What is a pulpotomy

Question:

“I have a tooth where i would like to save the portion not damaged by bacteria.  i am only being presented an option of root canal. can i opt to have a pulpotomy — usually this is only for <16.
I would like to preserve my radicular pulp/ dentin. (not symptomatic)”

Answer:

Pulpotomies are usually just a temporary fix.  More often than not, once bacteria reaches the pulp tissue, there’s no sure sign of judging the extent of it’s invasion.

Pulpotomies are oftentimes performed on primary teeth, or in emergency situations on adult teeth to alleviate extreme pain.  If it is a primary tooth, then we would encourage you to pursue the pulpotomy option.  However, if this is a permanent tooth, and you elect to have the pulpotomy, there is a chance that symptoms will return later on (anywhere from 1 week later to 1 year later).

In a situation like yours, it’s best to remove the entire pulp tissue, thoroughly disinfect and sterilize the canals, and fill with a therapeutic material to ensure the bacteria will not return.  We encourage you to have a root canal, but in the end, the decision is entirely yours.  The article below will detail decay, pulptomies, pulpectomies, and full root canal treatment.  We hope this helps you in your decision.

What is Tooth Decay?

Tooth decay (also called caries or cavities), is a very common and preventable oral disease. Basically, it happens when naturally occurring bacteria in the mouth produce acids after interacting with food (especially carbohydrates) left on teeth. This eventually wears away teeth over time if not treated. The type of treatment necessary after bacteria have caused damage to teeth depends on the extent of the decay. These include:

• Dental filling (this involves removing the decay and replacing the lost tooth structure with amalgam or dental composite material).
• If the decay has been long-standing and has compromised an extensive amount of tooth structure, an extraction may be recommended. The missing tooth or teeth may be replaced by a dental implant, dental bridge or removable partial denture as necessary and recommended by a dentist.
• Tooth decay may be extensive enough to cause a dental.  A dental abscess is serious enough to warrant immediate treatment.
• If the decay has extended to the pulp, a root canal treatment may be necessary

What is Root Canal Treatment?

After a root canal therapy, a crown (also known as a cap) is usually placed over the tooth to protect it. This is necessary because the canal(s) have been cleaned and filled, and the tooth is more susceptible to fracture (it’s more brittle). The canals formerly contained the blood and nerve supply for the tooth, which nourished and maintained the tooth.

What is a Pulpotomy?

A pulpotomy is a type of root canal treatment procedure that is usually performed on primary teeth. It involves the removal of the tissue from the pulp chamber of tooth. Pulpotomies are necessary if the pulp has been violated, either by decay or a tooth fracture. Pulpotomies are different from the root canal treatment done on permanent (adult) teeth in that only a part of the pulp is removed. A pulpotomy procedure may be recommended for a few reasons, including:

• Pulpotomy in children may prevent unnecessary loss of teeth due to a possible infection (the procedure is therefore preventative).
• Pulpotomies may be recommended to save the tooth, hence the space needed for adult (permanent) teeth to erupt.
• A pulpotomy procedure may give a developing permanent tooth a chance to fully develop, after which a conventional root canal therapy is done. This is called apexogenesis.

The success of the procedure depends on the extent of the decay and the patient’s own immune system.

What is a Pulpectomy?

More often than not, if the aim is to prevent the early loss of baby teeth, all of the pulp may be removed from the tooth. This procedure is called a pulpectomy. A pulpectomy procedure may be recommended in the following instances:

• When a tooth has a deep decay.
• When a tooth is fractured, causing exposure of or damage to the pulp.
• Where there is large dental filling.

Whether or not the tooth is symptomatic is a part of assessment that a dentist uses to diagnose the tooth’s condition. If the tooth is asymptomatic with a large decay extending into the pulp, this may be a necrotic pulp (meaning the pulp tissue is dead). Pulp necrosis is one sign that a tooth will need a root canal treatment.

We hope that this was helpful!

Pain in tooth after root canal

Question:

“I have two root canals one on my upper left and the other on my upper right.  I have experienced episodes of pain in both since having the procedures done ~5 yrs ago. The most recent episode was a continuous sort of throbbing pain that persisted for three days before I decided to go to my dentist.  Each time one of these pain episodes occur my dentist takes x-rays and pokes around but is unable to provide an explanation and prescribes antibiotics.  A few days after taking the antibiotics the pain has dulled and goes away.  I no longer feel that this is an effective method in dealing with a persistent problem.  Antibiotics are discontinuing the pain, antibiotics attack and eliminate bacteria, so bacteria are a likely culprit to causing the pain.  Is a pain causing but not so severe bacterial infection able to be seen in an x-ray?  Should I request that my dentist remove the crown for a more thorough examination or is episodes of pain treated by antibiotics a part of the territory of living with a root canal? Lastly, am I supposed to even feel anything being that the pulp tissue is removed?”

Answer:

To specifically address your question, if the problem is alleviated by antibiotics, that’s a sure sign that there is a bacterial re-contamination.  This can be caused by a number of reasons that are outlined in our older article, called Failed Root Canal.  However, it is not normal for you to be feeling pain 5 years after a root canal.  The purpose of a root canal is to completely remove the source of infection, thus removing the source of pain.  It sounds like there may have been a missed canal (lateral canal, or a small canal at the apex), or a leaky crown, but the bacteria has found some kind of way to reinvade and re-infect the area.  It may be best to visit an Endodontist to have him/her reassess your tooth.  The Endodontist specializes in only root canals and has the technology to more closely examine your tooth condition.  Below we have detailed information regarding root canals.

What is a Root Canal Treatment?

A root canal treatment (also called root canal therapy) is a procedure that is done in order to attempt to save a tooth, usually after it has become badly decayed or infected. If the affected tooth is not treated, the infection or decay will usually spread to the tissues surrounding the tooth, including the bone.

Does a root canal hurt?

In most cases, the procedure is not painful, though there may be some sensitivity afterwards. Most cases of discomfort are felt if there was pain before the procedure (it goes away as the tooth heals), or if there is any complication such as a missed canal. One of the wonderful things about a root canal treatment is that the source of the pain is removed, the canal(s) thoroughly cleaned and disinfected, and the canals filled to prevent re-invasion of bacteria. Many patients retain their root canal treated teeth for life.

It’s important to note too that in most cases where there is discomfort after, the source is not in the tooth itself but in the periodontal ligament (PDL) surrounding the tooth. The infection in the tooth often spreads to the PDL (and in some cases the bone), which by itself is the cause of much sensitivity and discomfort.

What to do after a root canal

The root canal procedure has a success rate ranging between 68-95%. It is a welcome procedure for patients who have the opportunity to try and save their tooth or teeth. After the procedure is completed, a few things to know and expect:

• If there was tooth pain or an infection before the procedure, you may have some sensitivity for a few days after. This is because the tooth is healing from the tooth inflammation that was present before. Your dentist will most likely prescribe NSAIDs for the pain and inflammation. Antibiotics are used to treat oral bacterial infections, in cases where a tooth or teeth may have developed an infection.
• Avoid chewing on the tooth being treated until a permanent crown is placed. This will help you to avoid damaging or re-contaminating the tooth.
• Ensure that you complete the procedure by having a crown (cap) placed over the tooth. This helps protect the tooth from being exposed again to bacteria, and provides structural support and protection for a tooth that is no longer as strong on its own.

Pain years after root canal

Though not very common, there can be root canal pain years later. Reasons for pain after a root canal procedure include:

• Tooth fracture.
• A failed dental restoration (usually a crown) that has allowed bacteria to invade the tooth, causing a re-infection.
• The material sealed inside the canal(s) break down, allowing bacteria to recontaminate the tooth.
• Missed canal – not all canals were located, cleansed, and sealed during the procedure

Failed root canal

After root canal pain, a dentist will re-examine the tooth including the crown to determine the condition of the tooth and what needs to be done. It is sometimes tricky to isolate the problem, but two common approaches to relieving the recurrence of inflammation and infection include:

• A root canal retreat. Re-treatment is sometimes successful, and involves thoroughly cleaning and refilling the canals.
• Endodontic surgery may be needed in other cases. The most common endodontic surgery used to attempt to treat this is an apicoectomy (also called root-end resection or root resection). Basically, the tip of the root and the infected tissue around the root tip are removed. A small filling may be placed at the root tip to seal the root canal.

In extreme circumstances, the tooth may be non-restorable and will need to be extracted. Comprehensive evaluation is necessary for diagnosis and treatment of each patient’s case. Depending on the extent of the infection, changes are sometimes seen on a dental radiograph (dental x-ray) that indicate the presence of an active infection.

We hope this information was helpful to you!

Temporary Crown Came Off

Question:

“My temporary crown came off during dinner tonight.  I purchased some OTC dental cement and used it to replace the temp. Holy Toledo! Talk about hurt!!! It’s been 1 hr (& 1 pain pill) ago & it’s still hurting! (it IS seated correctly as my bite is fine)
My dentist is several hours away so I cannot make several trips back & forth to get answers.  #1- does this pain mean I need a root canal? #2 if he seats the perm crown is it possible to do the root canal later on? Thanks for your help – I’m afraid it’s going to be a L-O-N-G night!”

Answer:

It’s likely that the extended exposure of your prepared tooth may have caused you some sensitivity and pain.  Your enamel has been removed in preparation for your crown and your dentin is exposed.  Dentin communicates directly with the pulp/nerve tissue.  This means when air, cold, or any other sensation hits your teeth, it will be interpreted as pain!  It doesn’t necessarily mean that you will need to have a root canal therapy. Your temporary crown may not be adequately sealed, thus causing a condition called reversible pulpitis.  It will easily go away once your tooth is properly protected.  Your dentist will be able to examine your tooth’s condition and determine what is necessary. We encourage you to get back to your dentist as soon as possible, where you can be provided with the appropriate professional services.

Let’s take a more detailed look at dental crowns and temporary dental crowns.  Also, look below for our chart on tooth pain interpretation.

Temporary Crown

A temporary crown is placed to protect a tooth or teeth that have been prepared to receive a permanent crown. The permanent crown is a ‘cap’ that is shaped like a tooth to restore a tooth or teeth to proper function, form and esthetics. The preparation of the tooth or teeth essentially involves removing some of the tooth structure so that the crown can fit comfortably on the tooth or teeth. Reasons you may need a crown include:

• The provide coverage and support for a tooth that has a large filling, with not much tooth structure left.
• To cover a dental implant.
• To restore a badly broken or worn down tooth.
• To protect a weakened tooth (for example after a root canal therapy).
• As part of a dental bridge.
• To restore desirable esthetics in discolored teeth or awkwardly shaped teeth.

Temporary Crown came off

If the permanent crown isn’t ready to be placed immediately after the preparation, a temporary crown is placed to protect the tooth. In the situation where your temporary crown came off, it is important to get it put back in place (as you did) as soon as possible. Even when there is a temporary crown loose, it needs to be re-seated. The main reasons:

• To protect the prepared tooth from fracture or other damage
• To prevent decay
• Maintaining coverage protects the tooth from sensitivity and pain due to exposed dentin

We hope this was helpful to you!

Save My Smile Team

Tooth Crown Pain

Question:

Help!!  The tooth under my crown is hurting.  What does this mean and what should I do?  I’ve only had this crown for one year!!

Answer:

Sorry to hear that your tooth is in pain.  This can mean a number of things.  Let’s take a look at the many reasons for pain under a tooth crown:

Carious lesion/cavity under your crown

Sometimes, bacteria are able to find its way under the margins of crowns if not cleaned properly (see article on brushing).  If this happens, it could result in a painful situation, especially if the tooth nerve still remains in the tooth.

Bacteria not completely removed while preparing tooth for crown

In order to prepare a tooth for a crown, alot of tooth structure must be removed.  However, sometimes bacteria may still remain on the tooth structure that cannot be visibly seen by the dentist.  If this occurs, pain will occur at a later time.

Crown not being correctly adjusted in mouth

It could be “too high”, which means your bite could be off, and may need to be reduced by the dentist.  It could also mean that the crown isn’t adjusted to tightly “hug” the tooth and seal off the margins.  If the margins aren’t tight and snug, bacteria could easily creep in and eventually cause tooth crown pain.

Be sure to visit the Dentist to fix the problem

Your best bet is to go to the dentist to evaluate your options.  First, make sure the dentist runs a couple of tests to ensure that the pain is indeed coming from that tooth.  Sometimes, pain in one area is projected to a nearby area, this phenomena is called referred pain and occurs quite frequently.  If the dentist identifies this tooth as the source of the pain, then you’ll have a couple of options.  The crown may just have to be readjusted, which will only take a few moments, or it may have to be removed and the situation assessed from there.  Depending on the extent of bacterial invasion, you may just need the crown re-prepped, a root canal, or even an extraction.  Also, depending on your dentist’s office polices, he/she may offer to re-do your crown for free.

Good luck!