Preserving the original tooth structure is pretty important to have better functional value and aesthetic appearance. Having a natural smile is equally important too. Regular dental check-ups would certainly allow you to have control of your oral hygiene. However, damages do occur. It is always better to treat the damages at the earliest stage with conservative modalities rather than worrying later for invasive therapies. Root canal treatment (RCT) is a kind of invasive procedure when compared to normal filling. It could be sorted out at the early stage of caries. 

When to choose for root canal treatment?

There are various conditions, where inevitably you have to opt for root canal procedure. In most instance, these situations will arise out of your own negligence. 

Dental caries extending to the pulp :

Tooth decay will start as a mild black spot on the tooth surface, particularly on the fissure region, and slowly progress its growth by invading inside the tooth structure. It is not a sudden emergent; however, if left unheard and with poor oral hygiene, the bacteria would invade much faster to reach the pulp. The pulp is the innermost vital organ in the tooth structure that contains blood vessels and nerves.  

Dental caries
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When caries reaches the pulp, it has no other option than root canal treatment. However, you still have time to detect and protect your tooth before reaching the pulp. Once the bacteria invade the enamel and reaches dentin, you will start to feel mild sensitivity now and then. Also to hot and cold. When caries progresses, sensitive and pain intensity will also amplify. Also, it turns into sharp, continuous pain rather than dull and intermittent one. 

So you must know when to see a dentist. The moment you find a black spot would be the best time to go for conservative and preventive treatment. The more you delay, greater will be the destruction, loss of tooth structure, functional impairment, mental stress, unnecessary pain and expenses. 

Not necessarily decay has to be wider and broader. Sometimes, decay might appear superficial and pinpoint from outside. But the rate of invasion will be much deeper though it takes a narrow path and reaches the pulp. 

What are all the easy locations that can kick start decay?

Pit and fissures on the tooth

The contact point between the tooth 

Crowded and rotated tooth

Posterior teeth which are of the less cleansing region

These places have to be taken care with caution to prevent caries formation.

Iatrogenic exposure of pulp :

For any filling material, it requires a minimal amount of dentin thickness in order not to irritate the pulp. However, if the caries is so deep and invades almost close to the pulp, it might also go for a root canal treatment rather than a simple filling for two reasons,

Either, the pinpoint of pulp horn gets exposed while in the process of removing caries as the extension of decay is so deep 

Or, an extremely minimal thickness of dentin might not be sufficient to prevent pulp irritation due to dental fillings.

In either case, for some people, pulp irritation gets recovered with the calcium hydroxide base, and in that condition, you might not require RCT. However, for some of you, it won’t provide a positive response, where you have to opt for root canal treatment. 

Severe attrition and abrasion :

Clenching of teeth or over-brushing can wear-off the enamel layer of the tooth. When it is severe, it exposes the pulp and causes pain and sensitivity. IN such condition, root canal treatment will be the only option. For older people, it might be an age factor. But, if it happens for a young adult, care should be taken to reduce the stress level. Too much clenching of teeth is likely to cause temporomandibular joint ( TMJ ) disfunction and care should be taken before it goes out of hand. 

Tooth fracture :

Unexpected fracture of tooth structure, due to trauma or after biting a hard substance or due to malaligned teeth, etc will give an acute pain and sensitivity. In such a case, if the natural tooth is in a condition to get preserved, then root canal treatment has to be done. 

Pus or abscess formation :

Bacterial infection spreading due to caries or gum disease gets multiple and has the capacity to necrose the pulp and cause pus formation. These abscesses get accumulated at the bottom of the tooth and in the worst condition, it can further invade deep and destruct the bone. 

If the gums are strong enough to hold the tooth, root canal treatment is one good option depending on the prognosis of the tooth. 

How successful is the root canal treatment?

It is still fine to go for root canal treatment than losing your tooth. Nothing can replace the natural tooth structure and root canal treatment is one best way to preserve the natural structure even after severe destruction. According to WebMD, root canal treatment has a high success rate of 95%. Even for most of the people, it can last for a lifetime, providing that your gums and other supporting structures are healthy and supportive.

Reasons for root canal treatment failure :

 Missed out canals and when it gets infected separately. Sometimes, the tooth has multiple minute accessory root canals which are more likely left untreated.

An undetected fracture of the root of the tooth

Improper sealing of the canals, which causes seepage of fluids into the tooth in the long term. 

When root canal treated tooth is not protected with the crown, it could brittle the tooth structure and fails the treatment effort.

Likewise, 

Root canal treatment is a definitive treatment for certain scenarios. It truly depends on our hand to decide whether to make it as an optional one by taking proper care of oral hygiene. If you look for an alternative to root canal treatment, then the removal of the tooth is the only option followed by dentures ( either fixed or removable ) or implants. 

As said, “ prevention is better than cure “.  

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