Tooth Pulps & Root Canals
“Root canal? Ouch!” That is what most of my Portland patients tell me, but luckily root canal treatments take away toothaches to make you feel better.
Usually dentists prefer to treat infected root canal pulps before they start to hurt because this is the most comfortable way to go. Waiting for a tooth to hurt before starting root canal treatment is usually less comfortable.
Permanent teeth are alive with nerves and blood vessels located in the middle of the tooth in the area called the pulp. Bacteria infected pulps or teeth that have been traumatized may have damaged pulps that cannot heal. If the pulp cannot heal, the tooth will become painful and may cause serious health problems. To avoid these problems, the tooth must be extracted or receive root canal treatment.
The steps of permanent tooth root canal treatment:
Primary teeth with infected pulps are treated differently than permanent teeth.
Primary molars last until about age 11 or 12 so we like to save them with root canal treatment, if we can, instead of pulling them out and placing a space maintainer.
Because primary teeth roots need to dissolve away when the permanent teeth start to grow in, the root canal material used for baby teeth should be dissolvable or not go all the way down the root canals.
Most of the time, primary teeth with infected pulps are treated with a partial pulp removal called a pulpotomy.
The steps of primary (deciduous or baby) tooth pulpotomy procedure:
These pulpotomies are very successful for teeth that have not infected the bone supporting the tooth. If the bone around a tooth gets infected, then all the pulp tissue must be removed, even the root canal tissue. This complete pulp removal is called a pulpectomy.
A pulpectomy procedure is similar to the adult root canal treatment in that files are used to clean and shape but the material we use to fill the root canals is much different because the roots are supposed to be dissolved away as the permanent teeth erupt.
The root canal filling material for primary teeth must be resorbable or dissolvable. I use a material called Vitapex (a mixture of calcium hydroxide, iodoform, and silicone lubricant) with great success healing abscessed teeth.
Pulpectomy treatment for primary teeth is mostly reserved for only the most important teeth: the second primary molars before the eruption of the permanent molars.
When faced with the options of a painful toothache, a root canal, or an extraction, most people will be pleasantly surprised that those root canals are the best option and not an “OUCH!” after all.
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