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!

Pulpitis: Reversible pulpitis vs Irreversible pulpitis

Question:

“What procedure is done to fix reversible pulpitis”

Answer:

Causes of Tooth Pain

Whether it’s on and off, lingering or thumping, tooth pain is really uncomfortable and sometimes makes it hard to do anything else while the pain persists. Tooth pain causes are outlined in the article. Brushing at least twice a day and flossing daily, along with regular dental visits, are sure ways to prevent tooth decay (cavities). The modified bass technique is an effective brushing technique.

What is Pulpitis?

Pulpitis is an inflammation of the dental pulp. It’s primarily caused by bacteria that enter the pulp. The bacterial infection itself begins with tooth decay. Pulpitis may also be caused by any other type of injury to the pulp. Symptoms of pulpitis range from very mild to very severe. There are two types, and the pulpal diagnosis of each differs based of factors explained below.

What is Reversible Pulpitis?

This means that the tooth inflammation can be reversed, and the tooth symptoms relieved. The tooth therefore has a chance to heal and recover. The inflammation is usually secondary to decay, but may also be due to pulpal injury. Reversible pulpitis symptoms include:

• Tooth discomfort from contact with anything cold or another stimulus.
• Tooth symptoms that are relieved when cold or other stimulus is removed.
• Symptoms that gradually get better.
• Usually the discomfort experienced can be relieved by over the counter pain medications.

Treatment for Reversible Pulpitis

If a tooth has caries (tooth decay) and symptoms of reversible pulpitis, a dentist will remove the decay and replace the lost tooth structure with a dental filling. This reversible pulpitis treatment is usually sufficient to reverse the process. The symptoms normally improve over time, gradually disappearing.

What is Irreversible Pulpitis?

When the pulp tissue (nerve of the tooth) is damaged beyond recovery, this is known as irreversible pulpitis. The pulp will eventually die, and if the tooth isn’t treated soon enough, a tooth abscess (tooth infection) may occur.

A tooth vitality test is often done to confirm a diagnosis of irreversible pulpitis. The usual treatment of irreversible pulpitis is a root canal therapy. This is necessary in order to save the tooth. Irreversible pulpitis symptoms include:

• Spontaneous pain (pain that arises without any provocation). Tooth pain that wakes you up in the middle of the night is usually a sure sign of irreversible pulpitis.
• If the pain is brought on by a stimulus, it usually lingers even after the stimulus is removed.
• The symptoms generally get worse.
• Root canal treatment is usually necessary to treat the problem.

We hope that you found this information helpful!

What is referred pain?

Question:

“For about two months, been having terrible teeth pain, lower and upper left side.  Ringing and pressure in ears, along with awful headaches.  [I am] going to a second dentist tomorrow [for an opinion], with lots of dizziness.   My lips are inflamed as well as the inside of my mouth.  I have drainage in the back of my throat.  My sinuses are too clear and it hurts when I breathe through my nose.  Does anyone know what this could be?  I am suffering badly.  Thank you.”

Answer:

There are several common causes for tooth pain. Please refer to posted article. Another less well known cause is what is called referred pain. This basically means that the tooth pain may not actually come from the tooth in question, instead it is carried over (or referred) from another tooth or another area in the body (i.e. ear infection).

Causes of Referred Pain

Reasons a tooth may ache due to referred pain include:

• A tooth infection (such as a tooth abscess) that travels to another tooth/teeth
• Referred tooth pain from an ear infection
• Referred tooth pain from heart attack
• Referred tooth pain from trigeminal neuralgia, a condition where there is pain in trigeminal (facial) nerves that supply sensation to teeth.
• Referred tooth pain from a sinus inflammation or infection.

Maxillary Sinus Infection (Sinutitis)

The maxillary sinuses are located in the upper jaw and behind the cheekbones. A sinus infection can be the cause of severe headaches, discomfort or pressure in or below the (eyes), pain in the ears, and upper facial pain. This type of infection affects teeth because of how close teeth in the upper jaw are to the sinuses. Causes of maxillary sinus infection include:

• An allergen (a substance or particles that you are allergic to)
• A ‘bug’ (some kind of virus, bacteria or fungus)
• An oral infection that has travelled to the maxillary sinus

Even small oral infections (for example a tooth cavity or a small tooth abscess) can lead to a maxillary sinus infection.

Symptoms of sinus infection

Symptoms of a sinus infection include:

• Sinus headache
• Facial pain
• Toothache- this is the most common cause of referred pain in a tooth or teeth
• Cough

It is very important to have a full evaluation and proper diagnosis by a dentist to determine if any oral condition is the cause, or if they can be ruled out, and what treatment is necessary. Good luck with your search for dentists.  We are sure this information can help guide you and your health care provider along the right course towards a proper diagnosis.

We hope that this information was useful to you!

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My root canal failed!

Question:

I had a root canal done and it abscessed. I haven’t got it finished all the way yet. Can I safely pull the tooth, and be done with it.

Answer:

Now before you think about pulling the tooth, let’s think about some other factors that will come into play down the road.  Once that tooth is gone, the tooth behind it and the tooth across from it (in the opposite jaw) will begin to slowly drift into the open space.  This will cause the other teeth to drift also, resulting in open spaces amongst your teeth.  You will eventually have to replace the space with either a bridge, implant, or partial denture which are all pretty costly.

Root canal procedures don’t have a 100% success rate, sometimes they do fail.  However, retreatment is always an option and definitely cheaper as compared to some of your other options.  Being that your procedure wasn’t finished, the pathway for bacteria wasn’t completely blocked meaning it had an opportunity to repopulate or wasn’t completely removed.

If would be best, in the long run, if you were to return to have the procedure completed or retreated.  Yea, it may be cheaper and easier to pull the tooth now, but believe us, you may regret this decision down the road.

Good luck with your decision,

SaveMySmile Team