In the center of every tooth lies a space which houses nerves and blood vessels (dental pulp). These structures are necessary to keep the tooth alive and respond accordingly to the environmental conditions impacting on the tooth. When the tooth develops a cavity as a result of dental decay the bacteria present in the mouth will stimulate the pulp tissues to start building more tooth structure within this space to wall off the pulp from the invading bacteria. But also it causes toothache thereby alerting the individual to the problem. In fact, any stimulus which has the potential to cause problems for the tooth is made apparent by pain which is elicited from the nerves in the pulp.

Figure 1. This diagram shows a picture of a tooth in cross section. One half shows an abscess at the tip of the root and the other half shows the pulp inflamed due to the presence of bacteria. Courtesy of Dr Noel Garza.

When bacteria invade this space and cause significant inflammation in the pulp, the person experiences toothache. The inflammation may resolve in some cases once bacteria are removed and the cavity sealed with a restoration. However in some cases the inflammation persist leading to irreversible pain requiring the pulp to be removed with root canal therapy.

The pulp can also die and the tissues may shrivel and leave the space for invading bacteria to flourish unnoticed. The bacteria eventually make their way through the tooth and eventually out of the tooth into the surrounding bone (See figure 1). This leads to an abscess which can be very painful. Again if the tooth is to be saved the pulp chamber and canals need to be disinfected and filled. Following root canal therapy a crown should be used to protect the tooth as root canal treated teeth tend to be weaker especially if the result of pulp death has been the result of significant tooth breakdown.

After root canal treatment it is very important that the tooth is sealed perfectly as any defects in the restoration or cracks in teeth will lead to the pulp chamber and canals becoming re-infected. The best prostheses to achieve this are Crowns and onlays.

Figure 2. Shows an instrument used to clean the pulp canals. It is called an endodontic file. This instrument is used to clean the walls of the main canal in teeth. Courtesy of Colgate.

Root canal therapy involves the use of a rubber dam which is a sheet of latex placed over the tooth to isolate the tooth from the oral environment. This will prevent bacteria from the mouth getting into the tooth. It is also there to protect the patient’s airway from the disinfectants and instruments used to disinfect the tooth canal and chamber. Once the space within the tooth is disinfected it is dried, medicated and sealed. The tooth is sometimes left temporarily sealed for weeks to months to allow the antibiotic to work within the tooth space.

If the tooth is not causing any more pain after the requisite time, it is then filled from within to ensure no bacteria will thrive in the tooth. The tooth is then restored to seal it and restore full function.

Root canal therapy allows for a problematic tooth to be retained in function. The only alternative to a tooth causing toothache is extraction. This is in most cases the worst thing to do as it does create greater problems in the long term.

At ProCare Family Dental our philosophy is to keep all natural teeth as long as possible before the consideration to extract is made. The longer a natural tooth is left in place the better the future will be for the oral environment. It also means very expensive and complicated procedures to replace missing teeth can be avoided.