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Root canal therapy lacks pain, saves teeth

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The idea of undergoing a root canal makes some people hesitant to make a trip to the dentist. Yet, the procedure has likely been done for thousands of years. Egyptian soldiers have been found with evidence that they had something like root canals. The treatment has lasted because it is a way to help maintain natural teeth, which experts say is best for patients.

This week on “Take Care,” endodontist Dr. Linda Levin sheds some light on the procedure that she likes to call a therapy, what it actually does for a patient’s mouth and how it is better for him or her in the long run. Levin is the president of the American Association of Endodontists, as well as an associate professor at the University of North Carolina at Chapel Hill School of Dentistry.

Before getting into the details of the therapy, Levin believes it is important to understand a little dental anatomy.

Each tooth in a person’s mouth is hollow. However, the empty space contains a special kind of connective tissue initially used for tooth formation. It then gives the tooth blood supply and allows the immune system to have access.

Plus, that tissue gives a person the sensations of hot, cold and sweet.

When a patient is in need of root canal therapy, they will come in with a range of symptoms or no symptoms at all. Some signs include lingering cold or heat sensitivity, creating a toothache, and spontaneous aching in the tooth.

Other dental problems can cause pain but the most common is the pulp (found inside the tooth) becoming inflamed or infected or it is necrotic (dead). This can occur due to a deep cavity or crack that exposes the center of the tooth to the oral environment, sometimes caused by a sharp blow to the mouth or a sports accident.

While there are a lot of good bacteria in the human mouth, Levin says those bacteria are not good for the central area of a tooth.

It is the job of a patient’s general dentist to make the judgment call on whether or not he or she needs a root canal.

“Obviously, if there is swelling or a total lack of response to testing, that could be an indication that the nerve is completely necrotic or dead,” Levin said.

However, the signs are not always so obvious. Sometimes, they will only show up on a radiograph.

X-rays only show hard tissue, thus leaving the pulp undetectable. Yet, there is still a way for a general dentist to see indications of the therapy being needed.

“What they will show you is a response that the body will often have to an infected root canal system and that is bone loss,” Levin said, “usually around the root tips but also can be around any other area where there is a canal exit to the outside of the tooth.”

The procedure itself is a “glorified tooth cleaning,” according to the doctor who still maintains her own private practice in Durham, North Carolina.

“A lot of the bad stories that come with root canal therapy aren’t associated with the procedures themselves, but more with the pain that brings the patient in,” Levin said.

The therapy begins with the doctor numbing the area, just like the patient is receiving a dental filling. From that point, he or she should be able to feel vibration but no pain at all.

The endodontist then makes a small opening into the root canal system within the tooth. Special instruments are used to measure the tooth and then clean it through a combination of scrubbing and rinsing with antiseptics to get rid of any tissue or bacteria from inside the tooth.

The hole in the tooth is then closed up with a root canal filling material designed to seal the canal and prevent bacteria from re-entering the canal.

Once the treatment is completed, the patient may need to go see his or her general dentist for a crown or filling depending on how the tooth was restored.