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Root Canal Endodontics Mexico
Board Certified endodontist providing high quality root canals
A Root Canal is a treatment used to repair and save a tooth that is badly decayed or becomes infected. The root canal consists of removing the nerve and pulp of the tooth. They are removed completely and the inside of the tooth gets sealed and cleaned. The pulp need to be removed because the bacteria can begin to multiply in the pulp chamber, which can cause and infection or abscessed tooth.
Before Endodontic Treatment
Root Canals or endodontic treatments are preformed under local anesthesia. There are no restrictions after the procedure like driving, sports or working. All medications for blood pressure, thyroid problems, diabetes or any other conditions should not be paused. If there are any questions call our office prior to your appointment.
Please eat a full meal before the treatment. After the root canal you might have to take antibiotics or Ibuprofen for the pain. Dr. Irma Gavaldon will advice you.
Why would I need a Root Canal
The reasons you would need a root canal are
This is definitely the most common reason for a root canal to be performed. It is most likely to happen as a result of dental decay. Less commonly, it is due to trauma or cracked teeth. If the tooth has irreversible pulpitis, (due to for example a very deep filling or deep decay) then the damage is such, that the tooth is not able to recover and will die off over time. See– Signs and symptoms of a root canal for more of a discussion.
If the tooth is very painful to touch and you can’t bite down or chew on it, it is likely you have a dental abscess. It is important that we identify the source of the abscess- is it an acute peri-apical abscess coming from an infected tooth or a periodontal abscess? An abscess of gum origin is quite different and requires other treatment.
If sensitivity is affecting your life and you can’t eat and drink without pain something needs to be done. If all other treatments have failed for sensitive teeth then as a last resort a root canal can be performed.
If you want to restore a tooth but there is not enough tooth left to support a filling or a crown, then a postis required. In order to put a post into the root of a tooth it is necessary to first perform a root canal, then remove some of the root filling material (GP) without disturbing the seal to allow a post to be placed on which the dentists can build up a core to retain a crown
On occasions, if you are having cosmetic dental work done- particularly crown and bridges, the shape of the tooth may need to be changed so much that preparing the tooth will expose the nerve in the middle. In these circumstances a root canal must be planned and performed to prevent nerve pain from the procedure. Orthodontics should be considered as an alternative that will make this unnecessary and preserve your natural teeth
If together with your dentist, you decide it is best to keep some roots either for a precision attachment to help hold in a denture or simply to help preserve the supporting bone, then the roots of the teeth on which the denture will sit, need to be root filled and sealed. To simply leave them underneath will cause them to decay away, give pain and eventually require extraction.
Root treatment may be considered for teeth where the nerves are questionable- where perhaps extensive restorations are planned. Especially if a tooth is to serve as part of a bridge, then it can make sense to choose to root fill the tooth before this is done. If root treatment is not carried out and the nerve becomes painful or dies off after the bridge has been fitted, it will be a lot more difficult to treat- the likelihood of success will be lower, and the fit and finish of the bridge affected.
If you have knocked or banged a tooth then sometimes the tooth responds by laying down more dentine (known as secondary dentine) and progressive X-rays will show the space for the canal inside disappearing. At this point root treatment may be considered while the canal is still easily accessible, though studies have shown that only up to 15% of these ‘sclerosed teeth’ may actually cause any problems in the future.
What Signs and Symptoms would show if you needed a Root Canal?
The signs and symptoms you may experience or notice which suggests a root canal may be needed. if you should have root canal treatment -what questions he will ask and why- what tests he is likely to perform to arrive at a diagnosis.
Signs you may notice:
A sinus is a tract or tunnel that drains infection which has built up around the apex (end) of the root through the bone and into the mouth. It may look like a mini ulcer or nodule on the gum and often gives a bad taste, as pus will be draining from it. Often, because the infection has a place to drain, there isn’t pain associated with the tooth until the tract gets blocked and then it becomes very painful with the build up of pressure. Sometimes you can insert a GP point (the material used for filling a root canal) into the sinus and it will follow the track of the infection and point at the source- when possible… this is a very good way of identifying the tooth causing the problem.
This indicates a collection of pus has formed and is generally a sign that a tooth has abscessed. Whilst this could be of tooth or of gum origin, in my experience a facial swelling is more likely to be the result of a necrotic pulp (a dead nerve).
If you have half your tooth missing or a huge area of decay, the nerve will no doubt have be affected to some extent. It may be that just that the tooth needs to be restored or it may be that the nerve is dead or damaged beyond repair and a root canal is needed.
Symptoms you may notice:
Pain that lasts for minutes/hours -(not seconds) after a stimulus such as cold
Pain that wakes you in the night or disturbs your sleep
Pain when you touch a single tooth.
Pain not relieved entirely by traditional painkillers
Pain when you bite down (though a problem with the bite, such as a high filling and a couple of other potential issues must also be ruled out)
Pain that occurs spontaneously with any stimulus such as hot or cold
A bad taste in your mouth (when combined with other things above- not just in isolation).
At Ocean Dental Cancun specialists in this field of dentistry exist. They have additional training and experience, and their practices are set up specifically to treat these conditions with speciliased high-tech equipment (high magnification microscopes and ultrasonics). As a result the success rate of their root canal treatment would be higher.
The success of a root canal treatment at 10 years is reported to be:
- 90-95% for an initial root canal (i.e. the first time it has been attempted) if there is no area visible around the end of the root on the X-ray.
- 80-85% for an initial root canal if thereis an area associated with the tip of the root on the X-ray.
- 65% for a re-root treatment (i.e. following an unsuccessful first attempt) or if pus is evident at the start of treatment.
The success of a root canal comes down largely to one main point- has the whole root system been sufficiently disinfected, appropriately filled and properly sealed? If the answer is “yes”, the root canal is very likely to be successful. Any factor that influences achieving this outcome, will therefore effect the success of the root canal treatment.
How infected the canal(s) are initially. The more infected the root system, the poorer the prognosis as the percentages above suggest. How much tooth remains may not affect the success of the root canal procedure directly but it will affect how good the crown is on top and therefore how long you have a useful tooth in your mouth.
How complex the root canal system is, how curved, how many and how accessible the canals are- these factors will all influence the difficulty of the treatment and the outcome. Is it the first time it has been attempted or is it a re-root canal treatment?. Is it a natural tooth you are going into, or through a crown, in which case orientating yourself can be more difficult.
U.S Licensed and Trained American Dentist in Mexico
All Dentists are a Specialists in Their Field.
Specialists provide the highest possible quality root canal treatment, with additional experience, knowledge and high-end equipment. Each dentist will normally have a specialist who they refer to. Some dentists prefer all root canals to be completed by specialists, others will do the majority themselves and only refer more difficult cases and complications.
At Ocean Dental Cancun we carry out a number of special investigations to supplement the information he has gained from asking questions and examining your mouth. These will serve to make the picture of the problem a little clearer:
In any root canal cases, or where a root canal problem is suspected, then a Periapical X-ray (often shortened to PA) is required. Peri means around and apical is dental speak for the apex or end of root, so the view records the whole of the root of the tooth in question and its supporting tissues (that is one that records the whole end of the tooth).
Teeth that respond positively to electric pulp testing or cold tests for the most part are alive and those that do not, are dead. This is a crude and sometimes not an accurate measure of the living status of a tooth, but it can help to identify the potential offender when it is uncertain which tooth the pain is coming from. Let’s say a number of teeth all have deep large fillings and could all be responsible for the pain. If you were to apply a cold test to all the teeth and only one of them had no sensation, the others could be assumed to have living nerves and make the one that didn’t- the focus of the dentist’s attention.
Procedure for a Root Canal
Root canal is a long procedure- most of the time, dentists will complete the treatment in one to three visits. Each appointment could be around an hour in length, depending on the situation. If the case is very simple and the tooth only has one canal, then the whole thing may be completed in just one sitting.
On the other hand, if a tooth is heavily infected, extra appointments may be needed in to dress the tooth. Note, dentists in the United States are fans of doing most root canal treatment from start to finish in a single appointment.
Dr Irma Gavaldon will begin by diagnosing your problem- identifying which tooth is the culprit and discussing the options, risks and possible consequences for the tooth. An X-ray should be taken as part of this and will let the dentist assess the shapes and number of the roots and ensure the prognosis is a good one.
We will assume that your tooth needs a root canal and you have decided to go ahead with treatment.
Anaesthetic as mentioned previously may not always be needed, but given it is a long procedure and to make you more relaxed, most of the time it makes sense to put some in anyway.
This has two purposes:
- To protect you from the materials the dentist is using– we don’t want the dental bleach used to disinfect the canal getting into your mouth or risk any of the small files or materials being swallowed or inhaled.
- To isolate the tooth- keep it dry and prevent any bacteria getting into the canal from your blood or saliva.
Root canal work should ideally always be performed under rubber dam.
It is important removed as much caries (decay) and bacteria from the top of the tooth as possible before accessing the pulp (nerve) chamber and they will do this using standard burs and drills.It is important that the dentist removes as much caries (decay) and bacteria from the top of the tooth as possible before accessing the pulp (nerve) chamber and they will do this using standard burs and drills.
Remember the key to a successful root canal is removing bacteria and preventing it from getting back in. As I have mentioned previously, different teeth have different numbers of roots and they can have more than one canal in a root.
There are two way can do this; the first and still most reliable is using X-rays. Files will be placed in each canal and an X-ray taken to see how far down they go. They have little rubber stops on the end to allow the dentist to measure the length.
The length will be adjusted accordingly so that the preparation of the canal goes almost to the end. Ideally the root canal will be 1-2mm from the apex (end of the root on the X-ray). This is known as the ‘working distance’ and needs to be calculated for all of the canals in the tooth as their lengths will vary.
The second way is using an apex locator- a high tech instrument that measures ‘electrical impedance’ by placing an electrode in the root canal and sends a signal to the dentist when they are at the end of the canal.This is useful for circumstances when the end of the root on the X-ray is not actually where the apical foramen or constriction is.
Sometimes both methods will be used together for an accurate picture.
Now we have established how far down we need to prepare the root canal, we need to clean it and shape it. Cleaning is necessary to remove as much bacteria as possible from the root system, any remnants of nerve tissue and dentine that has been infected. It is this stage that is the most crucial to the success of your root canal treatment.
The cleaning process requires what is known as a ‘chemo-mechanical preparation’. This simply means that it requires chemical action in the form of dental bleach and mechanical action in the form of filing. Because the root canal system in reality is not just one or two main canals but a complex of interconnecting smaller canals, using files alone to prepare the main canals is not enough.
The chemical action of the bleach (sodium hypochlorite) is essential to disinfect the places that the files cannot reach and studies have highlighted how crucial frequent washing of the canal is to success.
Dentists have two main choices when it comes to using root canal files in order to enlarge, shape and smooth the canals.
- Hand files.
- Rotary files.
Nowadays the majority of dentists will use a combination of hand and rotary files.
Hand files are small flexible files that are inserted and twisted around against the walls of the canal. The dentist will start off with a thin file and move up in sequence to progressively thicker files until the sides of the canal are smooth clean and free from soft and infected dentine.
Rotary files look quite similar to hand files except they connect to a special slow handpiece (drill) and take the hard work out of preparing the canal as they do the rotary action automatically.These are a pre-determined sequence of automatic files used in a handpiece.
Think how a normal toothbrush requires you to do little circles and the cleaning action yourself but the electric toothbrush does it for you.
Different systems are available and each has a sequence of progressively larger files to follow. The’ beep beep’ noise you may hear is like a van reversing. It is saying that the file is retreating so as to not exceed the torque and risk fracture.
Lubrication for all files with a special paste that softens the dentine is important and the more bleach to disinfect the better.
After preparing to these distances the dentist may dress the canals with a special medicine, most commonly calcium hydroxide. This paste has a very high PH to kill off remaining bacteria in the canal before you come back to have the root canal filling placed. A temporary filling is then placed to stop bacteria getting in before your next visit.
It is important that before the final root filling is placed, that each canal is free from any infection.
Signs that there may still be infection present include:
- Continued pain
- Persistent moisture in the canal.
Give the tooth back its looks and ability to chew.
Root Canal Complications
Root canal has a high success rate but there are a number of complications that can arise during any routine root canal procedure of which you should be aware. Some of these may be anticipated before hand from studying the X-ray but mostly they cannot be predicted. Fortunately they are not common and do not necessarily need the tooth to be removed.
Missed root canals
Most teeth have a standard root formation, 1, 2 or 3 roots and up to 4 canals. Sometimes a dentist can miss a canal if the tooth has more canals than anticipated or if it is in an abnormal position. If this happens bacteria remain in the infected canal and can re-contaminate the tooth.
The actual anatomy of the root canal system is a lot more complex than we often give it credit for. We talk about it in terms of 1-3 canals when the reality is, it is a complex maze of smaller interconnecting canals around these big canals. The root may have large lateral and accessory canals that are difficult to sterilize.
Despite our best efforts using the dental bleach, if sufficient bacteria remain in these canals they could cause the treatment to fail. Unusual shaped roots may make cleaning difficult- if for example they are particularly curved or have canals that join together and then separate.
Fractured root or crown
Root treated teeth and those without a blood supply are more brittle and more prone to fracture. The location and extent of the fracture will determine if the tooth can be saved, but more often than not an extraction will be required.
Sometimes root fractures are detected before treatment or during treatment. However sometimes they will go un-noticed or occur as result of a grinding habit, or because a crown was not placed.
If for some reason the tooth becomes re-infected the root canal is deemed to have failed. This may be due to insufficient, inadequate cleaning, complex root formations or connections to the outside of the tooth via a fracture or lateral canal.
Perio- endo lesions
If the tooth has associated periodontal problems this can provide a continued source of bacteria and infection and the prognosis becomes questionable.
Root Canal FAQ
The root filled tooth needs to have a good seal to prevent bacteria getting in and re-infecting it. The dentist will place some variation of glass ionomer, composite or amalgam to replace the missing part of the tooth. Teeth that have had the nerve and blood supply removed during a root filling are much more brittle than those normal living teeth. This leaves them prone to fracture, which if it occurs, often leads to the tooth being lost.
The phrase ‘root canal’ is generally enough to put fear in the minds of even the toughest individuals, but truthfully it’s not a very painful procedure. I think it is largely a fear of the concept of ‘taking the nerve out of the tooth- Aaarrrghh.’ I see a patient’s face when they sit up and I say,’OK all done!’They have this slightly confused look and reply ‘That’s it? That was a root canal? What’s all the fuss about?’It just has a bad reputation because very occasionally a nerve decides it doesn’t want to go numb.
When you have a tooth removed, the nerve of the tooth obviously has to be made numb to allow extraction, so simply removing the nerve from inside the tooth (a root canal) is generally less of a problem- it
Antibiotics are only required where the infection has spread to the surrounding tissues. Symptoms of systemic spread that indicate antibiotics are necessary may include feeling generally unwell and having a fever/ high temperature. If there is a large collection of pus, which presents often as an obvious facial swelling, antibiotics (in addition to draining the abscess) are mostly needed.
Draining the abscess will provide massive relief as the pressure dissipates; but this is not always possible and antibiotics may need to get into your system first before anything can be done such as numbing the tooth to extract it or drain it.
Any root canal complication that permits bacteria to continually enter (such as perforation, root fracture, perio-endo lesion, poorly sealed filling) is likely to result in failure. Similarly if sufficient bacteria remain in the root canal following completion (as a result of inadequate cleaning by the dentist, missed canals, accessory and lateral canals, difficult root formations, under filing) failure is likely to result.
The success rate of root canal is high, but on occasions due to complications or despite our best efforts to disinfect the complex system of multiple connecting canals, the treatment fails. We all have different immune systems and abilities to heal, sometimes unfortunately, it just happens.
If your root canal has failed then you have the following options:
- Re-root canal treatment. As it sounds, this means taking out the old root canal treatment and trying to re-sterilize and fill the canal or canals for a second time. Often it may be worth considering a referral to an endodotist specialist to have this done.
- Apisectomy. See below.
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