Endodontics

A root canal procedure usually requires two or more appointments and can be performed by a dentist or endodontist (a root canal specialist).  Laramie Dental Arts has established referral patterns with highly trained specialists in the event this is the best course of treatment for you.

While the tooth is numb, a rubber dam (a sheet of rubber) will be placed around the tooth to keep it dry and free of saliva. An access opening is made on top of the tooth and a series of root canal files are placed into the opening one at a time, removing the pulp, nerve tissue, and bacteria. If tooth decay is present, it will also be removed with special dental instruments.

Once the tooth is thoroughly cleaned, the space will now be shaped and filled with gutta-percha. Gutta-percha is a biocompatible material that is somewhat similar to rubber. Cement will be applied on top to ensure that the root canals are completely sealed off. Usually, a temporary filling will be placed to restore functionality to the tooth prior to the permanent restoration procedure. During the final visit, a permanent restoration or crown will be placed.  This will protect the tooth and prevent it from breaking, and restore it to its full function.

After treatment, your tooth may still be sensitive, but this will subside as the inflammation diminishes and the tooth has healed.

You will be given care instructions after each appointment. Good oral hygiene practices and regular dental visits will aid in the life of your root canal treatment.

Cracked and fractured teeth are common dental problems. As people retain their natural teeth longer (due to advances in dental technology), the likelihood of cracked teeth increases. There are many reasons why teeth may crack, for example: biting on hard objects, trauma, and grinding or clenching the teeth. All of these behaviors place the teeth under extra strain and render them more susceptible to cracking.

When tooth enamel is cracked, pain can become momentarily debilitating. When no pressure is exerted on the crack there may be no discomfort. However, as the cracked tooth performs a biting action, the crack widens. The pulp and inner workings of the tooth then become exposed, and painful irritation occurs. As pressure is released again, the two parts of the crack fuse back together and pain subsides. If left untreated, the pulp becomes irreversibly damaged and constantly painful. The resulting pulp infection can affect the bone and soft tissue surrounding the tooth.

Symptoms of a cracked tooth may include:

• Unexplained pain when eating.
• Sensitivity to warm and cold foods.
• Pain with no obvious cause.
• Difficulty pinpointing the location of the pain.

What Kind of Cracks can Affect the Teeth?

There are many ways in which a tooth can be cracked. The specific type of crack will determine what type of treatment is used. In many cases, if the crack is not too deep, root canal therapy can be performed and the natural tooth can remain in the mouth. In other situations, the tooth is too badly damaged and requires extraction.

Here is a brief overview of some of the most common types of cracks:

Crazes – These are generally tiny vertical cracks that do not place the teeth in danger. These scratches on the surface of the teeth are considered by most dentists to be a normal part of the tooth anatomy. A craze rarely requires treatment for health reasons, but a wide variety of cosmetic treatments can be performed to reduce the negative aesthetic impact.

Oblique supragingival cracks – These cracks only affect the crown of the tooth and do not extend below the gum line. Usually, the affected part of the tooth will eventually break off. Little pain will result because the tooth pulp (that contains the nerves and vessels) will remain unaffected.

Oblique subgingival cracks – These cracks extend beyond the gum line, and often beyond where the jawbone begins. When a piece breaks off, it will usually remain attached until the dentist removes it. Oblique subgingival cracks are painful and may require a combination of periodontal surgery (to expose the crown), and endodontic treatment to place a crown or other restorative device.

Vertical furcation cracks – These cracks occur when the roots of the tooth separate. This type of crack almost always affects the nerve of the tooth. Because the tooth will not generally separate completely, root canal therapy and a crown can usually save the tooth.

Oblique root cracks – These cracks tend not to affect the surface of the tooth at all. In fact, the damage is only apparent below the gum line and usually below the jawbone. Root canal therapy may be possible; depending on how close the fracture is to the tooth surface. However, extraction is almost always the only option after sustaining this classification of fracture.

Vertical apical root cracks – These cracks occur at the apex (tip of the root). Though the tooth does not require extraction from a dental perspective, many patients request an extraction because of the high degree of pain. Root canal therapy alleviates the discomfort for a while, but most often, teeth affected by such cracks are eventually extracted.

How are Cracks in the Teeth Treated?

There are many different types of cracked teeth. Some can only be exposed using X-ray machines, while others are clearly visible to the naked eye. In cases where the tooth root is affected, root canal therapy is the most viable treatment option. The pulp, nerves, and vessels of the tooth will be removed, and the resulting space will be filled with gutta-percha. A crown or filling will be added to stabilize the tooth and it will continue to function as normal.

When the crack is too severe for the tooth to be saved, the dentist will perform an extraction. There are a number of restorative options in this case, such as bridges, dental implants, and partial dentures. All of these structures can restore biting, chewing, and speaking functions.