Overview
The dental pulp contains
connective tissue, blood
vessels and nerves. Dental pulp
infection is primarily caused by tooth decay (caries) or it can be
secondary to other causes, such
as trauma, cracks or excessive
tooth wear.
Causes
- Caries or tooth decay is the most common cause of dental pulp infection.
Other pathways for bacterial invasion into the tooth structure and infection
of the underlying dental pulp are through:
- Defective fillings or restorations
- Cracks in the tooth structure as a result of excessive biting of hard food
or objects are potential pathways for bacteria and noxious stimuli to
irritate the dental pulp.
- Traumatic injuries to the face and mouth from sports or other
accidents can cause teeth to fracture, loosen or even be knocked
completely out of the socket (avulsion). Any damage of the tooth
structure, surrounding gum or supporting bone will allow bacteria
colonisation from saliva, leading to an inflamed dental pulp.
- Excessive wear of the hard outer layers (enamel and dentine) of the tooth due to parafunctional habits like grinding of teeth also make the dental pulp more vulnerable to bacterial or acidic attack.
 Signs and symptoms
- Unprovoked pain
- Pain on biting
- Prolonged sensitivity to hot
or cold
- Discolouration of the tooth
- Tenderness of the overlying gums
- Abscess or swelling
Sometimes, there may be no
symptoms at all. When the dental
pulp inflammation or infection is left
untreated, it can eventually cause
severe pain, abscess (swelling) and
loss of the supporting bone.
It is best to consult with your dentist
if you have any of the symptoms
mentioned for a more accurate
diagnosis and treatment.
Diagnosis
Diagnosis of the dental pulp status
of your tooth is done by your
dentist using clinical examination
and investigations. Some of these
investigations include:
- Pulp vitality tests, such as thermal
tests or electric pulp tests. These are
used to determine if the dental pulp
is still alive.
- X-rays (radiographs) are used to
determine the extent of tooth decay
and surrounding bone inflammation
caused by dental pulp infection.
Treatment
Treatment is determined by the
diagnosis.
If the stage of dental pulp inflammation
is assessed to be reversible, it can be
resolved by eliminating the causative
factors e.g. removing the decay and
restoring or filling the tooth, sometimes
with a medicament base, to return the
dental pulp to its normal healthy state.
However, if the dental pulp is
irreversibly damaged or infected, root
canal treatment has to be carried out.
Root Canal Treatment
 Root canal treatment (RCT) treats
diseases and injuries to the dental
pulp so as to conserve the tooth that
will otherwise have to be extracted.
The procedure is relatively comfortable
and often painless as the tooth is
anaesthetised during treatment.
- Removal of the infected or inflamed
dental pulp is the first step of RCT.
Under local anaesthetic, an opening
is made in the crown of the tooth
to get access to the infected or
inflamed dental pulp within.
- All RCT procedures are done by
isolating the tooth with a rubber
dam to provide a clean and salivafree
environment.
- Using small, specially-designed
hand or rotary files, the root canals
are cleaned and shaped to a form
that can be sealed. Debris within
the canals is removed by flushing
with an anti-bacterial solution.
- The canals are finally filled or sealed
with an inert material called guttapercha.
The tooth should be restored to
full shape and function by either
a permanent filling or a crown,
depending on how much of the tooth
is left. This should be done as soon
as possible as there could be a risk of
tooth fracture due to biting forces.
RCT may be done in single or multiple
visits depending on the tooth
complexity.
In between treatment appointments,
medicaments may be placed within
the canals and the tooth is covered
with a temporary filling. Often, X-rays
are taken to determine the length of
the root and to monitor the various
treatment stages.
A root canal treated tooth can function
normally and can be maintained with
routine dental care and oral hygiene
measures.
Prevention
Regular check-ups with your
dentist and practising good oral
hygiene are the best modes of
prevention. Decay or a defective
filling can be detected and treated
early before there is irreversible
damage to the dental pulp.
Avoid chewing on hard objects
such as ice, hard nuts or pens so as
to prevent cracked teeth.
You should wear a mouth guard
if you participate in contact sports
to avoid dental trauma. Any activity
involving speed has an increased
chance of falling and the potential
of getting in contact with a hard
piece of equipment.
A mouth guard helps to distribute
the force of impact in any accident
to prevent the likelihood of dental
injury to the front teeth.
Do not clench or grind your teeth.
If you clench or grind your teeth at
night, speak to your dentist about
getting a night guard.
|
