How to figure out when a root canal treatment is correct?

The root canal treatment is recommended when the nerve and the blood supply of the tooth (known as the pulp) is infected. In most cases this happens because of a deep decay or injury. Sometimes this treatment is necessary in order to prepare the tooth for a crown.

A root canal treatment is performed in one or two sessions. Sometimes there are infections at the root apex due to incorrect root canal treatment and that might require two sessions of treatment if the dentist can't clean and dry the canals properly in only one appointment. There are no poisons or other dangerous substances used in order to "kill the nerve", only correct irrigation with sodium hypochlorite, after a proper shaping and cleaning of the root canals. One thing you should know is that the root canal treatment will not hurt because a local anaesthetic is always used. Sometimes, after the completion of the treatment there may be some tenderness if pressure is applied for a few days or up to a week. This is no need for worries and this sensation should go away under pain control drugs that sometimes dentists prescribe.

A correct root canal treatment contains 3 important aspects:

1. X-rays (radiographs)- one before the treatment and at least one more after the treatment. The before x-ray indicates on what situation the doctor begins to work on and what aproach to use for that specific situation. After the treatment the dentist can verify the work and have the certainty that the root canal treatment is done correctly (as seen in the first photo).

2. Rubber Dam (Dental Dam)- is the green membrane ( you can see it in the second photo) that is placed around the tooth in order to isolate it. The tooth must be isolated so all the chemicals that we use to irrigate the canals do not reach your tongue, or flow into your throat or inside your stomach. We also do not want your saliva to reach inside the tooth and contaminate it because the root canals must be disinfected and of course, saliva is not sterile.

3. Apex Locator- is an electronic device used to determine the position of the apex of the root when we reach it with a file through the tooth. This event is signaled with a beep, a flashing light or a pointer on a dial and thus we can also determine the length of the root canal, making sure that we do the treatment all the way until the end of the root, with a perfect precision.

It is quite easy to see x-ray the precision of the treatment on the check up x-ray. First of all, it is essential that the filling of the root canal with gutta-percha and adhesive cement (to ensure complete sealing) is all the way up to the apex of the root canal, not before it, nor passing over the apex. You can see in the picture a white line in the tooth, that is the gutta-percha cone. It is right at the very apex of the root. If it is not like this, the treatment must be repeated. Secondly, the white line in the tooth must be thick, compact and very visible as a result of a proper shaped root canal space.

If all these 3 aspects are fulfilled, we have all the chances to prevent the appearance of a infection inside the bone around the root apex or if this infection already exists, we can treat it. So, this way, in most cases we are preventing apicectomy (a sugical intervention at the root apex) that is unnecessary. Clearly, only these 3 points are not enough, but they are very important and they must not be omitted.

One should remember that in the vast majority of the cases (almost all of them) there are no antibiotics prescribed and the pulp of the tooth it is not killed with poisonous substances or other medication. The majority (if not all) of the treatments are made the way it is described above. The correct treatment is NOT done by antibiotics and poisons, but by cleaning, shaping and filling. Take care of your health and please stop using unnecessary drugs!

Every tooth is worth saving, but not every tooth can be saved!

Bogdan Fondrea - www.dentaldesign.ro

A Brief Look into "Stone Age" Dentistry

Would it be safe to consider dentistry as the oldest profession known to humankind? Maybe not, since that position is already taken, if I am not mistaken. I also doubt the fact that dentistry is going to be the last profession ever invented. Ever since ancient times people have been used to treat their teeth to the best of their knowledge, and will do the same as long as it is needed.

Our forefathers did not have all the third millennium materials easily available for us today, nor did they use ceramics, titanium implants, or zirconium. They did not whiten their smiles with state-of-the-art plasma lamps and they had a different opinion regarding dental prophylactic measures than we do today. Nevertheless, they paid a reasonable amount of attention to their dental problems and always did their best to solve them. As for anaesthetics they had the only one best option: not to use them at all. But sometimes the pain grew so extreme that they had to come up with all kinds of drugs in order to get mentally prepared. They would use plants, smoke or they would even dance themselves into a deep state of trance so that the dental intervention could become bearable. Plant cocktails prescribed by medicine-men were administrated just as the antibiotics of today's world and some of them, surprisingly, did a fairly decent job.

On the other hand, pain killers and antibiotics were not always efficient enough to cure the hurting patient, so a direct dental intervention turned out to be mandatory. A viable solution was in high demand and when self-curing was not possible, a designated "dentist" was the best and only option. Instead of a dental drill for treating cavities, they used a rudimentary bow and arrow, similar to the one used for starting a fire. The cavity formed was filled with bee wax. Instead of dental implants, animal teeth were placed in the bleeding socket where a tooth was lost as a result of a battle or hunting accident. In a similar way, they used sea-shells or any other objects available at hand. Surprisingly, some of these items got well integrated in the natural jaw bone. As for cosmetic whitening, ancient people (and very few contemporary tribal communities in remote geographic areas) used to have their teeth blackened with paint or even ash. This is an interesting indicator of how aesthetics is different from culture to culture and specific to a certain time span.

Looking into the future, with the hindsight knowledge we have today, dentistry might follow similar dramatically changing patterns in the future very much in the same vein as today. Maybe in no more than just a few decades, our modern techniques could seem rudimentary and barbaric. It may be that materials and treatments will significantly evolve, but the unwritten dental law will still be the same and will remain untampered: painless, functional, beautiful smile.

As a conclusion, along with our scientific community, I tend to agree that dentistry emerged as both a science and an art form with the emergence of the first toothache and will stay here as long as we have to chew, love to smile and have the desire to speak.

Dr. Bogdan Fondrea - www.dentaldesign.ro