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Wednesday, March 7, 2012

What is a Root Canal?

What is a Root Canal? Sounds bad doesn’t it? Well, where a pulpotomy is the removal of the pulp tissue in the upper chamber of the tooth, a pulpECTOMY (root canal) is the complete removal of all pulpal tissue including down to the end of the roots. Root canals are often needed if a front tooth is traumatized or even knocked out. Yes, we can often save a knocked out permanent tooth, but it may take a root canal to do it. Often severely decayed teeth simply “give up the ghost” and die. All that dead stuff in there, well, the body cannot get to it to naturally clean it up.

We dentists do root canals or pulpectomies if the tooth is dead. There is a slight difference in how we approach permanent teeth as opposed to baby teeth. With permanent teeth, pulpectomies are often used to “save” a dead or abscessed tooth. You have to get the dead tissue out. You can get it out with a pulpectomy or you can take the tooth out all together. Well, if it’s my tooth, I would rather save a needed permanent tooth if at all possible with a pulpectomy. Some permanent teeth have up to four canals; that can be very complicated and expensive. By the way, I often refer patients (usually teenagers) to the Endodontist for permanent tooth root canals. They do that kind of stuff all day long, are experts, and have all the tools right at hand. Root canals are very useful at saving permanent teeth.

Now, in baby teeth it is a little different. If a baby tooth abscesses, you usually choose to remove it rather than attempt a root canal/complete pulpectomy. Why not do a root canal to save the tooth? Well, on rare occasions we do try, but there are several reasons that we do not. First, root canals on baby teeth do not really work that well. Pulpotomies do. Full root canals are more unpredictable as far as results. Secondly, often there is not enough baby tooth root left to adequately remove and fill the canal space. You see, baby teeth roots are meant to slowly dissolve as the permanent tooth erupts. Baby teeth have anatomical differences that you don’t see as much in permanent teeth: accessory canals, unseen vascular openings, twists and turns, and great variation. Also, as far as filling up the cleaned out root canal space, well, you can’t put in the regular gutta percha material. You have to put in something that will dissolve along with the baby tooth root or at least not interfere with the normal process. Hmm, what to do? Well, 99% of the time, where we cannot do a pulpotomy (i.e. the tooth is still vital), we need to remove the abscessed baby tooth. Fortunately, removal of the tooth is 100% effective at removing the offending stuff in there. Healing will take place rapidly. Unfortunately, if you loose the baby tooth too soon you need to place a space maintainer.
Why would you even try a pulpectomy (root canal) on a baby tooth? Good question. Like I stated, most of the time if the tooth is still vital and just has lots of decay, you can do a pulpotomy. If it is abscessed, we remove the tooth. Now, there are rare times we might attempt a real baby tooth root canal. The one that comes to my mind is when you have a second baby molar (the one in the way far back) that is dead, but not to the point of bone loss and severe symptoms, and the new permanent 6year molar is just about to erupt, and there is no easy way to place a space maintainer. If there is enough root structure, and if the tooth is not mobile and causing massive infection, cleaning out the dead tissue with a root canal might just keep the tooth viable long enough for it to guide in the permanent molar. Once it is in, if the baby tooth gives trouble you can easily remove it and place a proper space maintainer, or if the new tooth is fairly close, just remove it and allow the new tooth to erupt without incident. Sometimes we will do this on front baby teeth to help save the tooth for appearances sake. Problem is, that front teeth come out earlier than the back teeth, so if the child is any older than about four and half there may be root resorption from the erupting tooth. If the child is any younger than three years old, and the issue of cooperation becomes a bigger issue.
How do you do it?
With a baby tooth pulpectomy (root canal), it get’s a little technically detailed as to what you have to do. First, you need a relatively cooperative patient. It is easier to work on a slightly wiggly child to remove a tooth than do technically more precise procedures. Second, you have to remove the bulk of the necrotic or dead tissue. That is sometimes more difficult due to the strange anatomy of baby teeth. The good news is that you usually do not need to be as precise with the cleaning and filing out process as with a permanent tooth. You try to do a thorough job, but you don’t have to spend what seems like hours filing out the root canals of the tooth. Once the tissue is removed and the canals filed out and irrigated as best you can, you place something like Zinc Oxide Eugenol paste or various other kinds of paste materials in there. It kind of sets up after a few minutes and hopefully seals it all up. Then you usually do a crown on top to seal it up and restore an obviously very decayed tooth. Then you need to observe the tooth for a few months/years, to make sure there are no further problems.

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