Root canal treatment

Root canal treatment, also known as endodontic treatment, is the process of removing infected, injured or dead dental pulp from your tooth. A tooth is made up of 3 main components: a hard protective shell referred to as enamel, a softer and sensitive middle layer referred to as dentin and a soft tissue inner layer called a dental pulp (“nerve”). Dental pulp is composed of nerve tissue, lymph tissue and blood vessels and is considered to be the vital part of a tooth. If dental pulp is sufficiently traumatized – whether by exposure to oral bacteria via deep dental caries, a fracture in the tooth that enters the pulp or a forceful blow to the face – the tooth begins to die and root canal therapy is often required in order to prevent or eliminate infection and prevent tooth loss. If dental pulp becomes infected it needs to be removed, otherwise the tooth can cause pain and/or swelling. Your dentist may notice the infection from a dental x-ray or from other changes within the tooth. If left untreated, an infected tooth can cause serious oral health problems.

Each root canal treatment procedure starts with a local anaesthetic (freezing). To protect your tooth from bacteria in your saliva during treatment, the dentist places a rubber dam around the tooth being treated. Then a dentist makes an opening in the tooth to reach the root canal system and the damaged pulp. Using very fine dental instruments, the dentist removes the pulp by cleaning and enlarging the root canal system. After the system has been cleaned, the dentist fills and seals the canal and the opening of the tooth is then sealed with either a temporary or permanent filling. Root canal treatment may be done in 1 or 2, very occasionally more, appointments. After root canal treatment, your tooth may be tender for the first week or two. Bad pain or swelling are NOT common – if this happens, call your dentist.

After the root canal treatment, your tooth has to be restored (fixed) to look, feel and work as much like a natural tooth as possible. Your dentist may use a permanent filling or a crown to restore your tooth. The choice of restoration will depend on the strength of the part of the tooth that’s left. A back tooth will likely need a crown because chewing puts a great deal of force on back teeth. If there is not enough of the tooth left, posts may be used to help support the crown.

You can still get a cavity or gum disease after a root canal treatment. Root canal treatment does not protect your tooth from other types of damage. With proper care and regular dental visits, the tooth could last as long as your other teeth. Most of the time, a tooth that has had root canal treatment can be saved. However, there are cases where everything possible has been done to save the tooth and still the tooth must be extracted.

Most root canal treatments are successful. But in some case a second root canal treatment is needed – this is called retreatment. When retreating a tooth, the root canal filling material is taken out and the canal system is recleaned, reshaped and refilled.

Sometimes root canal surgery (“apicectomy”) is needed when a regular root canal treatment cannot be done or when it has not worked. Surgery is done to check the end of the root for fractures (cracks), to remove parts of the root that could not be cleaned during regular root canal treatment and to clear up an infection that did not heal after regular treatment.

 Our dentists in Westport Dental Centre have vast experience and postgraduate training in root canal treatment of both front and back teeth as well as in restoring them to the highest possible outcome. Very occasionally we may however need to refer you for the root can treatment to a specialist endodontist. An endodontist is a dentist who has completed a minimum 3 years university post-graduate specialty program in endodontics. Endodontics is a specialty of dentistry concerned with the treatment of the dental pulp of the tooth. If your child’s primary (baby) tooth is damaged and needs root canal treatment, we may refer you to a paediatric dentist for this procedure. A paediatric dentist has at least 2 years of extra university training in treating children.

Teeth removal and oral surgery

Oral surgery is any procedure that includes cutting into or removing tissue from your mouth. It includes procedures like removing a tooth, gum surgery, and getting dental implants. Oral surgery also includes getting rid of diseased tissue from the mouth, correcting jaw problems or repairing a cleft lip or palate. Most minor oral surgery procedures in Westport Dental Centre are performed by our experienced general dentists and whenever there is a need for more complex oral surgery procedure, we are fortunate to have an oral surgeon specialist from Dublin, dr. Andrew Norris, visiting our practice on occasional basis.

Tooth removal (extraction) is the most common oral surgery procedure and involves removing a tooth from its socket in the jaw bone. Before your dentist considers extraction, every effort will be made to try to repair and restore your tooth. However, sometimes a tooth extraction is the only solution. There are several reasons for removing a tooth and these include:

  • Severe tooth damage or trauma – either due to extensive decay or fracture, or advanced gum disease
  • Malpositioned/non-functioning teeth – to avoid possible complications to your oral health
  • Orthodontic treatment (braces) – to make space for better teeth alignment
  • Extra teeth – when they block other teeth from erupting
  • Radiation therapy of head and neck area – to avoid possible complications
  • Chemotherapy
  • Organ transplant

There are two types of tooth extractions:

  • Simple extractions – these are performed on teeth that are visible in the mouth and are usually done under local anaesthesia
  • Surgical extractions – these include teeth that cannot easily be seen or reached in the mouth, either because they have broken off at the gum line or they have not fully erupted. Performed by dentist or oral surgeon, surgical extractions require some type of surgical procedure, such as bone removal, removing and/or lifting and folding back all or part of the gum tissue to expose the tooth, or breaking the tooth into pieces (called tooth sectioning). Surgical extractions can be done with local anaesthesia and/or conscious sedation.

Tooth extraction after-care

Since bleeding is normal after an extraction, your dentist will have you bite on a piece of gauze for about 30 minutes to put pressure on the area and allow the blood to clot. Some swelling and discomfort are normal after a tooth extraction. Cold compresses or ice packs can help decrease the swelling. If your jaw is sore and stiff after the swelling dissipates, apply warm compresses. Sleeping with your head elevated with extra pillows also may help. In addition your dentist may recommend you take an over the counter pain reliever such as paracetamol or ibuprofen for several days. With surgical extractions – which generally cause more pain afterwards – your dentist may prescribe a prescription pain medication.

Mouth Cancer Screening

Mouth (oral) cancer is a disease resulting from abnormal cell growth in the mouth, lips, tongue or throat. People over the age of 45 are most at risk. The good news is that oral cancer can be treated successfully if caught early enough. All dentists in Westport Dental Centre have the expert skills and training to detect early signs of the disease and can help you to understand your risks. Mouth cancer screening is a procedure we do routinely each time you have your regular dental check-up with us.

There are certain signs and symptoms which should be checked by your dentist as soon as possible after you spot them. These include:

  • White or dark red patches in your mouth, or on your lips or tongue
  • Lumps or changes in the texture or colour of the mouth tissues
  • Bleeding or numbness in the mouth, sores or patches that do not heal
  • Difficulty swallowing, changes in taste or tongue sensation
  • The actual cause of oral cancer is not known but risk factors include:
  • Consumption of tobacco products (cigarettes, chewing tobacco, cigars, etc.)
  • Heavy alcohol consumption (it is especially dangerous to combine smoking and alcohol)
  • Oral sex
  • Prolonged, repeated exposure of the lips to the sun
  • Poor diet
  • Genetics and gender (more men develop the disease than women)
  • A history of leukoplakia – a thick, whitish-colour patch inside the mouth

 

Treatment of oral cancer depends on severity and location of the disease, as well as the age and health of the patient. If oral cancer is suspected a biopsy (surgical removal and microscopic examination) of the suspicious area may be taken, along with imaging tests such as x-rays, ultra-sounds, CT scans or MRIs. If oral cancer is confirmed is usually treated by chemotherapy, radiation therapy or surgery.

To help prevent oral cancer see your dentist regularly and stop using tobacco products, limit alcohol consumption, limit sun exposure and use UV protective lip balms, eat a healthy diet with lots of fruits and vegetables and check your mouth regularly for signs and symptoms and report any changes in your mouth to your dentist right away.

Bad Breath

Bad breath, also called halitosis, is a very common oral health problem. People of any age may have halitosis which is mostly caused by sulphur-producing bacteria that normally live on the surface of the tongue and in the throat. Sometimes these bacteria start to break-down proteins at a very high rate and odorous volatile sulphur compounds (VSC) are released from the back of the tongue and throat.

Apart from the sulphur-producing bacteria that colonise the back of the tongue, the other major causes of halitosis are:

  • Dental factors – such as gum disease or poor oral hygiene
  • Dry mouth – caused by medicines, alcohol, stress or medical conditions
  • Smoking – which starves the mouth of oxygen.
  • Less common causes of halitosis include:
  • Acid and bile reflux from stomach
  • Post-nasal discharge – for example, due to chronic sinusitis
  • Foods - such as onion, garlic or cauliflower, which induce certain odours. However, these effects are only short-lived.

Having halitosis can have a major impact on a person. Because of bad breath, other people may back away or turn their heads. This can cause a loss of confidence and self-esteem.

There is no one treatment for halitosis. The treatment will depend on what is causing the problem. Avoiding dehydration and good oral hygiene, including brushing and flossing, are very important. Some mouth-washes, lozenges and toothpastes can assist in fighting halitosis. Gentle but effective tongue cleaning may also be required. A variety of tongue brushes and scrapers have been produced in recent years. The tongue should be brushed in a gentle but thorough manner, from the back towards the front of the tongue, keeping in mind that the hardest to reach back portion smells the worst. People with chronic sinusitis may find the regular use of saline nasal spray helpful. A course of an antibiotic, effective against anaerobic bacteria (such as metronidazole, to reduce the overgrowth of sulphur-producing bacteria), may also help.

Crowns

A crown, also called a cap, is a hollow, artificial tooth used to cover a damaged or decayed tooth. If your tooth is damaged but not lost, a crown can be used to restore its shape, appearance and function. You may need a crown if you have a root canal treatment, a large filling in a tooth or a broken tooth. The crown restores the tooth and protects it from further damage. Crowns can also be used to cover a discoloured or misshapen tooth. A tooth that has been fixed with a crown, looks and works very much like a natural tooth.

This is how a crown is made:

  1. Your dentist gives you a local anaesthetic.
  2. To make room for the crown your dentist files down the tooth that needs to be restored
  3. An impression of the filed-down tooth and nearby teeth is taken. This impression is used to custom make your final crown. The crown is built using restorative material and it will be the right shape for your mouth.
  4. Until your final crown is ready, your dentist places a temporary crown over the tooth that needs to be restored. The temporary crown is usually made from an impression of your tooth before it was filed down. It protects your tooth until the final crown is ready. A temporary crown may not have the same shape and colour as a final crown.
  5. On your next visit, your dentist takes off the temporary crown and puts on the final one. Your dentist checks to make sure the crown is the right fit, shape, colour and bite. If it is, the crown is cemented into place.

 

These are the steps dentists most often follow in making a crown, but your tooth may need special care. You may need orthodontic treatment, gum treatment or root canal treatment beforehand. It may take more than 2 visits or your visits may be longer.

There are 3 predominant choices of restorative materials for the full coverage crowns:

  1. Porcelain-fused-to-metal
  2. All-ceramic (all-porcelain)
  3. Gold

The material selection is determined by the clinical demands at hand, aesthetic demands, strength requirements, material durability and restorative space available.

Porcelain-fused-to-metal crowns provide a strong, durable and aesthetic treatment option. One of the key factors for aesthetic and functional success of this type of crown is ensuring the preparation of the underlying tooth structure provides adequate space for the appropriate thickness of the material selected. Additionally, the artistic skill of the laboratory technician creating the crown will determine its aesthetic appeal. One consideration in porcelain-fused-to-metal crown is that these crowns may tend to show the underlying metal margin at the gum line as gum recede over time.

The predominant material choice for all-ceramic crowns today is either zirconia or aluminous materials. They provide a metal-free aesthetic option with a number of benefits. By eliminating the need for supportive metal core, an aesthetic all-ceramic crown can be created with reduced thickness of material. This makes them a more favourable treatment choice in cases with limited space. Additionally, the elimination of the metal core allows for light transmission through the porcelain for better optical, life-like properties and a higher level of aesthetics.

Gold crowns, although not as popular treatment choice for aesthetic reason, are still indicated in some instances. For example, patients with strong bites and those with parafunctional habits (such as grinding or clenching) might be better served with a gold crown. The traditional restorative material can provide stronger support to the remaining healthy tooth structure. Gold crowns offer a level of durability that is appropriate for teeth located in the back of the mouth (such as the molars), where they will not be visible. Gold crowns tend to offer greater longevity and require less preparation than all-ceramic and porcelain-fused-to-metal crowns. When chewing, gold crowns tend to be less abrasive to the opposing tooth than porcelain. This helps to prevent excessive wearing of the teeth.

Crowns are strong and generally last for about 10 years or longer if you take good care of them. Brush and floss your crown, just like you clean your natural teeth. Crowns may not be as strong as your natural teeth. So like your natural teeth, remember not to bite down on hard objects or use your teeth to open or cut things.

  1. Bridges
  2. Dentures