What Is Dental Pulp?
The pulp or pulp chamber is the soft area within the center of the tooth and contains the nerve, blood vessels, and connective tissue. The tooth's nerve is in the "root" or "legs" of the tooth. The root canals travel from the tip of the tooth's root into the pulp chamber.
A tooth's nerve is not vitally important to a tooth's health and function after the tooth has emerged through the gums. Its only function is sensory -- to provide the sensation of heat or cold. The presence or absence of a nerve will not affect the day-to-day functioning of the tooth.
Why Does the Pulp Need to Be Removed?
When pulp is damaged, it breaks down, and bacteria begin to multiply within the pulp chamber. The bacteria and other dying pulp remnants can cause an infection or abscessed tooth. An abscess is a pus-filled pocket that forms at the end of a tooth’s root. In addition to an abscess, an infection in the root canal of a tooth can cause:
- Swelling that may spread to other areas of the face, neck, or head
- Bone loss around the tip of the root
- Drainage problems extending outward from the root. A hole can occur through the side of the tooth, with drainage into the gums or through the cheek into the skin.
What Damages a Tooth's Pulp in the First Place?
A tooth's pulp can become irritated, inflamed, and infected due to deep decay, repeated dental procedures on a tooth, large fillings, a crack or chip in the tooth, or trauma to the face.
What Are the Signs That Root Canal Therapy Is Needed?
Signs you may need root canal therapy include:
- Severe toothache pain upon chewing or application of pressure
- Prolonged sensitivity (pain) to hot or cold temperatures (after the heat or cold has been removed)
- Discoloration (darkening) of the tooth
- Swelling and tenderness in nearby gums
- A persistent or recurring pimple on the gums
Sometimes no symptoms are present.
The Root Canal Procedure
Root canal therapy requires one or more office visits and can be performed by a dentist or endodontist. An endodontist is a dentist who specializes in the causes, diagnosis, prevention, and treatment of diseases and injuries of the teeth's dental pulp. The choice of which type of dentist to use depends to
some degree on the difficulty of the root canal procedure needed in your particular tooth and the general dentist's comfort level in working on your tooth. Your dentist will discuss who might be best suited to perform the work in your particular case.
The first step in the procedure is to take an X-ray to see the shape of the root canals and determine if there are any signs of infection in the surrounding bone. Your dentist or endodontist will then use local anesthesia to numb the area near the tooth. Actually, anesthesia may not be necessary, since the nerve is dead, but most dentists still anesthetize the area to make the patient more relaxed and at ease.
Next, to keep the area dry and free of saliva during treatment, your dentist will place a rubber dam (a sheet of rubber) around the tooth.
An access hole will then be drilled into the tooth. The pulp, along with bacteria and related debris, is removed from the tooth. The cleaning-out process is accomplished using root canal files. A series of these files of increasing diameter are each subsequently placed into the access hole and worked down the full length of the tooth to scrape and scrub the sides of the root canals. Water or sodium hypochlorite is used periodically to flush away the debris.