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What to do when a Cavity Start to Hurt

The unfortunate aspect here is that in the initial stages of tooth decay, there will not be any pain. The way we are complacent, a visit to the dentist keeps on getting postponed. Due to prolonged neglect, when the cavity gets deeper and deeper and involves the pulp tissues, which contains nerves and blood vessels, it leads to excruciating pain.

If you are CAREFUL, you will never experience a BIG LOSS/Big Pain. In most cases as the decay progresses you will experience sensation to cold water, ice-cream, drinks etc, its time to go to a dentist immediately. In most patients tooth at this stage can be saved just by a simple filling. Next you start getting sensation on taking hot beverages, this progression now indicates that cavity has reached very close to nerve chamber. Next stage is Night pain- this indicates that dental caries has reached nerve chamber, it may also lead to sever pain and then swelling.

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Many a patient turns to the dentist at this last stage, to get relief from this pain. They may even suggest the remedy for that- by asking us to remove the offending tooth.

This request to remove the tooth stems from ignorance- ignorance of the importance of maintaining each and every tooth, and ignorance of the treatment option which is available. When the tooth decay affects the pulp, the tooth has to undergo root canal treatment (rct).

Each tooth has got narrow canals in the centre of the root, which may be straight or curved. In the root canal treatment, these canals have to be cleaned and filled. It has to be cleaned of the diseased pulp and the soft and unhealthy portion of the surrounding dentin walls. Now, here a great difficulty lies. Since the roots of teeth are embedded in the bone, we cannot see the root canals. Even though X-rays are helpful, it is only a two dimensional picture. Always ask to see the x ray (radiograph) it will give you an idea how well the root canal treatment has been done, for example see the pic below

It is said that a good Endodontist, i.e., a specialist in root canal treatment, should have eyes at his fingertips. We have specialised instruments to clean the canals. For locating the canals and to decide whether the canals have been cleaned thoroughly, we depend on the feel by our fingertips. This feel is developed by years of practice and concentration. This can make a lot of difference in the outcome of a root canal treatment done by a novice and an experienced specialist.To see a slide show explanation on root canal treatment CLICK HERE

Once the root canals are cleaned and enlarged, they have to be filled. This filling should occupy the full length of the canal, at the same time, it should not go beyond the root tip and enter the bone. To determine the canal length, electronic appliances are available abroad, which are prohibitively expensive. Here again, X-rays are of some help, but limitations are there due to the two dimensional aspect.

The root canal filling, if not properly done, there may be spaces in between. Here, the tissue fluids seep in, and bacteria will multiply, and cause infection. A properly root canal treated tooth can serve like a natural healthy tooth- provided- the crown is protected properly. This can be done by cementing a metal cap in most of the cases. Otherwise, there are chances that the crown may split under the chewing force, which can lead to extraction of the tooth.

Even when there’s extensive destruction of the tooth crown, it can be brought back to form and function. To accomplish this, first, the tooth is root canal treated. Then part of the root canal filling material is removed. A strong metal post is cemented into this empty canal space. Around the protruding portion of the metal rod, base is built up, over which, a cap is fabricated and cemented.

There is a common belief that root canal treatment is very painful. With the availability of modern equipments and techniques, in diligent hands, this is not true. In ninety percent of cases, it is painless. When the pulp is in a highly inflamed state, the deep anesthetic effect is difficult to obtain, which can cause some pain- but not so severe as to avoid root canal treatment and go for extraction. I sincerely hope that all of you will give a serious thought to these aspects and will not consider extraction of tooth as a treatment of choice.

Important things to NOTE If you are getting rct done, make sure that the dentist has specialised by doing a masters degree or courses in endodontics. RCT in vast majority of cases can be performed in ONE visit if your doctor is using good Endodontic techniques.

Root Canal treatment is more painful when done in multiple sittings:This study published in Feb 2011 in a leading journal (from America) concluded "Patients experience less frequency of short-term post-obturation pain after single-visit than those having multiple-visit root canal treatment." To see the study CLICK HERE

Why your tooth has fractured after rct and full crown

To make life easy many dentists now use instruments for root canal which have very high taper, these instruments remove lot of unwanted tooth material, after the tooth is cut for crown, tooth becomes weak and with a heavy bite is breaks from neck. see pic below and link to scientific study . Beware and ask what is the taper of instruments being used, 6, 8 or 10 taper is very dangerous for long term health of your tooth.

Has your dentist done proper Root Canal treatment...FIND OUT

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