Root canal treatment is often the most feared of dental treatments, but don’t panic… Endodontics (endo=inside / dontics=teeth) is that branch of dentistry which is concerned with treatment of damage to the nerves inside our teeth as a result of disease or injury
What are all these nerves doing in my teeth?
It may appear strange that nerve tissue inside a tooth exists in the first place. After all, why should sensitive teeth or tooth ache be useful to the patient?
The collection of blood vessels and nerve tissue with special dentine forming cells begins during childhood. Teething babies experience their discomfort as two opposing groups of cells line up inside their gum to form enamel and dentine. Gradually, the blood supply retreats and a bell-shaped structure begins to take form and grow through the gum, with the enamel on the outside and the dentine forming internally. As the crown of the tooth is completed, root formation with further dentine develops until finally the roots are complete, leaving the dentine forming cells, nerves and blood vessels entombed inside the tooth with an outlet at the tip of the root. The ability to form further dentine remains throughout the life of a patient.
When damage is inflicted upon a tooth as a consequence of trauma or decay, this triggers the tissues remaining inside the tooth to begin further dentine formation for protection.
If the damage is minor or slowly developing, the nerve tissue has a greater chance of forming this protective barrier. But if it’s extensive or rapid, the nerve tissue itself may become damaged resulting in unwanted discomfort and pain. Using a sedative dressing with Oil of Cloves has been the mainstay for managing this painful condition since the Phoenicians in 2000 BC. But you may require an Endodontist to help.
Root Canal Treatment
The specialist in Endodontics will take an x-ray of the tooth to establish the position and shape of the nerve chamber before treatment begins. Each and every nerve canal extends to the tip of the root and is unique for every single tooth with respect to length and shape. A measurement of the length of the root is secured so that all the damaged nerve tissue and blood vessels are removed. The inside of the nerve chamber and canal is cleaned and the space remaining is then filled with an inert material. The tooth is then re-filled and restored.
Clinical studies have demonstrated that elective root canal treatment carried out in the early phase of irreversible nerve damage is more successful than the unpleasant alternative of waiting for the nerve to die, allowing the formation of a dental abscess at the end of the root. This has implications to the patient to seek attention as soon as symptoms arise as the retention of the tooth could become more compromised.
As the root canals may be less than 1mm in diameter, the use of a microscope becomes a necessity for the Endodontist to carry out the treatment.
How to find an Endodontist
The General Dental Council assists the public in distinguishing between those General Practitioners with a ‘special interest‘ from the fully accredited Specialists. Visit the GDC and type your local area into the “Town” field to find all registered specialists near you (UK only).
The General Dental Council website lists the following Specialists in Endodontics in Bath:
Gillian BoswellEdgar Buildings Dental, 7 Edgar Building, George Street, Bath, BA1 2EE
Toby TalbotThe Talbot Clinic, Tasburgh House, Warminster Road, Bath, BA2 6SH
Specialities: Restorative Dentistry, Periodontics, Prosthodontics & Endodontics
If a General Dental Practitioner considers the shapes of the root canals difficult to negotiate, they may consider referral to the Specialist Endodontist. A recent review of root-filled teeth carried out by General Dental Practitioners demonstrated the presence of ongoing pathology/infection in up to 50% of root-treated teeth ~ compared to root-treated teeth by Endodontists showing an absence of pathology in 95% of teeth if uninfected and 85% of teeth if infected.