Toothache occurs at various times and in various circumstances, both the acute one and the chronic one that drags on over weeks or months. In 90% cases it is caused by pulp problems. Pulp is the inner most part of the tooth that consists of nerves and blood vessels. It occupies the inner space of the tooth which can be compared to a cave with numerous side tunnels that make up a complicated maze: there is the so called main chamber in the tooth crown and a varying number of root canals located in the root.
Most often toothache is a symptom of pulp infection with bacteria. Pulp infection gradually leads to its death and bacteria quickly penetrate into all recesses of the space it takes.
Unless adequate treatment is initiated at this stage, the products of bacteria and nerve decomposition in the pulp migrate through the root to the bone and cause inflammation there.
What is canal (endodontic) treatment about?
In short, the treatment can be divided into two stages. It starts with a thorough removal of all pulp that is infected with bacteria from the space it takes.
Then the space which has been cleaned and widened (the canals in all roots) is tightly sealed with a special filling material. The results are monitored by an x-ray film.
Sometimes pain can occur after canal treatment (spontaneous or while beating), yet it subsides after a few days.
Is canal treatment always effective?
Where inflammation occurs in the bone under the root, the treatment’s effectiveness can be assessed only after 6-12 months. This is more or less how long it takes to cure the tooth after the final filling of the root canals. The x-ray film made at that time is compared with the initial one to see whether the treatment which can be regarded successful from the technical point of view is tolerated by the body.
It should be remembered that a small percentage (2-8%) of these procedures are ineffective and in such cases teeth require repeated canal treatment, surgery or even need to be extracted. Additionally, where inflammation occurs in the bone under the root, there is a risk (14-26%) that despite correct treatment the changes in the bone may not be reversed. Then the treatment consists in a surgical removal of the inflammatory change, and sometimes in the removal of the whole or part of the tooth.
Is canal treatment really so difficult and uncertain?
Leczenie kanałowe wymaga wyjątkowej precyzji i często dużej ilości czasu. Zabieg jest nierzadko skomplikowany, ponieważ w jego trakcie mogą się pojawić następujące trudności:
- pulp cavities (chambers and canals in the root) have various shapes and irregularities, and information on their location and number is based on statistical data which is confirmed only to some degree;
- spaces with atypical shapes are hard to clean with specialist tools;
- dead pulp infected with bacteria which remains in the recesses that are not completely clean can cause failure of treatment;
- the instruments used during the treatment have limited strength and can break in very tight or curved spaces, and it may be impossible to remove a broken part of the tool.
Why is canal treatment so expensive?
Canal treatment often takes a lot of precious time. In addition it requires:
- expensive equipment, i.e. surgical microscope, specialist devices for cleaning, widening and filling the pulp cavity after the pulp is removed;
- many little yet expensive instruments that are delicate and therefore are often disposed of after a single use;
- expensive disinfection liquids for rinsing tooth canals;
- taking several x-ray films (before, during and after treatment).
Is canal treatment worthwhil
Although canal treatment is one of the least reliable methods in stomatology, it helps keep one’s own teeth that otherwise would have to be extracted for a long time. Unless there are any surprises related to an atypical shape of the pulp cavity, where each stage of the therapy is performed precisely, success is very likely.
Therefore canal treatment is always worth trying to save a tooth. Especially that it is undoubtedly less expensive than replacing a missing tooth with an implant or bridge, and requires no intervention is the neighbouring teeth.