We have all at least once in our lives experienced a toothache. It is never a pleasant experience. However, there are few reasons for this pain and it’s not always the same. Depending on the cause of pain the nature and characteristics of pain may vary. There are three types of tooth disease that can cause a toothache:
- Dental caries: When the number of bacteria in the oral cavity is increased, hard and soft tissues are prone to infection. Dental caries is an infection of the tooth, precisely enamel, and dentin. When it occurs, it may be symptomatic or even with no symptoms at all. Usually, patients with caries lesions experience acute pain during eating or drinking cold food or drinks. The pain is present while they consume groceries and it quickly disappears. Removal of affected tissue and placing certain protective baseliners on the pulp wall this problem can be easily solved.
- Pulpitis: When bacteria in caries lesion persist there long enough, they spread forward the dental pulp. Dental pulp disease or pulpitis is the infection of dental pulp. It can be acute or chronic, sometimes followed with pus. Another classification is reversible and irreversible pulpitis. Symptoms vary depending on the type of infection. There always strong, usually spontaneous pain present. If there is a pus due to infection the pain will weaken on cold stimuli. Chronic pulpitis usually has no clinical manifestation. In both cases, the infection ends up with pulpal necrosis, in other word pulpal death.
- Apical periodontitis: After pulpal necrosis, bacteria still persist in tooth canal. With their further propagation infection usually, develop in periapical tissue. At the top of the tooth root infection destroys bone and form apical cyst or granuloma. This condition can present in the acute or chronic form. Acute periodontitis is followed by swelling in the region of root apex and spontaneous pain or pain during chewing. Since the main cause of this clinical condition is actually periapical abscess it can result in a fistula that actually drains the puss from abscess into the oral cavity and that way reduces the pain. Chronic apical periodontitis is often asymptomatic until it evolves in the acute phase or is diagnosed accidentally during radiographic procedures. In some cases, this condition can be caused by the traumatic bite or in a combination of periodontal infection of dental pockets, when the infection starts in the destroyed bone around the tooth and progresses all the way to tooth apex.
- Traumatic injuries: All mechanical destructions of the tooth are considered as traumatic injuries. Broken tooth during sports or other accidents sometimes ends up with pulpal exposure to outer sources of bacteria. This usually leads to pulpal inflammation. When dentist preparing teeth for crowns and bridges with highspeed burs pulp can be affected and inflamed. Since highspeed burs rotate and remove dental tissue by friction, water cooling is necessary. Sometimes it is not enough to prevent pulpal inflammation and endodontic treatment is the only solution in order to save the prepared tooth.
In general, three out of four above mentioned conditions requires endodontic treatment: irreversible acute pulpitis, chronic pulpitis, apical periodontitis and pulp inflammation caused by trauma. So what exactly is the endodontic treatment? When bacteria invade the pulp chamber they cause the infection that is progressively spread toward apical bone. The main aim of endodontology is to neutralize and remove bacteria from inside of a tooth. After removing the cause of the infection, empty pulp chamber and root canals should be filled with adequate materials that will obstruct this empty space. To achieve this goal, dentists specialized in endodontology use mechanical and chemical tools.
By preparing access cavity, which is the first step, dentist actually creates proper space inside your tooth for the following treatment. Access cavity is specific for each type of tooth, according to its specific anatomy and morphology. This way the pulp chamber is completely visible and the entrance to root canals is accessible. Sometimes, the entrance to canal requires remodeling with special burs.
Next step is a determination of working length. In order to do so, a dentist needs a special device called Apex locator that helps them to determine working length which means the length of the entire tooth- from control point on the tooth’s crown to the end of root called apex. Whit the assistance of hand file that reaches the apex while connected to Apex locator the working length will be determined. After this procedure, your dentist will know where is the end of the affected tooth, so he or she will not operate further than this point.
At this point, your dentist will start to clean the root canal mechanically and chemically. For mechanical cleaning hand or rotary files are used. This instrument can be simply described as thin dentated needles. By using rotary and longitudinal movement canal walls are cleaned and shaped while any debris is removed out of the canal. Beside this, irrigation of root canal is equally important. For irrigation few different chemical solutions are used: sodium hypochlorite, chlorhexidine and/or sterile saline. As a lubricant, EDTA is used. It smoothes the canal surface and helps mechanical cleaning.
If medication is necessary, calcium hydroxide is used for that purpose. Calcium paste is placed into canals and left there for 7 days. The main goal of calcium hydroxide medication is to decrease the number of intracanal bacteria by creating an alkaline environment. After 7 days, the medication is removed from the canal by profuse irrigation with sodium hypochlorite, flowable EDTA solution. This is followed by mechanical cleaning when the hand or rotary files are used again.
When canals are clean and disinfected yours dentist will start the last step of endodontic treatment. After canals are dried, the filling material can be inserted into canals. Filling materials are gutta-percha points and paste that should plug the apex of treated root or fill the gaps between gutta-percha points. This depends on technic of obturation. When canals are filled, control of filling should be done by radiography. If it confirms proper filling of canals it is considered that tooth is well treated and it can be furtherly treated for restoration or prosthetic.
Endodontic procedures are usually not a visible part of dental work for patients. Sometimes it is not appreciated enough by patients or even other dentists. What is the most important when we talk about endodontic treatment is that your tooth can be actually saved for a very long period of time. Tooth treated this way can be used as a part of a future prosthetic work. So, when we compare how expensive or time consuming endodontic therapy could be, but on the other hand, realizing the benefits of this procedure and the value of saved tooth, it becomes clear how important and valuable endodontic treatment is.