Endodontics is the main branch of dentistry that deals with root canal treatments.

When it comes to endodontic treatment, root canal therapy is usually the first thing that comes to mind. Among dental procedures, root canal treatment is often one of the most feared. Today, root canal treatment is performed in a single session for vital teeth, while for non-vital teeth, it is usually completed in two sessions.

Anatomy of a Tooth

The visible part of the tooth in the mouth is called the crown, while the part embedded in the bone is called the root. The tooth consists of several layers. The outermost part of the crown, which is visible in the mouth, is called enamel. Enamel is one of the hardest tissues in the human body. The root portion of the tooth, which is covered by the gums and surrounded by bone, is covered by a layer called cementum. Beneath the enamel and cementum layers lies the dentin layer. Dentin is the largest layer of the tooth and, unlike enamel, contains nerve endings, playing a role in pain sensation. Beneath the dentin layer is the pulp, which contains the tooth’s nerves and blood vessels. The pulp plays a crucial role in the eruption and development of the tooth. Even after the tooth has erupted, the pulp helps relay pain signals to indicate problems within the tooth.

How Does the Pulp (Tooth Nerve) Become Infected?

Every person has bacteria in their oral cavity. Under normal conditions, these bacteria do not cause harm. However, when bacteria combine with food particles, acids are produced in the mouth. If these acids are not removed, they damage the enamel and cause cavities. If left untreated, these cavities extend to the dentin layer beneath the enamel. Although dentin warns us through pain, if the decay is still not treated, microorganisms begin to move towards the pulp. The pulp attempts to protect itself through various defense mechanisms, one of which is pain. However, if the decay remains untreated, microorganisms destroy the blood vessels and nerves within the pulp, leading to infection.

Another way for the pulp to become inflamed is through trauma. A blow to the tooth can cause the nerves and blood vessels at the root tip to rupture, leading to the death of the pulp. If microorganisms subsequently invade the pulp, infection occurs. Additionally, long-term periodontal (gum and surrounding tissue) disease can also lead to pulp infection.

How to Identify an Infected Tooth?

Pain and sensitivity to hot and cold foods and drinks, as well as discomfort while eating, can indicate an infection or the early stages of one. Significant discoloration of a tooth may also be a sign of infection. If a cavity extends into the pulp but remains untreated, the infection can spread through the root tip into the jawbone, causing swelling in the face. In such cases, in addition to dental procedures, antibiotics may be prescribed.

There is a common belief that teeth causing facial swelling should be extracted after the swelling subsides. However, this is an outdated approach. Even teeth that cause significant infections can be saved with root canal treatment and continue functioning like healthy natural teeth for many years.

Stages of Root Canal Treatment

1. Taking an X-ray to identify the problematic tooth.
2. If the tooth is still vital, administering local anesthesia to eliminate sensitivity in the tooth and surrounding tissues.
3. Removing decay from the enamel and dentin layers and creating an access cavity to reach the pulp.
4. Determining the working length using electronic devices and confirming it with an X-ray.
5. Using rotary instrument systems to remove infected dentin layers and microorganisms inside the root canal.
6. Disinfecting the root canal with various antiseptic solutions during instrumentation.
7. If the tooth is non-vital at the beginning of treatment, placing an antiseptic dressing inside the canal and allowing time for disinfection before filling the canals in the next session.

After root canal treatment, the connection between the tooth and surrounding tissues is sealed to prevent reinfection. If damage has occurred to the surrounding tissues, the goal is to allow for healing.

Following root canal treatment, especially for vital teeth, mild pain or discomfort when biting may occur for a few days. This is a normal response after the procedure. Today, with proper treatment techniques, the success rate of root canal therapy is up to 90%.