Let’s get to the root cause

When is a root canal recommended as against a simple filling?

Shallow cavities detected early can be tackled with a simple filling. A root canal is advised if your tooth cavity has got bigger and deeper and has reached the nerve [pulp of the tooth]. It may also be advised when there is a long-standing decay, accidental trauma to the tooth, or cracked and severely worn out teeth.

If the infection from the damaged tooth spreads to underlying tissues it can lead to dental abscess, swelling in the gums and further breakdown or loosening of the affected tooth. If severely damaged, the only option left is removal of the tooth. Some signs or symptoms which suggest a tooth might require root canal therapy are spontaneously occurring pain in the tooth, severe sensitivity to cold or hot beverages which lasts for a while, tenderness or pain on biting, and swelling in the gums or jaw associated with a decayed tooth.

In what way does a root canal affect the life of the tooth?

If care is taken, a root canal treated tooth is like any other natural tooth which has a long life. This is generally a one-time treatment and is usually not repeated.

Can a root canal procedure be repeated? If yes, in which cases?

Sometimes, after a root canal procedure there may be signs of re-infection, like pain or abscess below the root; in such cases a repeat root canal is needed. It depends on a variety of factors such as if the root canal anatomy is complex or inaccessible, or if there is a presence of sharply curved roots, or if the canals were inadequately sealed. If these can be determined, and there is a possibility of addressing them by a repeat procedure, then it should be attempted. A general dentist can do it. But it requires special instruments like a microscope and an endodontist may be referred if more expertise is needed.

What are the risks associated with repeating a root canal?

There is no risk in repeating a root canal treatment. If the reason for the failed root canal is diagnosed, then the prognosis is excellent. However, one should be cautious if the tooth structure is not strong enough to hold the cap or if the problem may not be solved by a repeat procedure, then extraction is the preferred choice.

What are the lifestyle habits that bring the tooth to a stage that it requires root canal?

Eating habits are the main cause of decay. Late night dinners which lead to skipping of bed-time brushing have a major role in dental problems. Consumption of aerated drinks, cakes and chocolates which have less roughage, high amount of simple carbohydrates, natural or refined starches such as white bread and chips increase dental decay.

The bacteria in the mouth react with the sugar particles left on the tooth surface and produce acids. Saliva has the capacity to neutralise the acid. However, repeated acid attack due to in-between snacking, eating late at night and not brushing surpass the buffering capacity of saliva, causing the acid to dissolve the tooth structure and leading to decay and cavity formation.

Does age have any effect on the incidence of cavities?

Age has no effect on the incidence of cavities. Elderly people may have more wear and tear of teeth which leads to frequent need of dental treatments.

Is root canal a very painful procedure?

Root canal is no longer a painful or long procedure as is feared. With advanced techniques and specialised instruments, the entire procedure can be completed [for a majority of people] in one or maximum two sittings, with no or minimal pain and very little post operative discomfort.

Does a root canal reduce the life of the tooth?

If care is taken, a root canal treated tooth is like any other natural tooth which has long life. This is a life time treatment and is usually not repeated. People think that once a root canal is done the tooth is dead or of limited service. But if proper treatment is carried out even a pulp-less treated tooth functions as good as a natural tooth, serving us for years. Sometimes the tooth may become brittle or lose its natural colour over a period of time, as a result of the root canal treatment. But this can be dealt with either through bleaching, veneering or capping the tooth. Back teeth [molars] usually need a cap or crown for additional mechanical strengthening after a root canal treatment.

Is a root canal advised for cavities in milk teeth?

Milk teeth are soft in structure as compared to adult or permanent teeth, hence can decay faster. Feeding milk to babies [in whom milk teeth have started erupting] at night and putting them to sleep immediately can cause a severe form of decay, called baby bottle decay. This causes damage to all the front milk teeth. This can be prevented by feeding them a little early, or giving them some water after milk and gently wiping their teeth with a soft wet cloth.

Parents often wonder why root canal treatment is advised in case of milk teeth since they will eventually fall off. But milk teeth are needed to maintain the space required for the permanent teeth to erupt. If removed prematurely it can lead to crowding of the teeth.

What would you advise to altogether avoid the pain of cavities and root canal?

Meticulous removal of plaque [sticky film of bacteria and food debris on the surface of teeth] by brushing twice a day, daily flossing, rinsing after every meal, healthy diet including lots of fibre and roughage, keeping regular meal times, regular dental checkup to detect early cavities and prevent their progression to root canal infection are all necessary to have good oral health. Use a fluoride containing toothpaste as fluoride makes the enamel resistant to acid attack.

For children between 3 – 6 years, parents should assist while the child brushes to ensure only pea-sized toothpaste is used and paste is not swallowed [too much ingested fluoride can cause fluorosis of teeth].

For children below three years, a fluoride toothpaste is used only if his/her dentist recommends. Newly erupted permanent teeth have deep groves and pits on their biting surface. Decay usually starts in these pits where food tends to get stuck. These areas are sometimes inaccessible to fluoride or brushing [size of pits are smaller than the thickness of bristles]. A preventive procedure called pit fissure sealing can prevent these areas from decay.

This was first published in the September 2012 issue of Complete Wellbeing.