Endodontics

What is endodontics?

At Estudi Dental we offer specialist endodontic services at our clinic in the centre of Barcelona. When we talk about endodontics it simply means treating the inside of teeth and molars (back teeth). There are various reasons why a patient might need endodontic or root canal treatment for the nerves in their teeth or molars. This is commonly known as root canal treatment. At our ESTUDIO DENTAL BARCELONA Dental Clinic, we work with dentists who specialise in endodontics and who have the experience and qualifications to provide the appropriate treatment for each case.

The most common reasons for requiring this treatment are very deep decay that has reached the nerve or broken or cracked teeth or molars that expose the nerve and are very painful.

Types of endodontic treatments

Endodontic treatment for tooth decay

In the case of deep decay, it is important to note that treatment may involve two processes.

1. Tooth decay can mean that the nerve dies slowly, without causing much pain to the patient. As the nerve begins to become necrotic (it begins to die), it becomes infected which sets off an inflammatory reaction and damages the bone surrounding the tooth. In these cases, the symptoms are usually pain on chewing and/or a throbbing or stabbing pain around the tooth. With these symptoms of infection, the patient needs immediate treatment because in many cases if mild pain is ignored, an abscess or gum boil can form, producing intraoral inflammation (in the gum) and in some very severe cases extra-oral inflammation (in the face). In both cases, if the patient experiences severe pain they should visit a dental clinic where a dentist specialising in endodontics can carry out endodontic treatment, commonly known as a root canal.
2. The other possibility is that the decay reaches the nerve, creating acute inflammation and causing severe pain.  In this case too, the patient should visit a dental clinic, where a dentist specialising in endodontics can carry out endodontic or root canal treatment.

Endodontics for broken teeth

In the case of broken teeth or molars, this can cause immediate pain because the nerve is exposed, creating inflammation and a great deal of pain.

There can be various causes of broken or fractured teeth.

1. Deep decay that has gone undetected by the patient because it has formed between the teeth and the patient hasn’t noticed it. The tooth or molar usually breaks when the patient is chewing food and once the tooth is broken it is painful to drink cold liquids or chew and even air passing across the tooth causes pain. When this happens, the patient should visit the dental clinic where a dentist specialising in endodontics can carry out endodontic or root canal treatment.
2. Broken teeth can also be the result of trauma, whether that’s because of a fall, chewing something hard or blows to the face or accidents, etc. In the case of trauma to the teeth, there can be many different outcomes. However, if the damage to the tooth exposes the nerve and there is severe pain without touching the tooth, spontaneous pain or pain simply when air passes over the tooth, the patient should visit the dental clinic to be treated by a dentist specialising in endodontics for endodontic or root canal treatment.

Pain in teeth where the nerve has already been treated

In cases where there is pain in a tooth that has already undergone endodontic treatment, the cause is usually a bacterial infection or that the tooth has broken. These are complex cases and should be evaluated and treated by a dentist specialising in endodontics. In cases where the tooth or molar can be treated again it is possible to carry out a REPEAT ENDODONTIC TREATMENT, where the affected tooth or molar is cleaned and disinfected.

Other cases that should be treated by an endodontist

Dental trauma without an exposed nerve

Although not all fractures to teeth or molars expose the nerve, it is very important to visit the dental clinic and have the tooth evaluated and treated by a dentist specialising in endodontics because with this kind of damage there may be changes over the following months which can have negative results on the affected teeth.

Broken teeth

A simple fracture that does not expose the nerve means it is not necessary to treat the nerve, but the tooth should be evaluated by a dentist specialising in endodontics.

Pain on chewing or touching the tooth

Trauma with or without breaking the tooth that does not expose the nerve, but that is painful to touch or when chewing. The pain is because of inflammation to the periodontal tissues (gums) around the tooth and so the nerve should be evaluated by a dentist specialising in endodontics to decide whether the nerve is affected or not. This should be regularly reviewed for a period of up to one year.

Tooth mobility

Trauma with or without breaking the tooth and without exposing the nerve that results in tooth mobility and pain on contact with the affected tooth. In this case both the tooth and the nerve should be assessed by a dentist specialising in endodontics and regularly reviewed for up to one year.

Tooth intrusion or extrusion

Trauma with or without breaking the tooth and without exposing the nerve, where the tooth is pushed back into the gum and appears shorter or the tooth is pushed out of the gum and appears longer than normal. Both cases should be assessed and treated by a dentist specialising in endodontics.

Steps involved in endodontic treatment

Endodontic treatment, or root canal work as it is commonly known, is carried out by an endodontist and follows a series of very specific steps.

1. Diagnostic tests for endodontic treatment (root canal).

The endodontist carries out a series of tests on the affected area to detect which tooth or teeth are causing the problem.

Using an instrument, such as the mirror or periodontal probe, the dentist specialising in endodontics taps the teeth in question and depending on the reaction, will have an idea of where the problem is.

After the percussion test and depending on the results obtained, the endodontist will carry out a pulp vitality test which uses hot and cold stimulation of the tooth to determine whether the nerve is healthy or if it has been irreversibly damaged.

Lastly, once the affected area or tooth has been located, the dentist will carry out a periapical x-ray to confirm which area requires treatment as well as to analyse the nerve and evaluate the difficulty involved in the root canal treatment.

2. Preparing the tooth before the root canal

Once the endodontist has anaesthetised the area, the next step is to isolate the teeth to be treated. This step is essential to ensuring the success of the root canal treatment because if the tooth is not isolated it cannot be correctly disinfected and the root canal will fail over time.

Once the tooth has been isolated, affected tissue and decay is removed to access the nerve requiring treatment. This nerve, or what is left of it, is gradually removed by inserting files into the root canal which scrape and clean the area housing the nerve.

In between each filing, the dentist specialising in endodontics irrigates the area by washing it with disinfectant to help remove the bacteria that is often inside the root canal.

3. Sealing the root canal

Once the tooth is completely clean and prepared, the dentist fills the root canal where the nerve had been with a biocompatible material that seals the area and protects it from bacteria.

4. Reconstruction of the tooth using composite or endocrowns

This stage is the most important for ensuring the success of the endodontic treatment after the nerve has been removed. The tooth must be sealed with a composite reconstruction (filling) or with an endocrown or porcelain crown, depending on the case, to make sure the tooth lasts for many years.