From Filling to Root Canal Treatment to Extraction
We all need some dental treatment during our lifetime depending upon the severity of the cavity. I am a firm believer that we should never wait until we come to the point where we have to extract the tooth. Every tooth plays an important role in the mouth; they are like a family in which each member is irreplaceable.
To understand the treatment part, it is important to know the anatomy of your teeth. A tooth has two parts – crown and root.
Enamel is the strongest part of the tooth, forming the outer layer of the crown. Under it is the dentin and deep inside is the pulp. The pulp is the live part of the tooth. The pulp chamber is an empty space that is filled with blood vessels and nerves. The root has no enamel and has cementum instead of dentin.
Dental cavity first affects the enamel, usually referred to as enamel decay. When a patient’s cavity is limited to the enamel, we Dentists observe it for the next three months. We ask the patient to maintain good oral hygiene and come to the office for fluoride treatment once every week for three weeks. Fluoride re-mineralizes the enamel. If the patient is more than four years old, we have them rinse with mouthwash containing fluoride. After three months, if cavity hasn’t progressed, we continue to monitor it rather than fix it.
When the decay infiltrates dentin, it has to be treated. Dentin is much softer than enamel and the decay progresses very fast. The smaller the cavity, the better is the prognosis for filling. Once the decay starts getting deeper, the tooth starts getting sensitive.
When the bacteria from the decay enter the pulp (the live part of the tooth with nerves and blood vessels), it multiplies and causes infection and abscess. The infection and bacteria then travel out of the tooth through the apex. This is usually when the tooth gets extremely painful and sometimes can lead to serious infection and swelling. The swelling and infection can spread to your face, neck or head. At this point, the tooth will need Root Canal Treatment (RCT) during which the dentist will clean out the bacteria, remove all the live tissue in the tooth, and fill the empty space created in the pulp. After RCT, your tooth is non-vital or dead.
Although there are many other reasons why a tooth may need RCT, tooth decay is the most common. Root Canal Treatment used to be a very time consuming and elaborate process. The advancement in technology and new materials have helped redefine the whole process.
What does RCT involve?
Picture 1: Infected tooth—the infection is past the apex
Picture 2: Obtaining access and cleaning out the decay
Picture 3: Removing infected tissue
Picture 4: Filled pulp chamber
The first step involves the local anesthetic. Then the dentist opens up the tooth to get access to the pulp. During this process, he or she will also remove the decayed part of the tooth surrounding it. Once access to the pulp is obtained, the infected tissue is removed using a series of files. Periodically, the pulp is flushed to clean the debris out.
The next step is to fill the empty pulp and then cover it with temporary filling or a permanent restoration. Permanent restoration could be a filling or a crown depending upon the amount of sound tooth structure left.
If there is extensive loss of tooth structure or severe infection then extraction may be the treatment of choice. Your dentist will decide whether RCT or extraction will have better prognosis. But why wait till it comes to this point? See your dentist every six months so he or she can diagnose the problem at the early stage and treat it.
Dr. Humairah Shah is a dentist by profession and works in Torrance, California (USA). She has been working exclusively with children for the past 11 years.