When you let the cavity erode your tooth

Almost everybody has experienced cavities and other aches and pains that originate from the mouth. You usually think that it’s a trivial matter and you’ll pay a visit to the dentist to have it checked. But what happens when you ignore the pain in your mouth and allow the cavity to progress deeper into your tooth? The Health Capsule spoke to Dr. Vipula Wickramasinghe, General Secretary of the Sri Lanka Dental Association and Regional Dental Surgeon of the Colombo District, in order to find out the process of a root canal treatment and the different aspects of it.   

Definition 
Defining a root canal treatment Dr. Wickramasinghe said,“There are certain cases that we receive which are beyond normal fillings. What has happened is that the cavity has gone up to the pulp chamber. Then you have only two options; either to extract the tooth or do a root canal treatment. The root canal is when you treat all the canals of the tooth. Certain teeth have single canals, certain teeth have two canals, Some may have three or four. So we prescribe treatment to all these canals and make the tooth intact in the mouth. It will be in the mouth, but it is a dead tooth,” he said.

Signs that you need treatment   
Speaking on how the decision to perform the procedure is made he said,“There are certain patients that come with pain and there is no swelling. But when you examine carefully, you can see that the pulp is exposed in the cavity that’s formed in the tooth. Then you have to go for root canal treatment. In certain cases regarding the teeth, the tooth becomes a blackish colour without the patient’s knowledge. This may be due to a trauma that was experienced many years ago. with regard to certain cases you don’t have any pain, but there’s a cavity with an almost dead tooth in the mouth. But still if you feel the pulp protrudes you have to go for the root canal treatment,”Dr. Wickramasinghe said. 
“The cardinal rule is that you have to have an X Ray before a decision can be made whether you need to go for a root canal or not. Otherwise, if there is a colour change in the tooth you have to do a vitality test. In this test the doctor will get to check the vitality or the liveliness of the tooth. There are special gadgets called pulp testers and if the vitality is lost you have to go for the root canal treatment,” he continued.   

Infection 
When there is decay in the tooth the condition develops through the enamel, then the dentin and then it progresses into the pulp. As the pulp is exposed to the bacteria it will get infected. Sometimes you get severe pain due to pulpitis, which is infected pulp, which is called acute pulpitis. Sometimes you don’t experience pain, although the pulp that is exposed is infected. This is called chronic pulpitis. But if you talk to the patient the patient will say that around 3/4 months ago, he or she had a slight pain on that tooth. Thus the medical history of the patient is important.

Procedure   
Explaining the procedure Dr. Wickramasinghe said that there are four steps to be followed. “The first step is to make an access cavity to go into the root canal. The second step is obturation, which is that you have to remove all the pulp debris, all the infected particles from that particular root canal. The third one is irrigation, which is very important. When you are obturating you have to continuously irrigate the canal with different solutions, which are manufactured for this particular purpose. Obturation and irrigation happen simultaneously during the procedure. And finally you fill the canal with material which is bio compatible, but doesn’t react with the human body tissue. You have to fill the total canal, so there shouldn’t be any gaps or any leakages after the filling,” explained Dr. Wickramasinghe. 

“Since treatment is always under local anesthesia, there is no pain during the procedure. Normally antibiotics will be administered for the infected teeth. Sometimes you may experience slight pain during the course of the treatment. It isn’t a single visit treatment. Generally treatments is complete after two visits. But in certain instances, such as emergencies, we do one visit root canals,” he added.   

What to expect 
Dr. Wickramasinghe went on to explain why a root canal procedure is decided upon.“Normally patients want to retain the tooth in the mouth and not get it extracted, so the only option is to do a root canal. This is possible if the tooth has gone beyond normal fillings. When patients come to us the top half of the tooth has gone and the patient wants to have the original tooth restored,” he said.   

Explaining what comes after a root canal he said, “After we do the treatment we put what is called the crown. It is an artificial cover of a tooth, which is manufactured according to the patient’s original tooth. It is made with different materials. We have metal, porcelain and zirconia. This is a different procedure following the root canal. Before the root canal you have to explain to the patient that once you do the root canal the tooth dies and there is a higher tendency for it to become more brittle, so the top part of the tooth can break at any time, which is why you have to put a crown on top of the tooth to strengthen it. That provides the tooth with the strength as well as an aesthetic aspect,”he explained. 

Complications   
Explaining the complications that could take place, Dr. Wickramasinghe said, “If the infection is very strong then you can’t get rid of it because every time you try to obturate or irrigate the infection still remains, In such cases the procedure takes time. Sometimes there is unstoppable bleeding from the canal.  It is difficult to control the bleeding if the patient is taking aspirin or some kind of drugs or there is thinning of the blood. This is because the canal has small blood vessels. It is not that the patient can’t undergo a root canal treatment, but it takes a little time,”he said. 

“Sometimes, without any reason, patients experience continuous pain. If the patient has periodontal or gum diseases it’s a little difficult to administer the root canal treatment because the infection is so high. Sometimes there are certain operative factors as well. A basic complication would be that during the procedure the patient might feel slight pain. But all these things once identified can be treated. Once you finish the root canal you have to take an X Ray and see if you have done it correctly,” the doctor continued.   

Furthermore Dr. Wickramasinghe stated that if you don’t feel pain five years after a root canal treatment, then the procedure was successful.   

Avoiding treatment   
Dr. Wickramasinghe further advised, “Once you get a small cavity you have to go to a doctor and get it filled without leaving it to decay up to the pulp. If you can fill it from the enamel level or the dentin level you don’t have to do the root canal treatment,”he concluded.