Question

As a result of a never-ending inflammation, I have to have a root canal treatment at the dentist. What exactly is it about, what does the dentist do? Why does such painful inflammation of the dental nerve occur in the first place? Are there alternative treatment methods? H. B. in K. 

Short answer

If, due to a crack in the upper layers of the tooth, severe gum inflammation, deep caries, etc., stimuli caused by cold, acid, sugar or pressure during chewing penetrate through to the dental nerve, this can lead to inflammation of the nerve. The nerve then reports a massive toothache, which only subsides after root canal treatment or the death of the nerve. 

Root canal treatments aim to remove the tooth nerve from the inside of the tooth and its roots, clean and disinfect the resulting cavity and fill it with a filling material. The tooth itself remains intact. 

Cause: Tooth damage 

In a healthy tooth, the nerve is very well protected by the hard tooth walls. We only feel the dental nerves when a stimulus (cold, acid, sugar, pressure when chewing, etc.) reaches the nerve through these outer layers of the tooth. However, these stimuli only reach the nerve when there is damage, be it a crack in the upper layers of the tooth, severe inflammation of the gums with severe bone loss (periodontitis) or, classically, deep caries. 

Tooth becomes a pressure chamber 

Stimuli that penetrate deep inside the tooth disturb the nerve to such an extent that it can become inflamed. Inflammation is always associated with swelling. As this swelling cannot spread in any direction inside the tooth, there is additional pressure on the nerve. In this situation, the nerve reports a massive, unbearable toothache, which only subsides with root canal treatment or the death of the nerve. Without root canal treatment, the dead tooth can cause pain again later if the dead nerve becomes infected (with bacteria, for example). The dead tissue cannot defend itself against the pathogens and a so-called suppurative tooth develops, which again causes massive pain and often also swelling in the nearby jaw area. 

In order to carry out root canal treatment, access to the nerve must be established, i.e. a hole must be drilled into the tooth or an existing filling must be removed. The cause must of course also be removed, for example a crack must be sealed or the decay removed. The inflamed or dead nerve is removed up to the root tips using fine needles and files. As mentioned, the resulting cavity is cleaned, disinfected and filled tightly with a filling material. 

Alternative: Extract the whole tooth 

In certain cases, the removal of the tooth can be considered as an alternative to root canal treatment. The resulting gap can be closed with an implant or a bridge.

Author: Dr. med. dent. Jürg Eppenberger
Published in: Neue Luzerner Zeitung on July 09, 2012