[MERGED] Root Canal Therapy (The Endodontics Thread)

[smilewarrior]

^Kraven, please have a peri-apical x-ray taken. The x-ray needs to be examined by a dentist.

The presence of pus (nana) warrants immediate attention. Please look for another dentist who can accomodate you as soon as possible.

[feistyradical]

Please recommend a good endodontist. Yung wala masyadong sakit ang root canal work niya. I've never had it done and it will be my first time. Sabi nila masakit daw. I'm searching for an endodontist and not just a general dentist because gusto talagang expert siya sa root canal work. Please help and share your experiences as well.

Is there such a thing as laser root canal? Wala bang sakit ang laser root canal?

[smilewarrior]

Laser RCT is quite new. You might want to read this:

Use of Lasers in Dentistry

Laser energy, when added to root canal procedures, presents advantages and disadvantages. Currently, root canal procedures clean the canal space. Studies using extracted teeth inoculated with bacteria have shown that lasers can reduce the quantity of microorganisms. The walls of the prepared canal space contain tubular openings that harbor organisms, and the preparation itself causes formation of a layer of debris (smear layer) composed of organisms and tooth substances. Laser energy can remove the smear layer as well as dentin from the canal wall and will melt and resolidify the dentin to close the tubular openings.

The advantages of using the laser, however, are balanced by several disadvantages. Root canal spaces are rarely straight and more often are curved in at least two dimensions. Root canal instruments used to clean the space throughout its length can be curved to follow the curvatures in a tooth root. Laser probes can clean an area in a root canal space that is straight as long as the probe is in contact with the dentinal wall. The probes are made of glass and cannot be curved to follow the natural curvatures of the tooth root. When in contact with the dentinal wall, laser probes are capable of cleaning an area in the root canal space that is straight.

Further, the interactions involved between laser energy and the tissue cause rises in temperature. These increased temperatures can char the canal space, damaging it to the point that the tooth may be lost. The increased temperatures also may extend to the outer surfaces of the tooth, damaging the soft tissue that connects the tooth to the surrounding bone.If the temperature is high enough, the bone surrounding the tooth may also be damaged, adversely affecting the entire area, which can result in ankylosis.

I don't think endodontists here in the Philippines use lasers. A laser machine 5 years ago costs around P1,000,000.00 . Can you just imagine how much it would cost now and how much an endodontist has to charge for use of the machine? Most likely it would be the same price as a LASIK procedure ( around P80,000 per use).

I'm not an endodontist, I'm an orthodontist.

Endodontists in the Philippines are all members of the Endodontic Society of the Philippines (ESP).

Please send me or Misa Hayase a private message. We can refer you to endodontists.

All referrals here at What's Up Doc is made through private messaging.

[Romee]

To smilewarrior and Misa Hayase

I need to have my 2nd molar root canaled but the dentist that I recently consulted with doesn’t use rubber dam. Is it possible to carry out root canal treatment without the rubber dam?

[smilewarrior]

^It is actually better to use rubber dam when performing root canal . If you'd like, please find another dentist.

Some dentists actually specialize in Root Canal Therapy. They are called Endodontists. (Endo - "within", dontia - "referring to the tooth", "ist" - referring to someone performing a specific action ).

[xfreemanx]

HI resident dentist smile warrior and misa! Fellow isko (me!) needs your help. I had a molar refilled 3 months ago (used to have amalgam) since it appeared to have brown edges and started to hurt a little. had it refilled with white composite. Last thursday, i started feeling a recurring pain on the molar especially at night. I just took mefenamic to get me by..and visited my dentist to have it checked. She recommended RCT but I asked if there are cheaper options. I dont feel any fever or see any visible infections. She advised me to have it xrayed and I noticed that the results show that the filling was touching the darker part of the tooth (pulp?). Do I really need an RCT or can I just have it refilled with some kind of lining to prevent the filling from touching the pulp? What are my other options aside from extraction? Help!

[smilewarrior]

^Hello . From your description, I'd assume you'd most likely need root canal therapy, unfortunately.

I have a hunch you know that the tooth's pulp is a neurovascular bundle (composed of nerves and blood vessels).

Dental liners and bases (which act as a sort of "buffer" or "sheild" for the pulp) are only successfully used for very deep cavities that do not approximate/penetrate the pulp.

When a dental cavity reaches the pulp, a bacterial infection sets in. This infection needs to be addressed through root canal therapy.

Honestly, root canal therapy actually comes out cheaper in the long run, when compared to a Fixed Bridge or a Dental Implant.

You have to know though that root-canaled teeth tend to become brittle with time. As such, it is recommended that they be crowned (capped). You'll end up spending for both the root canal and the crown (jacket).

A porcelain crown will need to be replaced every 10 years.

Good luck.

[xfreemanx]

Hi smilewarrior,

Just went to my dentist and she looked at the xray. She saw another tooth in my upper jaw in close proximity to the molar that i think was hurting. The tooth had dark spot under an old pasta. She said she wants to fix that first kasi baka referred pain lang. The lower molar does not show any leakage or dark spots.. its just that the pasta is on top of the pulp, maybe touching it.

Unfortunately, she doesnt use amalgam and i said i prefer it than the composites since i never experienced any pain with my previous fillings. Also read that it last longer than composites. I decided to have the tooth filled first tomorrow by another dentist before I have the lower molar RCTd. She respected my decision and hopefully di ko na kailangan ng RCT.

What do you think doc?

[smilewarrior]

^That's perfectly fine . Hopefully, it is just referred pain. Kung ganoon nga, ang swerte mo.

Do keep us posted with the progress of your treatment. Good luck.

[xfreemanx]

will definitely do that school mate! Id like to thank you too for finding time to answer questions such as mine.. if only more people have access to the internet, they would find more help and have better dental health.. kudos to you sir. Serve The People at ialay ang talino sa bayan,,,

[xfreemanx]

Sir Smilewarrior,

Just came from the dentist and we drilled into the upper molar #7, which had a large cavity in it. Good news and bad news though. Good: The referred pain on the lower molar is gone so no need RCT on that. Bad: the upper molar #7 has to be root canaled, since its already dead. =( I suppose the pulp was starting to die when i started feeling the pain last thursday. Too late to save it.

I now have a question. I didn't have Upper Molar #7 RCTd yet since I plan to have my teeth braced soon. I have gaps in the upper and lower set like mike tyson's and madonna's. Would it be possible to just have #7 extracted (the dead tooth) and have my wisdom tooth #8 pulled into its position? Would it be better since an RCTd tooth #7 may grow weak and the wisdom tooth, taking its place, may be structurally stronger and will not have to be extracted? I have read that wisdom teeth are extracted since they may cause problems later and dont have corresponding lower molars anyway...

Please advise doc...thanks!

[smilewarrior]

Hello again xfreemanx . The position/orientation of your upper third molar needs to be checked. The orientation of your upper wisdom tooth can be seen from either a peri-apical x-ray or a panoramic x-ray.

If the third molar is upright (nakatayo, hindi nakahiga), there is a remote possibility that after your upper second molar is extracted (removed), your third molar will erupt / come out on it's own and take the place of your second molar. You may need to wait for a period of 3 to 6 months after the removal of the second molar for this to happen.

If that ever does happen, there may or may not be a need to correct it's position with braces.

It's your choice. Good luck.

[xfreemanx]

Hello again xfreemanx . The position/orientation of your upper third molar needs to be checked. The orientation of your upper wisdom tooth can be seen from either a peri-apical x-ray or a panoramic x-ray.

If the third molar is upright (nakatayo, hindi nakahiga), there is a remote possibility that after your upper second molar is extracted (removed), your third molar will erupt / come out on it's own and take the place of your second molar. You may need to wait for a period of 3 to 6 months after the removal of the second molar for this to happen.

If that ever does happen, there may or may not be a need to correct it's position with braces.

It's your choice. Good luck.

Hi Smilewarrior,
Actually, the wisdom tooth (third molar) is not impacted. It has already erupted and is upright. I have a periapical xray of this which I can send you.
So in this case, would it be practical and doable to just extract #7 (second molar?), and pull the wisdom tooth to its place? Would moving a molar to fill in such a big gap cause complications or have downsides? On the other hand, if I have #7 RCTd and have braces later, Ok lang ba kahit RCTd na sya. Would the brackets still be effective in pulling it?

Thanks!

[smilewarrior]

^Hello again. If you can take a picture of the peri-apical x-ray, please send it to me through private messaging, or if you don't mind please post it here, in this thread.

Honestly, it would have been easier if your third molar had not erupted yet, as it would be easier for it to drift forward and erupt close to your first molar (assuming your second molar had already been removed) .

Perhaps it's better for me to look at the x-ray first before commenting on what can be done.

[xfreemanx]

Here it is...kakahiya.



My teeth


http://s109.photobucket.com/albums/n...t=IMG_8608.jpg
The XRAY. Teeth encircled in RED are the ones I was pertaining too. They are my upper left molars (my left).

The dentist left #7 open for now while I have not yet decided if it is to be RCTd or extracted. Ok lang ba yun Smilewarrior?

[smilewarrior]

^Well, if you decide to have tooth number 7 left root canaled, tooth number 8 left will eventually need to be removed if you're going to have braces. After closing all the spaces with braces, tooth number 8 left will not have any opposing tooth to contact with. Tooth number 8 right will also need to be removed.

If tooth number 7 is root canaled, you'll have to wait six months before having braces. This waiting period is necessary for the root canaled tooth to heal properly.

If tooth number 7 is removed, it would probably be best to let tooth number 8 drift forward a bit, rather than immediately pulling into tooth number 7's position. You could probably wait anywhere from 3 months to 6 months for teeth number 8 to drift into the space a bit, then have braces.

If you decide to have tooth number 7 removed and you want the space closed, you need to have braces no later than 6 months the removal, or else you'll be needing a fixed bridge.

Honestly, it is not that easy to close molar spaces. It will take time. Add to this the generalized spacing between your other teeth and you're looking at 3 years of braces minimum.

The spaces will tend to re-open once your braces are removed, necessitating immediate placement of retainers for both the upper and lower teeth.

[xfreemanx]

Just dropping by to update you on my case, as promised. Had my upper molar root canaled. No more pain on lower molar. Referred pain is real! I was doubtful before but now im a believer. Good thing I did not allow my first dentist to RCT the lower molar, otherwise, we would have ended up treating the wrong tooth. I like my new dentist better. His clinic is along Del Monte Ave. RCT is way lower than the 10K which Ive read about somewhere in this forum. If you guys want his contact details, just PM me.

[gcarrie]

hi mga docs, need your opinions po. i just had my lower (front) teeth xrayed. sabi ng dentist na tumingin, may infection raw, actually may parang pus na nga on my gums. sabi niya wag na raw root canal, but extraction na raw. yung 2 teeth beside my 2 front teeth are naka-jacket, while the 2 front teeth mismo are buo pa naman. ayoko sana ipaextract kasi buo naman sya, pero sabi niya may infection raw kasi. he recommended extraction of the 4 teeth, then fixed bridge raw. 7500 for each tooth, plus 2 pa para kapitan ng bridge. that's 45k. or non-metal dentures which costs 20k. bukod sa wala akong budget, i really do not want my 2 front teeth extracted. wala na po ba talaga option? what will happen kung hayaan ko na lang? wala naman pain, although nangingilo sya minsan pero tolerable naman. wala po ba oral meds for the infection/pus? thanks!

[smilewarrior]

^If it is pus, you'll need antibiotics. Technically, you need a prescription in order to purchase antibiotics, so you'll need to have a dentist write one for you.

Antibiotics will only offer temporary relief. You really need them, but they are not enough to solve your dilemna. The source of the infection needs to be addressed.

Please look for another dentist, a different dentist, for a second opinion. You'll need to have an x-ray taken of your teeth, in order to assess whether they are amenable to root canal therapy.

Infections from the upper teeth, when uncontrolled can affect the eyes or the brain.

Infections from the lower teeth, when uncontrolled, can affect the throat or even the heart in extreme circumstances.

Please brush your teeth 4 to 5 times in a day. Please use dental floss.

[gcarrie]

thanks, doc