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

How is a composite filling made?

Sometimes you feel that one or more of your teeth hurt, maybe when you drink cold water or when you eat sweets. Perhaps when you look in the mirror you see dark spots on your tooth and maybe a part of it is missing. This is what we call a cavity. And our recomandation is to call your dentist. 🙂

Sometimes you look in the mirror and you see an old filling and the tooth feels sensitive. An x-ray is needed so that the dentist is able to diagnose if there is a cavity under that old filling or not. It is best to treat caries as soon as possible because at first it is small in size but in time it can deepen, affecting the pulp and maybe requiring a root canal treatment and possibly a crown. This will be more expensive and more time consuming for you.

Here you have a short description of the protocol regarding the treatment of a cavity.

1 The dentist will find the cavity that is giving you a hard time. Sometimes a X-ray is needed.

2 The dentist will determine the right treatment plan, after asking about your medical history.

3 Than a local anesthesia is peformed to numb the tooth. This way you will feel no pain during the procedure.

4 The neighboring teeth will be isolated with a rubber dam so the saliva won't enter in the preparation or under the new filling. Also, during the procedure dental material will be prevented from reaching your mouth. It is important that you are protected.

5 The old filling will be removed using diamond drills, with no pain (you are under anesthetic effect) and the tooth will be cleaned. No decay will be left. The dentist can make sure of this using caries detectors.

6 Now the new filling will be placed into the prepared tooth. Liners, adhesives, composites and other materials will be used. This will take some time and the artistic side of the dentist will emerge at this point. 🙂 At the end you can see that dentist are more than dentists, they are small artists, carving a new natural-looking tooth.

7 At the end, after removing the rubber dam, some adjustments will be made for the optimal occlusion.

8 Finally you can smile, chew and the pain is gone.

In the pictures above you can see the old filling, the preparation, and the new filling that is very similar with the natural neighbouring tooth. You can also see the metallic matrix placed between the teeth to help rebuild the missing wall in oder for the final reconstruction to mimic a natural enemal wall.

Now, at the end, don't forget that a composite filling is not made for life and is best to be maintained in optimal condition by brushing and flossing after meals and regular check-ups.

Dr. Bogdan Fondrea - www.dentaldesign.ro