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Endodontic Therapy


Date :26-Feb-2016 Author :Dr. Seby Varghese

The pulp of your tooth, which contains the nerve and tiny blood vessels, can become infected. The pulp has a limited ability to heal itself. This infection can be caused by a deep cavity that reaches the centre of the tooth causing the pulp to die.

Causes:
A traumatic injury to the tooth an extensive preparation (drilling) of the tooth. The extensive preparation may have been done to prepare the tooth for a crown (cap) or other large preparation for a restoration.
The pulp may or may not abscess immediately in these cases. It may take years for a problem to develop. The infected pulp tissue may or may not be painful. It may or may not be visible on a dental radiograph. A tooth with this type of an abscess is not usually extracted because the infection can be treated with endodontic therapy on the tooth. This routine procedure can save the tooth and enable you to avoid the harmful effects of tooth loss.
It is successful in more than 90% of the teeth in which the treatment is completed.
Endodontic treatment can take from one to three appointments to complete. Teeth can have one to four canals that need to be treated.

Procedure:
An opening is created to access the nerve, and the abscessed nerve is removed from the root or roots. The canals where the nerves had been located are then cleaned and shaped and a medication may be placed in the canal to promote better healing. When it has been determined that the canals are free of infection, they are filled with a special rubber-like material and sealed with a cementing medium. The abscessed area associated with the tooth will then begin to heal. It may take several months before healing is completed and for the tooth to become asymptomatic, that is, for any soreness in the area to disappear. Once the endodontic therapy has been completed, the tooth is usually restored with a cast crown or onlay. This is done to protect the tooth and prevent it from fracturing.
Failure to follow through with mandatory restorative procedures after endodontic therapy on a previously uncrowned tooth can result in a vertical fracture. If there is very little tooth structure remaining, we may also advise the use of a post and core to further help the tooth retain its final restoration. We will discuss with you the exact type of restoration that you will need.
Please note that this infection may cause discomfort between root canal appointments. This is normal and usually not a cause for any concern. Contact the office if there is pain and/or swelling. Remember to avoid biting down on the tooth until the root canal is completed and the final restoration has been placed. You may have had no discomfort from the tooth prior to the root canal treatment or have been unaware that you even had an abscess. However, you may experience pain or swelling after the root canal treatment has begun.
If we have prescribed antibiotics for the abscess, be sure to fill the prescription and take it until it is finished. It is important that you do this in order to quickly control the infection. If you do not take the prescribed medication, the resolution of the abscess may be delayed and problems with the postoperative pain are more likely.

Informed Consent for Endodontic Therapy
Endodontic therapy: Endodontic therapy is a procedure to retain a tooth that may otherwise require extraction. Endodontic therapy results in the removal of the pulp tissue (nerves and blood vessels) from the inside of the tooth then seals the space with a filling material. Endodontic therapy enjoys a high degree of success, but because it is a biologic procedure, success cannot be guaranteed or warranted. Occasionally, a tooth, which has had endodontic treatment may require retreatment, periradicular surgery or even extraction. During treatment there is the possibility of instrument separation within the tooth, perforation of tooth structure in gaining access to the canals and fracturing of the tooth itself. Following treatment the tooth must be restored to function with a protective restoration, usually a post and crown. Some teeth may not be amenable to endodontic treatment at all. Other treatment choices include no treatment, waiting for more definitive symptoms to develop, or tooth extraction. Risks involved in these choices include but are not limited to pain, swelling, loss of tooth, infection and spread of infection to other areas.
Complications of endodontic therapy and anesthesia may include swelling, pain, trismus (restricted jaw opening), infection, bleeding, sinus involvement and numbness of the lip, gum or tongue, which rarely is protracted and even more rarely permanent.
Postgraduate endodontic surgery: Certain inherent and potential risks in any treatment plan or procedure exist, and in this specific instance such risks include, but are not limited to:

  • Swelling, skin discoloration and pain requiring use of medication can occur with any surgery and vary from patient to patient and from one procedure to another.
  • During surgery your mouth will remain open for an extended period of time. Afterwards, you may experience pain and discomfort in your jaw joint. Trismus is limited opening of the jaw due to inflammation and/or swelling.
  • Infection is possible with any surgical procedure and may require further surgery and/or medications if it does occur.
  • Slight bleeding is usual for most surgeries and can be controlled. Significant bleeding can occur during or after surgery, but it is not common.

Local Anesthesia: Certain risks exist that, although rare, could include pain, swelling, bruising, infection, nerve damage and    unexpected allergic reactions which could result in heart attack, stroke, brain damage and/or death.

  • Numbness, tingling, or burning sensations in the lip, chin and/or tongue can occur from pressure or damage to a nerve, which passes below the roots of the lower teeth. This is usually always temporary, but it may remain for weeks or months, it is rarely permanent.
  • Sinus opening which might require additional surgery and/or medications because of entry into the sinus during treatment of upper posterior root tips which lie next to the maxillary sinus.
  • Gingival tissue in the surgical area may shrink, scar or recede            following surgery resulting in cosmetic disfigurement of a           permanent nature.
  •  Antibiotics may interfere with the effectiveness of oral           contraceptives. It is recommended that an alternative method  of birth control be used for at least one month.
  • Medications, drugs, anesthesia and prescriptions may cause drowsiness and lack of coordination, which can be increased by the use of alcohol. Be advised not to operate any vehicle, heavy equipment, or hazardous devices, while taking these medications and/or drugs.

Other treatment choices include no treatment, waiting for more definitive symptoms to develop, or tooth extraction. Risks involved in these choices included but are not limited to pain, swelling, loss of tooth, infection, and spread of infection to other areas. Endodontic surgery enjoys a high degree of success, but because it is a biological procedure, success cannot be guaranteed or warranted.

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