What is root canal treatment?
When a tooth is infected by bacteria and inflamed due to tooth decay, trauma, etc., it is called pulp disease. In severe cases, the periodontal bones will also be damaged. In order to treat dental pulp disease and retain the tooth, root canal treatment must be performed to remove inflamed or necrotic pulp tissue (commonly known as endodontic treatment/removal of nerve), and to repair and fill the root canal to prevent reinfection. Clinically, it is difficult to master the root canal with special difficulties caused by the foreign body blockage, perforation, bending and treatment or unknow root canal changes. At present, there is a more professional microscope-assisted root canal treatment, which is a major advancement in the treatment of pulpal diseases in recent years, which can effectively increase the internal visibility of the root canal.

What conditions need root canal treatment?
  1. Severe pain in the tooth or swollen gum, which is evaluated by a dentist as acute pulp disease.
  2. There is a deep cavity in the tooth, and the discomfort or pain persists after filling the tooth for 2 weeks, which is diagnosed by a dentist as pulp disease.
  3. Small pustules appear on the gums and are diagnosed as chronic pulp disease.
  4. The tooth is asymptomatic, but a root canal treatment is required after diagnosis by a dentist due to the production of dentures.
 
Procedures of root canal treatment: 
  1. A dentist will administer local anesthetics depending on the situation. Root canal treatment may cause pain. In general, if the pulp is necrotic, the treatment process should not be painful. If there is pain, local anesthesia will be administered to control the pain. The first treatment usually requires local anesthesia, and most subsequent treatments do not need it.
  2. The affected tooth is isolated with a rubber tent, the decayed portion is removed, and the pulp cavity is expanded.
  3. The root canal is rinsed with liquid medicine and the root canal is sealed after one or more treatments.
  4. During the process, several intraoral X-rays will be taken. At the end of each treatment, a dentist will temporarily fill the cavity of the tooth to avoid bacterial infection.
  5. The duration of each treatment is 1 hour to 1 hour and 30 minutes. The number of treatments is dependent on the location of the tooth and the degree of inflammation.
  6. If the root canal is more complicated and difficult to debride, or there are root canal calcification, bending, perforation and other phenomena, it is recommended to use precision instruments, such as microscope, to assist root canal treatment at own expense after the evaluation by a dentist.
 
Post-treatment precautions:
  1. After the root canal treatment is completed, pain and swelling may occur within 3-7 days. You can take painkillers as directed by the dentist. If the symptoms continue and are not relieved, please contact your dentist to arrange a return visit. If you experience acute pain, you can take medicine to control the pain or arrange an emergency treatment.
  2. During root canal treatment, you should avoid chewing food with affected tooth, otherwise it is easy to cause tooth fracture. Once the fracture extends to the root of the tooth, the tooth cannot be treated and must be removed.
  3. After the root canal treatment, the main structure of the tooth is lost. The molars need to be protected by crowns to reduce the risk of tooth fracture. A few anterior teeth with complete dentin only need to be filled up because the bite force is lighter.
  4. After the root canal treatment is completed, the clinical symptoms of most of the teeth can be improved. If the lesion has expanded and the alveolar bone of the apical area is damaged, long-term follow-up (6 months to several years) is required.
 
Reference
  1. Bartols, A., Bormann, C., Werner, L., Schienle, M., Walther, W., & Dörfer, C., E. (2020). A retrospective assessment of different endodontic treatment protocols. PeerJ, 8:e8495. doi:10.7717/peerj.8495
  2. Kucher, M., Dannemann, M., Modler, N., Haim, D., Hannig, C., & Weber, M. (2020). Continuous measurement of three-dimensional root canal curvature using cone-beam computed and micro-computed tomography: A comparative study. Dentistry Journal, 8(1), 16. doi:10.3390/dj8010016
  3. Shamszadeh, S., Shirvani, A., & Asgary, S. (2019). Does occlusal reduction reduce post-endodontic pain? A systematic review and meta-analysis. Journal of Oral Rehabilitation, 47(4), 528-535. doi:10.1111/joor.12929
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