Fillings and root canal treatments

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Why Fillings are Necessary
First of all, let’s go back to the day you were born. As a newborn baby, there were no harmful bacteria inside of your mouth. As you grew older bacteria found its way into your mouth. It could have happened when your mom kissed you or when you licked the floor as a baby. In any case, those bacteria have now set up a permanent residence inside of your mouth and you will have to deal with them for the rest of your life.These bacteria live on your teeth. Every time you eat something that they enjoy eating, such as candy, you provide food for them.
After they eat, they produce a very strong acid that eats away at your teeth. If you don’t remove this sticky layer of bacteri(commonly known as plaque) by brushing and flossing, the bacteria will keep destroying a tiny amount of your tooth structure every day until you get a hole in your tooth. These holes are known as dental caries.
Our bodies don't have the ability to repair dental caries.

When do we need to do something
Usually a tooth injured by dental caries looks different from the other teeth.. and of course it hurts! When we recognise there's something wrong with a tooth we  must call our dentist; that will be essential in order to prevent the risk of needing a root canal treatment or even removing the tooth itself.
Sometimes our teeth don't give us any warning even if they are injured by dental caries; that's why it is so important to periodically check the health of our teeth, and do dental hygiene (every 6 months).

What does my dentist do to remove the dental caries?
Hundreds of years ago cavities eventually caused people so much pain that they would have the tooth removed.
Amazingly, modern dentistry has found a way to let you keep your decayed teeth. All that needs to be done is to have the bacteria professionally removed and then to replace the hole in the tooth with a hard, tooth-like material known as a dental filling.
There are 2 different materials mostly used for filling teeth, which are amalgam and composite resin.
Amalgam fillings were more used in the past, as today this material is thought to be potentially toxic. The other reason why amalgam is not often used is beacause of its colour, so different from the natural white of our teeth.
Composite fillings are constantly improving. The composite resin is about the consistency of modeling clay. In order for the composite to harden, the dentist shines a bright blue light on it. Through a series of chemical reactions, the composite resin hardens into a very strong material that looks very much like a natural tooth.

How Do You Know If Your Filling is Too High?

After the filling is finished, you may feel some sensitivity in your tooth for a few days. If the tooth starts feeling sensitive only when you bite down, you should go back and see your dentist as this could be a sign that your filling is too high. Your dentist will be able to check your bite again and then smooth down the filling using some specialized attachments to the high-speed handpiece.

What is Root Canal Treatment?

Root canal treatment is used to save teeth which would otherwise need to be removed.
It is needed when the blood or nerve supply of the tooth (known as the pulp) is infected through decay or injury.
The infection can cause an abscess.

What is an abscess, and what causes it?
Sometimes, due to trauma or decay the “nerve” inside the tooth dies off. Any passing bacteria find this a source of nourishment and proceed to munch on the dead nerve and increase in number . Our body can’t do anything about this infection because along with the nerve dying, the blood supply to the tooth dies off too, so the body can’t send in some antibacterial cells (white blood cells) to attack the bugs. Eventually, the bugs start to spill out of the tooth and into the tiny space between the tooth and the jawbone. This starts an abscess, the body reacts to the invasion by pouring in defensive cells, which kill most of the bugs in the area, but still can’t get to the source of the problem, which is in the tooth. The dentist has two choices, extract the tooth and remove the bugs that way or do a root treatment. In a root treatment the inside of the tooth is cleaned and sterilised and then a plug is put in to bung up the space inside the tooth and stop more bugs getting in.

How is root canal treatment done?
Basically like this:

But there are other steps in between (see below).

What does root canal treatment feel like?

Usually a tooth that needs a root canal treatment gives us some typical symptoms: cold sensitivity, weird pressure build-up sensations and spontaneous twinges in the tooth. The dentist will do an x-ray to be sure the infections has reached the pulp and to check the canals of your tooth.

If the tooth is too inflamed the dentist can decides to give you some antibiotics before starting the root canal treatment in order to prevent the possibility of having too much bleeding during the treatment, which could even make it impossible.

The root canal treatment is a process  that takes different steps and at least 1 hour/1 hour and a half to be completed. The dentist will open the tooth, take out the nerve, clean and disinfect the canals; then he will place a medicated temporary dressing.

After up 1 to 3 weeks you will need to go back to your dentist to reconstruct your tooth. The root canal treatment digs your tooth and lives only the walls of it; the result is that your tooth is very fragile and it could break up. The dentist will put a mainstay that will give support to your tooth.

Most of the time this could not be enough: that's when you need to put a crown on the tooth. Crowns are teeth-shaped caps that are placed over the tooth to cover and restore it when it is cracked, broken or has had a deep root canal treatment. Crowns cover the entire part of the tooth that lies above the gum line.

Why is a dental crown needed?

A dental crown may be needed in the following situations:

  1. To protect a weak tooth (for instance, from decay) from breaking or to hold together parts of a cracked tooth

  2. To restore an already broken tooth or a tooth that has been severely worn down

  3. To cover and support a tooth with a large filling when there isn't a lot of tooth left

  4.  To cover and support a tooth after a root canal treatment

  5. To hold a dental bridge in place

  6. To cover misshapened or severely discolored teeth

  7. To cover a dental implant

  8. To make a cosmetic modification

Can the root treatment canal be painful, even after the treatment itself?

As we said a tooth which needs a canal treatment can be very painful; but often the tooth can aches even for a few days after the treatment. Pain upon biting down and dull pain is common and a recognised side effect of root treatment; it usually disappear within 48 hours or so.

This happens because during the root treatment a little bit of infected material will be pushed out of the end of the canal into the space between the tooth and the socket. This sets up a small area of local inflammation and can cause pain. It should be manageable with maybe a little bit of an anti-inflammatory drug like ibuprofen or similar.

What can I do if root canal treatment has failed?

Often it’s possible to redo the treatment even when the tooth is badly broken down.  Sometimes a tooth that has been treated doesn't heal properly and can become painful or diseased months or even years after treatment. When it happens you have a second chance: an additional procedure may be able to support healing and save your tooth.

A tooth may not heal as expected after initial treatment for a variety of reasons:

- narrow or curved canals were not treated during the initial procedure;

- complicated canal anatomy went undetected in the first procedure;

- the placement of the crown or other restoration was delayed following the endodontic treatment;

- the restoration did not prevent salivary contamination to the inside of the tooth.


In other cases a new problem can rise up with a tooth that was successfully treated:

- New decay can expose the root canal filling material to bacteria, causing a new infection in the tooth;

- A lose, cracked or broken crown or filling can expose the tooth to new infection;

- a tooth sustains a fracture.

The retreatment is almost the same as the first treatment: the dentist opens and cleans the canals, he can finds a new canal, removes any new infection, shapes the canals again and places the new temporary filling material. Once the tooth heals a new crown or other restoration is placed on the tooth to protect it.


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