Parkview Dental Care - David Bertagna, DDS
There are times when a person is given the diagnosis of chronic pulpitis or necrotic pulp of a tooth. The pulp is a complex tissue consisting of arteries, veins and nerves. Chronic pulpitis is the irreversible damage to the pulp located inside the tooth. A necrotic pulp is the death of the pulp, the sensitive living tissue that responds to cold, heat, pressure and touch of the tooth. Chronic pulpitis always results in the death of the pulp.
Chronic pulpitis is the result of trauma, whether from decay, periodontal disease or an accident that the tooth is unable to repair. The inflammation that results from this trauma causes the tooth to become necrotic. Necrosis is defined as localized death of living tissue. Once necrosis begins, it is almost impossible to stop unless that tissue is removed.
When a tooth becomes necrotic, there are only two choices available to treat the tooth, root canal therapy or extraction. Root canal therapy (RCT) is typically the treatment of choice. However, with the introduction of implant surgery, extraction of the tooth is becoming a popular trend.
Root canal therapy removes the chronic inflammation or infected tissue inside the tooth and gives the structure of the tooth a second chance, so to speak. The pulp of the teeth is located in one of three basic root types. There can be one root, typically found in the front teeth. Teeth may also have two roots, typically found on the bottom back teeth and the top premolars. The top back teeth typically have three roots.
This is important to understand because there are times when one root of a multiple root tooth may be affected and the others not. There is no way to treat the affected root without treating all the roots. All the canals of the root must be cleansed, shaped and filled with a sealant to complete the root canal therapy.
Usually a tooth that requires root canal therapy has been severely damaged. This usually indicates the need to restore the remaining tooth structure. A composite restoration can be utilized to replace the missing part of the tooth. Since the root canal therapy removes the living part of the tooth, the tooth will become structurally weakened. This can be compared to a tree that becomes sick or dies. The tree is more likely to break instead of bend when the wind blows against it.
Most of the time, a reinforcing post is placed inside the root of the tooth. This can significantly strengthen the tooth and allow the tooth to be restored with a crown. The placement of a porcelain crown on a tooth that has had root canal therapy is the normal standard of care. Some dentists suggest the crown as soon as the root canal therapy is completed. Others prefer to allow some time for healing. This is individualized for each patient experience.
Some consider root canal therapy to be controversial due to the healing process associated with the pulp and bone surrounding the teeth. Some practitioners believe that once the pulp or bone is infected, the ability of the body to resolve the trauma is significantly impaired. This may be due to bacteria being introduced to an area where blood supply is anatomically reduced. For this reason, some consider extraction the only choice for an infected tooth.
Most consider root canal therapy an excellent choice to repair damaged pulpal tissue as long as the surrounding bone is healthy or can be made healthy with treatment. When there is no way to treat the pulp with root canal therapy or the tooth is severely damaged, the only option available is the extraction of the tooth.
Whether a root canal is performed or the tooth is extracted, there are always choices.