ENDODONTICS

Treatment of caries is a quick and simple procedure up to the degree where the damage reaches a large volume or a nerve. Untreated carious defect becomes wider and deeper with time, the tooth becomes painful and the risk of losing a tooth arises. If a carious tooth or so called “hole” is not promptly treated, a complication of inflamed tooth nerve (pulpitis) may develop. In the event of untreated or insufficiently treated pulpitis, the nerve dies off as a result of the infection and an inflammatory process in the bone occurs (periodontitis). Meanwhile, if the patient fails to seek the help of a dentist during this phase of the development of inflammation, the inflammation of soft tissue occurs, swelling and purulent inflammation develops (abscess).

The pulp or so-called “tooth nerve” is the internal part of the tooth, which contains the nerves and blood vessels. Increased sensitivity of the tooth to cold and hot thermal stimuli and sweet taste, points to deep caries. Usually, the tooth starts reacting with pain to temperature, when the caries reaches the pulp. Pain that occurs without the presence of the stimulus also points to irreversible pulpitis. The pain may irradiate to the entire half of the face and, sometimes, the patient may fail to immediately understand that the cause of the pain is a tooth.

Nerve inflammation is characterised by severe pain that occurs and disappears without an evident cause. Night pain is common. Minor pain may occur, when the tooth is bitten on. These types of pain are a sign of irreversible nerve inflammation. If it is unclear which tooth causes pain, abstain from using painkillers before your visit to the dentist, since this can encumber the determining of the diagnosis. Less frequently, the pulpitis has an uncomplicated course without perceivable or visible symptoms. Thus, a patient may be unaware of their inflammation, which is detected during their visit to the dentist. Therefore regular visits to a dentist are important for prompt preventive examinations that allow one to avoid extensive tooth damage and inflammation. The prognosis of therapy in the event of pulpitis is usually good.

The only solution for the preservation of the tooth in the event of pulpitis is endodontic treatment or so-called “root canal treatment”.

If a tooth with pulpitis is not treated or the treatment was unsuccessful, the next phase of inflammation or periodontitis develops. Periodontitis is characterised by pain when biting on the tooth, which becomes more severe over time. The pain is localised and, therefore, it is easy to determine the affected tooth. In the event of periodontitis, the preserving of the tooth may be attempted in most cases. The dentist shall evaluate the possibility and prognosis of endodontic treatment, based on the X-Ray images and the amount and localisation of the carious lesion.

Another therapeutic alternative is the extraction of the tooth. If a patient has been having pain for a long time and no medical assistance for periodontitis is provided, an abscess develops. As the swelling develops, pain reduces, however, the overall situation deteriorates. Sometimes, the tooth can be preserved even in the event of an abscess, however, the prognosis is negative. The development of an abscess frequently results in the loss of the tooth.

Initially, the dentist will perform an examination and only after that, may the therapy be commenced. the procedure is performed under local anaesthesia. The removal of carious masses is followed by root canal treatment. Endodontic therapy is performed under magnification, thus ensuring maximum precision. Several X-Ray images are taken during therapy. They help in determining the diagnosis, specifying the length of the root canal and checking the quality of the filling.

Endodontic therapy of the tooth consists of cleaning of the root canals, which must be followed by the filling of canals and restoration of the dental crown.

Usually, each of the procedures is performed during a separate visit, however, there are cases, when the cleaning and filling or filling and the application of the filler may be performed within one session. During endodontic treatment, the root canals of the teeth are cleaned from the residues of the nerve and micro-organisms that have caused the inflammation. Cleaning of canals is a complicated procedure that can even take up to an hour.

The physician removes the residues of the nerve, determines the length of the canal by using an apex locator and X-Ray, cleans, rinses and expands canals. Then calcium hydroxide is inserted in the canals and the canal is sealed with a temporary filling. The next visit is usually scheduled after 7 – 10 days. During the second visit, the dentist fills the canals. Gutta-percha is almost always used to fill the canals. It is obtained from trees that are grown in Australia. The filling tightly seals the canal and protects it from repeated infiltration of the infection. Restoration of the tooth follows. If it is performed during a separate session, the tooth is sealed with a temporary filling. Frequently, high quality filling of an endodontically treated tooth cannot be performed, therefore, prosthetic therapy by means of onlays (ceramic fillings) or crowns is required. Usually, 2-5 visits are required for prosthetic therapy.