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What is RCT and why?
When the nerve of a tooth becomes infected, root
canal treatment can save the tooth.
You may realize you have an infected tooth because
it's sensitive to hot or cold, it causes swelling and pain, or
it gives you a bad taste in your mouth. You may also be completely
unaware that you have an infected tooth because you experience
no symptoms at all.
The white outside of a tooth that you're used to
seeing is the enamel. Inside the enamel is another hard layer,
the dentin. There's a small chamber at the center of the dentin
called the pulp chamber. The tooth pulp is a soft tissue made
up of nerves, arteries, and veins. The pulp extends from the pulp
chamber down through a narrow channel, which is the root canal,
all they way to the tip of the root. In general, teeth in the
front of the mouth have one or two root canals, while teeth in
the back of the mouth have two, three or four root canals.
How do teeth become infected?
Though some teeth without cavities can become infected, deep cavities
are the main cause of infection. Deep cavities can allow germs
to get into the pulp chamber. These germs cause infection and
the pulp dies. The pus from the infection eventually builds up
at the root tip and makes a hole in the bone. This is called an
abscess. A blow to a tooth may also cause the pulp to die and
then become infected. An infected tooth will never heal on its
own, and as it gets worse, It will continue to be a source of
infection that drags down your immune system, and that can affect
your entire body. This damage to the bone and the swelling inside
the bone can be excruciatingly painful, and even life threatening.
Years ago, an infected tooth would just have to be extracted,
but today, we can save your tooth with root canal treatment.
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Why a Capped
Tooth May need RCT
Any time a tooth has been damages and needs a
restoration, including a crown (cap) or a filling, there's a possibility
that the tooth pulp has been injured and will eventually die,
resulting in the need for a root canal to save the tooth. Teeth
die for various reasons: a blow to the tooth causes pulp damage,
germs infecting the tooth pulp, and sometimes for no apparent
reason at all.
The tooth pulp is a soft tissue made up of nerves,
arteries, and veins. The pulp extends from the pulp chamber down
through a narrow channel, which is the root canal, all the way
to the tip of the root. If the pulp is injured, or if germs get
into the pulp chamber, these germs cause infection and the pulp
dies. The pus from the infection eventually builds up at the root
tip and makes a hole in the bone. This is called an abscess. An
infected tooth will never heal on its own, and as it gets worse,
it will continue to be a source of infection that drags down your
immune system. Though a dying tooth may not show any symptoms,
common symptoms include: sensitivity to hot or cold, swelling
and pain, or a bad taste in your mouth.
We want the entire root canal procedure to be
comfortable for you, so the first thing we'll do is make sure
you're thoroughly numb. If you've had a crown placed on your tooth,
it's been permanently cemented in place. There are a few options
to choose from. In some cases, a small hole can be made in the
crown to get at the infection, and the root canal can be performed
through the crown. We use dental files to carefully clean out
the infected tissue and shape the canals to receive the filling
material. We take X-rays to make sure that all of the infected
pulp is removed. After placing the filling material, we then simply
place a filling in the hole in the crown. In other cases, we need
to remove the crown to properly perform the root canal. We then
seat a new crown on the newly root-canalled tooth.
Now you know that while a crown is necessary to
protect the outside of the tooth, it doesn't do anything to protect
the pulp inside. If after a procedure that pulp becomes infected,
only a root canal can save your tooth.
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RCT, As Easy
As 1..2..3!
 Root
canal treatment and restoring the tooth usually involves three
steps. First, we remove the infection to promote healing. Next,
we place filling material in the root canals, and then we crown
the tooth to protect it. We want the entire procedure to be comfortable
for you, so the first thing we do is make sure you're thoroughly
numb. We place a rubber dam around your tooth to isolate it from
the rest of your mouth. It protects you like a safety net; nothing
can fall to the back of your throat. It also keeps the tooth dry
and accessible so we can do a better job. To get at the infection,
we make an opening through the top of the tooth down into the
pulp chamber. This is a dental file. We use it to carefully clean
out the infected tissue and shape the canals to receive the filling
material. We take X-ray to make sure that all of the infected
pulp is removed. Then we place filling material to fill the root
canals.
But in some cases your RCT may require two visits
to complete. In that case we place a medicine in the tooth and
place a temporary filling, and schedule another appointment to
complete the procedure. On the second appointment, we remove the
temporary filling and place filling material into the root canals.
Sometimes it's necessary to then build up the tooth
with a post and core. The post adds much-needed retention for
the core material. It's cemented down inside one of the root canals.
Making a crown is the last step in restoring your tooth. It protects
your tooth and gives you back your smile.
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Apicectomy
An apicectomy is a minor surgical procedure, necessary
when root canal treatment hasn't completely healed an infected
tooth. After root canal treatment, an abscess, which is a hole
in the bone at the tip of the root, sometimes continues to grow.
To stop the infection, we make a small incision in the gums. We
remove the infection and then seal the tip of the root. Once this
has been done, the infection will heal, new bone will grow in,
and the tooth will be healthy again.
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Post
and Core
Sometimes, when a tooth has broken
off due to fracture or decay, there's simply not enough tooth
remaining to place a crown. Fortunately, there is a way to replace
the missing portion and save the tooth by placing a post and using
it to anchor a buildup, which is also called a core.
The first step in placing a post
is performing root canal therapy on the tooth. The nerve of the
tooth is removed and replaced by a filling material. The top of
the root canal is then shaped. A post is selected, tried in, and
then cemented or bonded in place. Depending on the situation,
we may use posts made of metal, fiber-reinforced plastic, or carbon
fiber.
After the post is in place, the next
step is the placement of the new core material. Once hardened,
the core material is prepared and shaped, and an impression is
taken. The placement of the temporary crown completes the first
appointment. On the second appointment, the temporary is removed.
The permanent crown is tried in and then cemented in place. When
a tooth is severely broken down, a post and core procedure is
an excellent way to build the tooth back up and save the tooth.
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Possible
Alternatives to RCT
 Once
the pulp of a tooth has become infected, your choices are limited.
You could choose to delay treatment. You could choose to have
the tooth extracted, or you could choose to save your tooth with
root canal treatment. The problem with delaying treatment is that
an infected tooth will NEVER heal on its own, and this can lead
to some very serious problems.
As the infection spreads down the
tooth and into your jawbone, the pain may become excruciating.
It could even put you in the hospital and threaten your life.
An extraction is only a short-term solution. While it does remove
the source of infection, it sets off a chain reaction of shifting
teeth and other dental problems. The only way to save your tooth
and keep it in your mouth is to remove the infection with root
canal treatment.
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Extractions
