Preface
Endodontic dentistry is the branch that deals with diseases of the tooth pulp. The pulp is located in the center of the tooth and within root canals in each tooth. The pulp is made up of connective tissues, nerves and blood vessels. The pulp nourishes the tooth during the appearance through the gums. At the time of maturity, the pulp can be removed without damaging the tooth. This happens because each tooth is nourished by the blood supply of the gingiva.



The removal of the pulp is called endodontic therapy, but can also appear as pulp therapy or root canals. These treatments are very common, for example in the US with this therapy they save about 24 million teeth each year.

Why should I?
Treatment of the pulp is needed for two reasons. The first is infection. Untreated caries are the most frequent cause of infection of the pulp. Caries are known to destroy enamel and dentin of the tooth until they reach the root canal. This allows bacteria to infect the pulp. Antibiotics cannot operate in infections within the tooth. Inflammation from infection reduces blood supply to the tooth. This reduction does not allow recovery of pulp.

The second reason for the treatment of pulp is that once the pulp is damaged it cannot be recovered. Trauma or tooth breakage can damage pulps. Injuries can also be caused by seal fillings or tooth preparations for the crown. The tooth may need pulp therapy.

When the pulp is inflamed but not infected, it can heal itself. Your dentist might notice if it can happen before you perform pulp therapy. If the pulp remains inflamed, it can be very painful and can result in infection.

Infection of the pulp can include the bone around the tooth. This can result in the appearance of abscess. The goal of the treatment is to preserve the tooth pulp, while removing the infected or damaged part, treat the infection, and do the filling of vacant channels with the material called gutta percha.

If the treatment of the pulp doesn’t happen, the infected tooth has to be removed. If you decide not to treat an infected tooth or injured one, the infection may spread to other parts of your body. It is always much better to preserve your tooth. If the tooth is removed, neighboring teeth will change positions. Take good care of your natural teeth and you’ll avoid other treatments, such as plants or bridges.

Treatment of the pulp in your tooth does not mean that the tooth will have to be removed after several years. If the tooth is treated with care, it will survive almost your entire life.

Signs and Symptoms
If you have infection of the pulp, you may not have pain at first. But, if left untreated early, the infection can cause pain and swelling. In some cases it may also occur in the formation of abscess.



Your tooth will need treatment of pulp (root canal) if:

There is pain in the bite, touch or pressure
Is sensitive to hot
Is sensitive to the cold for a few seconds
There is swelling near the tooth
It changed color (regardless of the pain)
It is broken
To determine if your tooth needs root canal treatment, your dentist often places cold or hot products in the tooth. The aim is to set higher or lower sensitivity compared with normal tooth. The dentist will examine the tissues around the tooth and the tooth may strike to determine the symptoms.

You may need an x-ray recording of the bone around the tooth. This can show extensions clutching the tooth ligament or black spots on top of the root. If any of them are present, the dentist will probably advise you to pulp therapy procedure.

Dentists may need more information on your tooth. He or she can use electric pulp testing. This device transmits electricity to the teeth and helps the dentist to decide whether the pulp is alive. This test does not cause pain or injury. May have small stinging pain, which will pass when the device is removed from the mouth.

Electrical device should not be used if you have pacemakers (pacemaker) or any other electrical equipment.

Duration of treatment
Pulp therapy can be done in one or more visits. It all depends on the situation. A treatment without complications of the tooth pulp can be performed immediately. Some teeth may be more difficult because of their position in the mouth. Some have more roots. The latter requires a longer time. Some teeth are curved channels which are hard to find. If you have an infection, you’ll have to visit the dentist several times until the removal of the infection.

At the time of completion of the treatment, your tooth will be covered and treated with artificial crown or standard filling.

Measurement and Cleaning of channels
Measurement

At first the dentist will numb the region around the tooth. The dentist has other methods to reduce your pain. Before your appointment with the dentist, you can be notified about the methods that are available.

The dentist will create a hole above your tooth to reach the pulp chamber. Then he or she will remove a portion of the sick pulp.

The dentist with have to measure the root canals. The dentist will need to know how long the channel is, so that he can cleanse it all. He or she also needs to know how much padding is needed to fill it.

To measure the root canals, the dentist uses X-ray or a device called apex locator. For rays, the dentist will place a needle into the groove and then use X-ray apparatus.

Cleaning

Once the channels are measured, the dentist will use special tools to clean all the sick pulp. Then the canal is cleaned with antiseptic. This helps in the treatment and prevention of infection. All ducts should be cleaned in the tooth.

Teeth have different number of channels:

Front teeth have one channel
Premolars have one or two channels
Molars have three or four channels
The position and shape of the root canal may vary. Some dentist’s microscope look inside the tooth to make sure that all the channels are cleared.

Shortly after ducts are cleaned, they are filled. Then a temporary filling is placed in the tooth. This padding is not long term.

In most cases you will need an artificial crown. This crown will enable the strength of the tooth and protect it from breaking.

The removal of the pulp enable respond to temperature changes. Your tooth is not sensitive to cold or heat after treatment of pulp. But, there are still tissues and nerves around your tooth so that it will still react to pressure and tactile stimuli.

After Treatment
After the procedure, your tooth may still show signs of pain for a couple of days. The more infection and inflammation there have been, the more the tooth will be sensitive after treatment. Avoid chewing on the side that is involved. You can take pills against the pain. Drugs that reduce inflammation can come to your aid. For example, ibuprofen or aspirin.

Possible complications
As in most medical and dental procedures, complications are possible here too. Here are some of the options on the table.

Sometimes when the treatment has begun, oxygen from the air can enable some of the bacteria to increase. This causes swelling and pain.

Blood vessels enter the tooth through a small hole in the top of the root. Sometimes during the treatment procedure, the bacteria is pushed through the hole into the surrounding tissue. If this happens, the surrounding tissue can be irritating and possibly catch an infection. It can be treated with drugs for the pain and sometimes even antibiotics.

During canal treatment drilling sideways the channel might occur. This can happen if the channel is curved or hard to find. The instruments used by dentists are flexible. They curve in the form of the channel. Sometimes they bend at the wrong time and form a hole sideways the channel. If saliva penetrates into the hole, the channel should be filled. Sometimes, the tooth must be removed. If the hole is positioned so that saliva cannot penetrate, the hole can be closed automatically.

Finding the root canals can be difficult. If all channels are not found and cleared, the tooth may remain infected. This can also happen if the channel is not measured correctly and the infected part of the pulp is left near the tip. In this case, the treatment procedure will be repeated again. Sometimes, root canals have other branches that dental equipment cannot reach.

The tip of the needle may break inside the tooth. If the channel is clean, your dentist may leave it inside. But if the channel is not thoroughly cleaned, the needle will be removed. This can sometimes be done by entering the channel. However, in some cases, the needle can only be removed by surgical procedure called apicectomy. A small incision is made in the gum by the dentist, to have access to the root of the tooth. The dentist will engrave the tip of the root and will reach the channel to remove the remains of the needle.

Pain
In most cases, you should not have any pain during the procedure. The dentist will numb the tooth and surrounding tissue with anesthesia. Notify your dentist if you feel any pain during canal treatment. Some people fear most from pinprick than pulp therapy itself. Today, Hangman narcotics and modern systems have made giving injections of anesthesia virtually painless.