Posts for: October, 2020
When decay spreads to the tooth’s inner pulp, a root canal treatment may be necessary to save it. It’s a common procedure: after removing all tissue from the pulp, the pulp chamber and root canals are filled with a special filling. The tooth is then sealed and a crown installed to protect the tooth from re-infection and/or fracture, possibly extending the tooth’s life for many years.
Sometimes, however, the tooth doesn’t respond and heal as expected: the number, size and shape of the patient’s root canals may have complicated the procedure; there may have been a delay before installing the final crown or restoration or the restoration didn’t seal the tooth as it should have, both occurrences giving rise to re-infection. It’s also possible for a second, separate occurrence of decay or injury to the tooth or crown to undo the effects of successful treatment.
It may be necessary in these cases to conduct a second root canal treatment, one that may be more complicated or challenging than the first one. For one thing, if the tooth has been covered by a crown or other restorative materials, these will most likely need to be removed beforehand. In cases where the root canal network and anatomy are challenging, it may require the expertise of an endodontist, a dental specialist in root canal treatments. Using advanced techniques with microscopic equipment, an endodontist can locate and fill unusually narrow or blocked root canals.
Because of these and other possible complications, a root canal retreatment may be more costly than a first-time procedure. Additionally, if you have dental insurance, your particular benefit package may or may not cover the full cost or impose limitations on repeated procedures within a certain length of time. The alternative to retreatment, though, is the removal of the tooth and replacement with a dental implant, bridge or partial denture with their own set of costs and considerations.
The complications and costs of a repeated procedure, though, may be well worth it, if it results in a longer life for the tooth. Preserving your natural tooth is in most cases the most desired outcome for maintaining a healthy mouth.
If you would like more information on root canal treatments, please contact us or schedule an appointment for a consultation. You can also learn more about this topic by reading the Dear Doctor magazine article “Root Canal Treatment.”
The sooner you get treated for tooth decay, the less likely you'll lose your tooth. That could mean a simple filling—or you might need a root canal treatment if decay has reached the inner pulp.
There's also another procedure for advanced decay called pulp capping. It's a bit more involved than filling a cavity but less so than a root canal. We can use it if decay has exposed or nearly exposed the pulp, but not yet infected it—otherwise, you may still need a root canal treatment to remove the diseased pulp tissue.
There are two types of pulp capping methods, direct and indirect. We use direct pulp capping if the pulp has been exposed by decay. After isolating the tooth to protect other teeth from contamination, we remove all of the decayed dentin up to the pulp. This may cause some bleeding, which we'll stop, and then clean and dry the tooth area.
We'll then apply a protective biocompatible material directly over the pulp to promote healing and protect it from further infection. We then restore the tooth's appearance and function with a life-like filling.
We use the indirect method, a two-part process separated by six to eight months, when the pulp tissue is close to the surface but not yet exposed. We initially remove the majority of decayed tooth structure, but leave some of it in place next to the pulp chamber. Although this remaining dentin is softened and decayed, we'll treat it with antibacterial chemicals, then cover it with a biocompatible material and a temporary filling.
Over the next several months the treated structure has a chance to re-mineralize as it heals. We then remove the temporary filling and assess the level of healing progress. If the regenerated dentin appears healthy, we can then remove any remaining decay and restore the teeth as we would after a direct pulp capping.
At the very least, pulp capping could buy your affected tooth time before a root canal will finally be needed. Under the right circumstances, it's an effective way to save an otherwise lost tooth.
If you would like more information on tooth decay treatments, please contact us or schedule an appointment for a consultation. You can also learn more about this topic by reading the Dear Doctor magazine article “Pulp Capping: A Procedure that may Save a Decayed Tooth.”