Root Canal Therapy

GOT A TOOTH PROBLEM?

In this section you should find everything you need to know about teeth: restoration, preservation, repair, and replacement of lost or missing teeth as well as treatment for common problems.
We want to make sure your teeth look good, feel good, and last the rest of your life-here's how we can do it for you.

teeth

Reconstruction
Replacement Dentistry
Root Canal Therapy
Sensitivity
Tooth Replacement
Tooth Whitening
Excessive Wear
Wisdom Teeth

Bruxism

The word bruxism is used to describe what happens when you clench or grind your teeth together-usually when you’re asleep, but you can also do it while awake. Another dental term that means the same thing is ‘parafunction’. Parafunction is loosely defined as doing things with your teeth other than eating, talking, or smiling.There is no widely-accepted reason to explain why you might do this, but recent research suggests a link with disturbances in patterns of sleep, and may be related to the causes of sleep apnoea. In some people, parafunction is a habit, like using worry-beads or chewing pens and pencils or biting nails.

Others do it when they’re awake but are completely unaware that they do. A partner might tell you they can hear you grinding your teeth while you sleep; someone might notice a repetitive movement of your jaw as you grind while awake. Dentists can tell if you have this habit when we see excessive wear, chipping and fracturing of your teeth.

In the past, dentists believed you could ‘cure’ bruxism by adjustments to patient’s bite. Other groups of dentists supported the idea that complex dental interventions to completely ‘reconstruct’ a whole mouth would prevent problems. While this might be a good idea for some people with extensive wear, it doesn’t stop people bruxing. The truth is still unclear about exactly what might work to prevent us from doing this. What is true is that trying to stop the habit when you’re awake and attempting to protect your teeth when you sleep does work to prevent damage.

It’s important to know if you brux or not: apart from excessive wear, fillings can fracture, as so can your teeth. You can chip porcelain crowns and veneers, and you can develop acute pain as a result of clenching too much. That’s why, during your initial assessment and examination, we’ll look for signs that you might be ‘parafunction’ with your teeth.

Bridges are used if you have lost a tooth; they are a way to replace a missing tooth or teeth.

New Dental Technology 

Cad-Cam Dentistry is a way to use computers to make crowns, bridges, inlays, onlays, and veneers-in fact, you can make a wide range of replacement parts for a host of different applications.

CAD stands for ‘computer-aided-design’ and CAM stands for computer-aided-manufacture’. There are some things humans do really well, and other things machines do so much better. Computers make dental ceramic restorations quicker, with more accuracy and precision than is possible using old-fashioned methods. Dental technicians can also use Cad-Cam to make their lives easier. It’s now possible to manufacture all-porcelain bridges using Cad-Cam. A range of other procedures that either took longer or were difficult or impossible to complete by hand can also now be undertaken using computers and dental milling instruments.

For more information, see CEREC®.

Crowns

Crown is a specialised filling that covers a tooth. Called ‘caps’ in the USA, crowns have been used for more than a hundred years to restore teeth. Today there are more than 20 different types of crowns dentists can use. Gold was a common material used in crown manufacture and it’s still used today, where it is usually covered by a layer of porcelain. Most crowns can be made from high-strength dental ceramics, so they look and feel just like your own tooth.

You will need a crown if you have a root canal therapy, or your own tooth has fractured, or if you have a really big cavity.

CEREC® is the acronym for one Cad-Cam dental system sold by Sirona Dental Systems. The letters represent Chairside Economical Restoration in aEsthetic Ceramic.
Cerec restorations are made using a ‘millable’ dental porcelain to manufacture crowns, onlays and veneers in a single appointment. Here’s how:

Step 1

Old fillings and decay are removed; your tooth is gently shaped and smoothed

Step 2

An image of the tooth is captured by a specialised camera

Step 3

Your new filling is designed with the aid of a ‘library’ of images and designs available within the Cerec software

Step 4

The Cerec computer sends instructions to a milling unit which manufactures the finished restoration. This only takes the machine about 10 minutes.

Step 5

The polished ceramic is bonded to your tooth, making it strong and comfortable once more.

But what's in it for you?

Here’s a comparison of old and new crown method:

Q: Are there any special precautions with my temporary filling? 

Remember it isn’t as strong as a definitive restoration. Don’t try to pull floss up out of the space between this tooth and an adjacent tooth until your final restoration is completed. Brush normally, and avoid things like Minties™. 

Old Crown Method

New Crown Method

Smooth and prepare tooth Same
Impressions of both jaws and tooth with rubbery stuff Get a video image of your tooth
Wait while the dentist makes you a temporary plastic crown Read a newspaper, have a snooze, go for a walk for 10-15 minutes
Impression sent to a dental technician Design and mill the crown
Wait 1-2 weeks Bond the crown, dental treatment complete
Second appointment, second injection, cement the crown
Two appointments with impressions and temporary crowns Summary: Single appointment, no yucky dental impressions

Cracked Tooth Syndrome

Cracked Tooth Syndrome is a collection of symptoms caused by a fracture in a tooth. 99.999% of the time, the culprit is an existing filling, although if you brux you can crack your own unfilled tooth. The most common filling material in fractured teeth is silver alloy or amalgam. An ‘amalgam’ is a mixture of mercury and a silver/tin alloy (with other trace metals). Although these alloys were improved in the 1970s, silver used in earlier decades was susceptible to a number of problems that only show up after years in use. One of these is a fracture pattern that starts internally and can take months to progress to a broken tooth.

As the fracture progresses microscopically, you might experience sensitivity to cold, particularly with cold drinks, or cold air in winter. With further development, your tooth might become sensitive when you eat, typically when you try to chew something tough (meat, nuts, hard candy, ice). Cracked tooth syndrome is a very distinctive pain on chewing: it can be exquistely painful—but the pain has an extremely short duration, and doesn’t last.

It can be very difficult to diagnose exactly which of your teeth tooth are fractured. Occasionally there can be multiple teeth that have the same problem, and it’s very common to have more than one fracture in a single tooth. Some fractures are ‘favourable’—and others can cause you to lose your tooth.

Treatment varies from onlays to crowns and root canal therapy, depending on where the crack ends.

Enameloplasty

Enameloplasty is a method of making tiny changes to your teeth by altering your tooth enamel. Tooth enamel is ‘insensitive’, so these changes don’t hurt and don’t take long.
Most of the time the changes make your teeth look better—like eliminating points, irregularities or smoothing small fractures on front teeth. Enameloplasty can also relieve the discomfort of rough teeth and can be used to effect minor alterations in occlusion.

Root Canals (Endodontics)

Root Canals (endodontics) is the art and science of treating teeth that have infected or damaged pulps. The pulp is a collection of soft tissues deep within your tooth; this tissue was originally responsible for forming your tooth. If bacteria infect the soft tissue, or it becomes exposed because of trauma, rather than have the tooth removed, endodontics (‘treatment inside the tooth’) is used to disinfect a tooth and allow you to keep it healthy. This treatment is also known as root canal therapy. 

What is Endodontic Treatment? 

Endodontics is a branch of dentistry that deals with the study and treatment of the dental pulp and tissues surrounding the roots of the teeth. Your pulp is a small soft-tissue organ found in all teeth: it helped form your tooth when you were growing and continues to function inside our teeth for the rest of our lives. The only time you might be aware of your pulp is when it reacts to heat, cold or sweet sensations (if you develop a cavity, for example). 

If you have an accident where your teeth are damaged or, if you clench and grind your teeth so much you crack your own tooth, bacteria can enter the pulp and it will react. 

It is sometimes very difficult to determine the precise cause of pulp irritation/infection. 

Endodontic treatment is focussed on diagnosing and treating the dental pulp after damage, to keep your tooth healthy. 

This includes performing root canal therapy, which involves removing infected or damaged tissue from the pulp chamber and root canals of the tooth, disinfecting the area, and sealing it to prevent further infection. 

Endodontic treatment aims to save teeth that would otherwise need to be extracted, preserving natural teeth and promoting oral health and function. 

Endodontic therapy might also be used to re-treat a tooth that has previously undergone root canal therapy but has become re-infected, and surgical endodontics which is done to fix problems with the roots of the teeth, such as external resorption. 

gutta percha root filling in place (pink)

How is Root Therapy done? 

Root canal therapy, or root canal treatment, is a dental procedure used to treat infected or damaged teeth. The infected or damaged pulp tissue is removed from inside your tooth and the space inside your tooth is cleaned and disinfected. We will seal your tooth to prevent further infection. 

Here's a step-by-step overview of the root canal therapy process: 

1. Assessment and Diagnosis: We examine your tooth and assess the problem. We might use 2D or 3D x-rays, special tests to determine if the pulp is infected and review what you tell us about the history of the symptoms. Symptoms that may tell us you need root canal treatment include severe toothache, sensitivity to hot or cold, or signs such as swelling around the tooth. Sometimes a pimple-like bump on your gum will tell us this is a long-standing infection. 

Assessment and Diagnosis

 

2. Control of pain: Root therapy is a delicate procedure that requires your absolute co-operation. Because of this, before starting the procedure, we will use local anesthesia to make you sure your tooth and the area around the affected tooth is really numb. We’ll also monitor your discomfort levels during the treatment to make sure you do not have any pain.

infected tooth

 

3. Pulp Removal: This is the first third of the treatment. When you are numb, we’ll make a small cavity in the biting surface of your tooth to get access to the pulp chamber and to the root canals. We use rubber dam to ensure your tooth is isolated. We use small instruments to carefully remove the infected or damaged pulp tissue from inside the tooth. This leaves the inside of your tooth clean and eliminates bacteria and debris.

initial stage of root therapy

 

4. Canal Shaping and DisinfectionThe middle third of the treatment is done by shaping smoothing the root canals, to create space for filling material. This process also thoroughly disinfects the inside of your tooth to kill any remaining bacteria.

 

5. Filling and SealingThe final third of the process is usually done during a second appointment. The root canals are filled them with biocompatible material called gutta-percha (link to window[below]), to replace the removed pulp tissue. You tooth is sealed with a temporary or sometimes permanent filling material to prevent recontamination.

 

6. RestorationIf your tooth was damaged by trauma or decay you may require a dental crown to provide strength and protection. The whole process of root therapy is necessary to preserve a tooth but it also might leave your tooth structurally weaker. Crowns restore function and appearance to teeth, and make the whole root therapy process worthwhile. 

Crown restoration

Root canal therapy is highly successful in saving infected or damaged teeth from extraction and relieving pain and discomfort associated with dental infections. With proper care and maintenance, a tooth that has undergone root canal treatment can function normally for many years. 

After Root Therapy Frequently Asked Questions 

How soon can I eat?
You can eat or drink straight away but it would be safer to wait until the anaesthetic wears off so you don’t accidently chew your lip. This is especially a problem for young people, so please keep an eye on children while they are numb. 

Are there any special precautions with my temporary filling?
Remember it isn’t as strong as a definitive restoration. Don’t try to pull floss up out of the space between this tooth and an adjacent tooth until your final restoration is completed. Brush normally, and avoid things like Minties™. 

Is endodontic therapy completed in a single appointment?
Endodontic treatment normally takes more than a single appointment. 

What sort of filling do I need after endodontic treatment is complete?
Today, there are more than 20 different materials and techniques available for restoring teeth . We will discuss the best option with you. 

Do I need antibiotics?
Unless you have a ‘cellulitis’ infection, or a swelling and a raised temperature, antibiotics are ineffective in treating dental pulp infections. 

What happens if I don’t do anything about this tooth?
You may develop a more serious infection which can’t be easily treated. Your tooth may fracture, or decay without you being aware of a problem. Because of this, you may lose your tooth. However, with appropriate and timely treatment your tooth has an excellent chance of lasting a long time. 

Is my tooth dead?
No. The periodontal ligament surrounding your tooth-root is alive—this is what makes root therapy possible. Teeth after endodontic treatment are best described as ‘non-vital’.  

Will my tooth go black?
Colour change in non-vital teeth is extremely variable. If treatment is started and completed within a reasonable period, there is a good chance teeth won’t discolour. However, some colour change in the short term may be unavoidable. Dark or discoloured teeth can often be whitenend and there are other excellent techniques for remedying this problem. 

Do I need to obtain a specialist referral?
‘Endodontists’ are dental specialists in endodontics or root therapy. I sometimes determine that treatment is too complex to be completed in this office and I may refer you for completion of treatment. If you would like a second opinion about your tooth I am happy to provide a referral–please ask. AQ 

Alternative care 

If you do not wish to keep your tooth I will discuss the most appropriate way to manage this process. It may involve a referral for tooth removal. 

After trauma 

If you have had splinting and stabilisation applied, this needs to be monitored and further treatment to remove the splinting will be required. 

splinted upper front teeth

 

You will also need regular review appointments. 

For teeth involved in a traumatic incident, this is usually at 1 week, 2 weeks, a month, and then every three months for a year. Yearly review appointments may also be necessary. These appointments can include dental pulp vitality testing, radiographs and monitoring of colour change. All of these are important in ensuring the continued health of your teeth. After trauma, dental pulps may lose vitality and the root of your teeth may start to dissolve in a process called external root resorption. It is important to catch this condition early and treat it appropriately. 

The term "endodontic" comes from the Greek words "endo," meaning inside, and "odont," meaning tooth. Endodontists are dentists who specialize in this field. 

As we age, pulp tissue becomes insulated with new calcified dentine hard tissue, and will react less and less: you may not even feel it when small cavities develop. This is the main reason we take x-rays, to catch cavities before they get too large. 

They are called ‘root canals’, but they are really small tubes, often with multiple branches. Canals is an old-fashioned term that just keeps hanging around. (this should be next to an animation of the inside of a molar tooth) 

Different teeth have different numbers of roots, and different numbers of root canals. Some molar teeth can have 4 or 5 canals. Most front teeth have 1 canal but some lower front teeth have 2. 

Fun Fact! Gutta Percha was used to make gold balls: https://www.evolutionofthegolfball.com/the-gutta-percha 

Dental Implant Maintenance: Why and How 

Your dental implants are a valuable investment in your smile and overall oral health. Just like your house or car or even your own teeth, they require proper care and maintenance to ensure they last a lifetime.  

The Importance of Dental Implant Maintenance 

Dental implants are renowned for their durability, functionality, and natural appearance. However, without proper maintenance, even the most well-planned implant rehabilitation can encounter problems over time. Here's why maintenance matters: 

Preservation of Oral Health: Maintaining good oral hygiene is crucial for preventing complications such as gum disease and peri-implantitis, which can jeopardize the stability of your implants. If we can’t see it we treat it, so it’s important for you to keep up your appointments. If you give us your permission, will make sure you never miss a hygiene maintenance appointment and your implants will stay healthy. 

Longevity of Implants: Regular maintenance helps identify and address any issues early on, prolonging the lifespan of your dental implants and avoiding costly repairs or replacements down the line. 

Protection Against Complications: By adhering to the maintenance routine we have prescribed for you, you’ll minimize the risk of implant-related complications and ensure optimal oral health and function. 

Features of Dental Implant Maintenance 

Now that we understand why maintenance is essential, let's explore key features of an effective dental implant maintenance regimen: 

Regular visits are a key ingredient for dental implant health. For the first three years following your implant placement we recommend using x-rays to ensure your bone health is optimal. We combine that with thorough examinations and professional cleanings to keep your implants in top condition. As the years go by, we may suggest radiographic surveillance especially if we notice any changes in your soft tissue. This normally involves simple x-rays to monitor soft tissue and bone levels around your implants. 

Daily Oral Hygiene: Just like natural teeth, dental implants require daily care to remove plaque and bacteria. Brushing at least twice a day with a soft-bristled toothbrush and using interdental brushes or floss to clean between implants can help prevent gum disease and maintain oral health. 

Specialized Cleaning Tools: we may recommend specialized cleaning tools such as interdental brushes, floss threaders, or water flossers to effectively clean around implants and prosthetic restorations.  

Avoidance of Harmful Habits: Certain habits such as smoking and excessive alcohol consumption can compromise the success of dental implants. Avoiding these habits and maintaining a healthy lifestyle can contribute to the longevity of your implants. 

Customized Care Plan: Every patient's needs are unique, and we have planned for a long future for your dental restorations . We develop a customized maintenance plan tailored to your specific oral health goals and circumstances. 

By incorporating these features into your dental implant maintenance routine, you can ensure the longevity and success of your implants for years to come. Remember, proactive care is the key to preserving your smile and enjoying the benefits of dental implants for a lifetime. 

Tooth Extractions

Tooth Extractions are the last thing we normally provide for our patients. But sometimes it’s the best treatment. Crowded teeth, wisdom teeth and extra teeth need to be removed. Trauma, or extensive decay can mean an extraction is the ideal treatment. Occasionally a tooth with severe periodontal disease cannot be kept or helped with periodontal therapy and requires extraction. If you need to have a tooth removed, I’ll provide instructions and help to plan for before and after. As for all prescribed treatment offered by me as a registered experienced health practitioner registrant, all patients are free at all times to seek a second opinion from another practitioner. Often on examination and after discussion, I will make clear to you that you may seek or should seek a second opinion for any and all treatment. For some people, specialist referral to an oral/maxillofacial surgeon is a desirable choice. If you would like to download a copy of our instructions for surgical procedures including extractions, please click here.

Fissure seals and Preventive Resin Restoration 

Fissure seals and Preventive Resin Restoration (‘PRR’) therapy are used when fissures in back teeth develop so they trap plaque and bacteria, causing decay and cavities. These cavities are so small, we need to use extremely small diamond-coated instruments to remove a thin layer of enamel to ensure all decay is exposed and removed. Once we are sure the surface of the tooth is healthy, tooth-coloured resin is securely bonded to repair the defect. These restorations can be expected to last many years, and are a wonderful way to protect the grooves in back teeth from biscuits, sticky foods and attack from sugary drinks.

These images show an upper molar before preparation, with the cavity prepared, and with the bonded resin restoration in place.

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