Endodontic (Root Canal) Treatments
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Endodontic treatment is focussed on treating the nerve space inside teeth -the root canal. In healthy teeth, this space contains the dental pulp - a complex of blood vessels and nerve tissue. If the nerve in this space becomes irritated, the tooth becomes painful - this is the 'toothache' you can sometimes feel.
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Bacteria in the root canal space can cause the nerve to be irritated and inflamed This process can cause acute sensitivity from a tooth making it very tender to hot and cold. Bacteria in this inflamed pulp can also irritate the ligament which holds the tooth in place. This can cause the tooth to be tender to bite on.
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Once the nerve space in the tooth has died off, the acute sensitivity can reduce, however, a dental infection can then develop. The bacteria that is inside the space in the tooth can release toxins through the end of the root which can lead to a dental abscess where there is pus/ infection under the tooth.
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Root Canal Treatment is a procedure where the space inside the tooth is disinfected to reduce the bacteria causing the pain. Once the space is cleaned and disinfected, the space in the tooth is then sealed with a Root Canal Filling.
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To prevent bacteria re-entering the space in the tooth, a strong filling is placed to seal the access hole in the tooth. Back teeth are at an increased risk of breaking so a crown is often recommended to protect back teeth.
Endodontic (Root Canal) Re-treatment
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If a previously root filled tooth becomes painful, it may be necessary to repeat or refine the previous root canal treatment.
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Before planning endodontic re-treatment, the tooth needs to be carefully evaluated to determine the cause of failure. Sometimes, in back teeth especially, if there is no crown on a tooth after the historical root filling, a crack can develop in the tooth. If the tooth has a crack in it, this is a pathway bacteria can re-enter the tooth. If there is a crack in the tooth, the prognosis for re-treatment is not good as if the tooth is re-treated, bacteria can re-infect the space in the tooth again through the crack and the tooth can become symptomatic again.
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In addition to a crack allowing bacteria into the tooth, historical root fillings can fail for a number of reasons including:
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Missed spaces inside the tooth and extra canals in the tooth
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Incomplete disinfection of the canals
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Not cleaning the nerve spaces to the end of the root/ blocked canals
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Re-infection of bacteria through an incomplete seal at the top of the tooth
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At your assessment appointment, a thorough examination of the tooth will be carried out. As well as looking for signs of cracks in the tooth, the tooth will also be assessed to see why the historical root filling has failed and how this failure can be managed. The pros and cons of treatments can then be discussed in addition to alternative treatment options.
Endodontic Micro-surgery (apicectomy)
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Endodontic surgery is a method of accessing the infected part of a tooth when a conventional approach is not possible.
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Bacteria or old root canal material around the end of a root (apex) can cause chronic irritation / infection. We have a state of the art CBCT three dimensional x-ray machine which allows us to evaluate the area in great detail to plan your case thoroughly.
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Working with an operating microscope allows treatment to be carried out in a controlled minimally invasive way which improves the prognosis of treatments with success rates of up-to 90%.
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Treatment is carried out under local anaesthetic, however, sedation can be arranged if required, for an additional fee. After the procedure, there are small stitches placed to hold the gum back in place and these can dissolve on their own after a week. Bruising and tenderness around the area should be expected for a few days after the procedure and normal painkiller tablets you would take for a headache can be helpful in reducing any discomfort and swelling.