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What causes tooth decay or dental caries?

The main cause of dental decay is dental plaque, a thick sticky substance that collects on the surface of the tooth. Dental plaque is made up of large amount of bacteria, food particles and salivary products. If food, especially those rich in sugar/starch is left in the mouth, bacteria act on it, breaking it down into acids. These acids then soften and dissolve the minerals of the tooth, producing microscopic cavities on the surface. Over a period of time, with repeated acid attacks, a chalky white spot develops (first visible sign of decay). Eventually the spot develops into a cavity. This cavity will collect more food particles and lead to further destruction and larger cavity.

Does every decayed tooth/cavity need treatment?

If left untreated, a cavity would continue to enlarge in size (both width and depth). In time, bacteria will reach the tooth pulp causing toothache and infection. A cavity has to be filled in the initial stages to preserve the remaining healthy tooth and prevent complications. If left untreated, a root canal treatment may become necessary to save the tooth, or in rare cases, the tooth may have to be extracted.

What conditions necessitate a Root Canal treatment?

Dental decay, fracture of tooth or loss of filling could lead to contamination of the dental pulp by bacteria. Dental pulp is a small chamber that contains the nerves and blood vessels of the tooth. A bacterial invasion will affect the blood flow to the tooth. In such situations a root canal procedure is carried out to clean the pulp off the bacteria, and to fill the pulpal space with special filling material. The aim of root canal therapy is to save the tooth in which the pulp has been damaged. The alternative would be a tooth extraction (removal) and replacement of the tooth with an artificial one.

What are the symptoms that indicate the need for root canal treatment?

1) Moderate to severe lingering tooth ache when having hot or cold foods.
2) Tooth ache that worsens in the night or while reclining.
3) Pain in the tooth or in the gums when chewing or biting (sometimes pain spreads to other areas of the jaws or face).
4) Swelling of the gums and tenderness of the tooth while chewing.
5) In extreme cases, a severe infection may result in high temperature and/or red and extremely painful swelling of the face.
6) In rare cases, there will be no visible or obvious symptoms.

How is a Root Canal treatment done?

First, the pulp chamber is accessed by making a hole in the tooth. In case of painful teeth, the area is anaesthetized before the procedure. Next, very fine, delicate and sterilized instruments called files are used to clean and shape the root canals. Then, the shaped, sterilized canals are filled using a biocompatible, inert material and the hole on the tooth surface is sealed. Finally, the treated tooth is crowned to prevent further damage. In most cases, the treatment is completed in a single sitting. In cases where the root canal is severely infected, a medicated dressing is placed in the pulp canals to disinfect the same. Such situations may call for two or three visits to the clinic.

Is root canal treatment painful?

The actual procedure in itself is not necessarily painful. In cases with hypersensitivity/ symptoms the procedure is done under local anesthesia, wherein a local anesthetic is injected to numb the area that is being treated. This ensures that the patient feels nothing. In cases of severe infection, antibiotics are prescribed to control the same and consequently, the pain. Usually, pain, if any, is felt only before treatment, caused by the infection, rather than during the procedure. For a few days after treatment, the tooth may feel sensitive, especially if the infection had been severe. If so, painkillers or even antibiotics may be prescribed.

What is root canal re-treatment and why is it done?

In some instances, infection remains in the root canal system even after a root filling has been performed. In such cases, a root canal re-treatment may become essential. The existing root filling is removed and in its place, a new and better root filling is placed to eliminate any spaces.
In rare cases, root canal treated tooth may get re-infected due to the following reasons:
1) Filled root canal is exposed to bacteria and saliva due to new decay or a loose/broken filling causing an infection.
2) Root canals are complex and often there is more than one canal in each root. Some canals are extremely difficult to reach and may be missed even with sophisticated instruments leading to infection.
3) Tooth with curved roots or with very narrow root canals, may pose difficulty in cleaning the canal and sealing, rendering it susceptible to re-infection.
4) Root canal treatment may fail if the treatment has pitfalls in cleaning and sealing procedure.
For re-treatment of a root canal, the tooth is reopened by removing the old filling and the canals are re-cleaned and refilled. Some cases may require surgical intervention in case of non-possibility of sealing the canal adequately.

What are crowns/bridges?

Teeth, which are extensively damaged by decay, excessive wear or fracture, need to be brought back to their correct shape to facilitate function. For instance, a root-canal-treated molar tooth, which aids in chewing, is crowned so as to avoid further damage by fracture. This is achieved by remaking the outer portion of the tooth with an artificial material. This “total covering” of the tooth using artificial material is termed as a crown. A crown can be fabricated with different materials depending on the patient’s need, area in question and the function. The common materials are metal free ceramic, porcelain fused to metal, or full metal.
In cases where one or more tooth is missing, a bridge is fabricated to replace and rehabilitate the missing teeth. A bridge is therefore a fixed artificial teeth prosthesis (which cannot be removed by the patient), which is supported on either side by strong, healthy teeth. Basically a bridge has two or more crowns, attached to adjacent healthy teeth and artificial teeth known as pontic.

What are the symptoms of gum disease?

1) Gums which bleed either spontaneously or when brushed and/or flossed (Healthy gums DO NOT bleed).
2) Swollen, red or puffy gums (Healthy gums are firm, pink and adhere tightly to the teeth and bones).
3) Bad breath or a constant bad taste in your mouth (Diseased gum tissues release volatile sulfur compounds which contribute greatly to halitosis).
4) Tartar build-up on the teeth.
5) The gumline going down towards the root surface.
6) Loose or shifting teeth and a change in the way the teeth fit together.
7) Mild, disturbing pain in the gum with occasional swelling in the gums.



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