solution, Root canal therapy, Ankylosis, resorption, Tempe, Chandler, Mesa, Phoenix, Gilbert, ArizonaDental avulsion means that the tooth has been completely knocked out of bone socket.  This usually happens to the front tooth when the young child endures physical contact in a sport.  Generally avulsed tooth can be replanted back with good prognosis.  Here is what to do in a dental emergency involving tooth avulsion:

Upon immediate avulsion, try to pick up the tooth by the crown area.  Avoid touching the root area where the vital cells are on the surface of the root.  We need the vital cells to help the tooth to reattach to the periodonteum after replantation.

Next is to clean the tooth with cold running water for 10 second.  Wash off any visible debris but do not scrub the tooth.  You can either replant the tooth into the original socket or put the tooth into a bottle of milk.  The longer the tooth is dried, the poorer the chance of survival.

Take the child to the dentist for evaluation.

I would take a couple of Xray image to verify the condition of the tooth and the bone socket.  I would take xray to verify for proper placement position.  I would splint the tooth together with the adjacent tooth and tell the patient to wear the splint for two weeks.  I would also put patient on an antibiotic regimen.  If tooth is contaminated with soil, I would recommend patient to have medical checkup and evaluate for the risk of titanus.

Sometimes, the tooth would need root canal therapy in the next 7-10 days, followed by periodic checkup and Xray radiograph.

If the tooth has been dried for more than 60 minutes, the prognosis of the replantation goes down.  Root ankylosis or root resorption may occur and the tooth may eventually be lost.

 

Written by Daniel Tee, DDS, MS

If you have any questions or want to schedule an appointment, Please call 480-820-6131
Practicing Emergency Dentist Serving Tempe, Chandler, Phoenix, Mesa, and Gilbert Arizona

Dental Emergency Exam — My Step-by-Step Diagnosis

People often come for dental emergency visit because either they have a toothache or a broken tooth.  I would like to show how I would go about greeting the patients and performing examination on patient who has a dental emergency.

With patient comfortably sitting in the dental chair, I would review patient’s medical history.  From reviewing patient’s past medical problems (such as hypertension, surgery) and medical allergies, this allows me to take necessary precautions for treating the patient.  For example, if patients have reaction to penicillin, I would know to prescribe to another type of antibiotics to patient.  Or if patient has had knee replacement surgery, I would have to premedicate the patient with antibiotics prior to dental visit.  And often patient’s existing medical problem may play a role in patient’s dental problem.  For example, diabetes can exacerbate the patient’s periodontal condition and more frequent periodontal cleaning visits may needed.

Dental Emergency, Toothache, Root canal therpay, porcelain crown,Tempe, Chandler, Mesa, Phoenix, Gilbert, Arizona, hypersensitivity, reversible pulpitis, irreversible pulpitis, dental xray, amoxicillin, Tempe Dentist,Next, I would begin to gather necessary background information on patient’s dental problem.  I would find out about patient’s chief complaint.  Chief complaint is the patient’s most pressing issue at the time.  It could be a toothache or broken tooth.  For example, the problem could be toothache on upper right tooth.  Also, I would map out the scope of the problems.  It could be affecting one tooth, or multiple tooth or the gum tissue.  Then I would ask a series of question relating to the onset time, duration, severity of the toothache and ask about what type of stimuli that can trigger the toothache.

After knowing scope of the patient’s dental problem, I would be able to have necessary xray image taken on the patient’s specified area of concern.  If there is dental problem, it would show up in the dental xray images.  If there is dental cavity, the outermost layer of the tooth structure would appear lesser in density on the dental xray image.

By reviewing patient’s symptoms, such as the onset time, duration and severity of the toothache, I can determine whether it is just a simple hypersensitivity reaction or the pulpal inflammation of the tooth that would require further treatment such as the root canal therapy and a crown.

Dental Enamel, Dental Pulp, irreversible pulpitis, reversible pulpitis, root canal, tooth abscess, Tempe DentistToothache can be categorized into two broad categories.  One is called the reversible pulpitis and the other broad category is irreversible pulpitis.  Reversible pulpitis means the tooth is having some transient reaction to the local stimulus and the response does not linger for more than 20 seconds.  Irreversible pulpitis means the tooth is having more serious inflammation and the nerve tissue within the tooth is not likely to recover even when the stimulus is withdrawn.  So if the tooth is painful to cold stimulus and the response lasts for more than 20 seconds, the tooth can be assumed to have irreversible pulpitis.  The tooth is undergoing downhill path.  The offense and the damage is so severe that the tooth cannot adequate fend off the attack.  More serious pain, inflammation, infection and swelling may occur if the tooth is left untreated.

By determining if the tooth is having reversible or irreversible response, I would then know how to proceed the treatment.  With the reversible pulpitis, if the tooth is damaged or decayed, I would remove the decay and repair the defect and this most likely would resolve the problem.

However, with irreversible pulpitis, the tooth may need to have root canal therapy treatment, followed by complete buildup of the tooth, and a crown is put on the tooth for full coverage protection.  The crown is necessary after the root canal therapy for two purposes.  One is to strengthen the tooth from whatever defect or crack it has.  Second, the crown serves as protective barrier from any potential bacterial leakage into the interior of the tooth.

If you happen to have toothache, please feel free to call my office for evaluation and treatment.

 

Written by Daniel Tee, DDS, MS

If you have any questions or want to schedule an appointment, Please call 480-820-6131
Practicing Emergency Dentist Serving Tempe, Chandler, Phoenix, Mesa, and Gilbert Arizona

Toothache — Dental Emergency Treatments

In the previous blog, we discuss about what toothache is,  We also points out that toothache can be caused by dental cavities, periodontal disease, infection and tooth crack.

Toothache, Tooth Abscess, Root Canal Therapy, Crack Tooth, Dental Emergency, Tempe, Chandler, Mesa, Phoenix, Gilbert, ArizonaTo treat the toothache, dentist would first have to find out about the causes of the toothache.  If the toothache is caused by tooth cavity, then the dentist would have to perform the filling procedure.  The dentist would have to remove the decay on the tooth.  With the deep decay, dentist would have to put a protective layer onto the deepest area of the cavity (closest in proximity to the dental pulp.)  Then the filling material is to repair the tooth back to its original shape or its current optimal condition.

However, if the toothache is caused by bacteria infection, we can try to control the infection with antibiotics.  However, later, the cause of infection would need to be addressed and this could be due to either periodontal disease or defect in tooth structure.  If it is periodontally related, then periodontal cleaning would follow after the infection is being controlled by antibiotics.  Or if the infection is due to the defect in tooth, dentist would have to repair the defect with either a filling materials or crown.

Sometimes, the infection cannot be adequately controlled by antibiotics because the nerve within the tooth is dying and is unable to fend off the bacteria attack.  Then the dentist would need to perform root canal therapy to remove the dying nerve tissue in the tooth and disinfect the tooth.

If the toothache is due to tooth crack, dentist would first have to determine the severity of the tooth crack.  If the crack is severe, the tooth might not be saved.  If the crack is moderate in size, dentist can put a crown on the tooth in order to prevent the tooth from further damage.  Crown holds the tooth together so that the crack cannot propagate.  Sometimes, the crack is affecting the pulp and if that’s the case, dentist would need to do root canal therapy before the final crown is put on.

I know this is a lot of information in this article. In future, I will go more in depth about each scenarios.  Thank you for reading.  Happy Blogging!

 

Written by Daniel Tee, DDS, MS

If you have any questions or want to schedule an appointment, Please call 480-820-6131
Practicing Emergency Dentist Serving Tempe, Chandler, Phoenix, Mesa, and Gilbert Arizona