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!

Pain after Root Canal

Question:

“I just had a root canal treatment in the top tooth, 5th from the middle. It’s been a month since the treatment, and I am having slight pain, it feels slightly loose.  What would you suggest for me to keep my tooth”

Answer:

What is Root Canal Treatment?

A root canal specifically refers to the space inside of the root of a tooth. A tooth may have one or more canals, just as they may have one or more roots.  Root canal treatment (also called root canal therapy or endodontic therapy) involves cleaning out the canal(s), disinfecting the canal(s) and then filling the canal(s).

Why do I need Root Canal Treatment?

Reasons why a root canal treatment may be recommended include:

• Tooth decay that has extended to the pulp
• Exposure of the pulp due to some trauma (this sometimes happens during rigorous sporting activities)
• A tooth that has become infected from decay (known as an abscessed tooth). Sometimes the infection may spread the bone surrounding the tooth.
• Internal resorption

Why does my root canal hurt?

There may be some sensitivity after the procedure, as the tooth heals. Pain after a root canal is not uncommon, though most patients may have no symptoms after treatment. In cases where there is associated pain, some reasons include:

• The associated pain is normal, as the inflammation slowly goes away and the tooth heals.
• There is an extra (much smaller) canal that may still need to be cleaned and filled. Teeth can be weird in this way (extra canals), and even the very best dentist can miss these hidden canals. This is usually corrected by the dentist or endodontist (a dentist who specializes in root canal treatment).
• The pain may actually be originating from the periodontal ligament surrounding the tooth.
• The root canal has failed, and a re-treat or endodontic surgery (also called root canal surgery) may be needed. If there is a dental infection at the root apex (tip), then an apicoectomy (which just means root tip removal) may be necessary.
• The tooth could have been fractures or perforated during the procedure.  Performing a root canal places a lot of pressure on the tooth.  Sometimes, if the tooth is weakened, it may fracture.  This could very well be the cause of your pain and looseness of the tooth.

Remember that each patient’s case is different, so diagnosing and treating depends on individual cases. Please see your dentist as soon as possible for evaluation to determine necessary treatment.

We hope this was helpful to you!

Cavity Basics

What is a cavity/tooth decay?

A cavity is an open pathway in the tooth which is caused by bacterial invasion.  In the dental world, it’s referred to as a carious lesion.  The severity of the cavity/carious lesion will determine which type of restoration is needed.

How would I know if I have a cavity?

If you experience pain in the tooth, more than likely it can be attributed to bacterial invasion/cavity.  However, keep in mind that tooth pain can be attributed to several other factors such as periodontal disease.  The best way to tell if you have a cavity is to visit the dentist.  Sometimes, cavities occur between our teeth, and the only way to determine its presence is on a radiograph/x-ray. 

What can be done to prevent cavities?

Brush, brush, and brush some more!!  If you brush 3 times a day, or even better, after each meal, you will remove food debris and other agents that act as magnets for bacteria.  If you are unable to brush that often, be sure to chew gum with Xylitol after your meals.  This will aid in remineralizing your enamel after a meal, thus making it stronger and more resistant to bacterial invasion.  Please see our article on gum with xylitol for more information.

Please see our article on cavity prevention for more information on maintaining a healthy mouth.