Get rid of the toothache


This is a specialist discipline in dental medicine that deals with the endodontic (internal) treatment of the tooth. In dental specialisation, this field is closely associated with restorative dentistry and cariology. Restorative dentistry and cariology treat the disorders of the hard tooth tissue (dentin), while advanced inflammatory changes to the pulp of the tooth, or the soft tissue, requires treatment of the root canal. This is performed using endodontic treatment, and is often called endodontics.

Why does a tooth hurt?

A toothache is an unpleasant symptom that most of the population has experienced at least once in their lifetime. A tooth can hurt for a number of reasons. Occasionally, the cause is thinned dentin, inflammation in the periodontal or periapical tissue, inflammation in the surrounding tissues of the oral cavity such as the sinuses, in which case the pain is reflected in the tooth, or due to a painful inflammation of the tooth (dental pulp) itself. In some cases, it is not easy to determine the source of the pain, and the dentist needs to perform a detailed examination and perform clinical tests and an x-ray. Once the cause is identified, the proper course of treatment can be determined.

How does tooth inflammation occur?

Inflammation of the dental pulp (also called pulpitis) can occur due to various causes, such as deep caries, grinding of the teeth or an improper bite that overloads the tooth. When a tooth becomes inflamed, the blood vessels within the pulp expand, increasing the capillary permeability and releasing fluid into the surrounding areas, which increases the pressure within the tooth. The tooth pulp is often also called the tooth nerve, though this tissue within the pulp chamber actually includes blood and lymph vessels and nerve fibres. Since the pulp chamber is a solid structure that cannot expand, any increases in pressure within the chamber create pressure upon the nerve fibres in the pulp, and the result is pain. Pain caused by an inflamed tooth can vary in character, and can expand or reflect in the surrounding structures. For example, pain in the teeth of the lower jaw may be felt in the ear, while pain in teeth in the upper jaw typically expand towards the eye. In reversable inflammations of the tooth (tooth pulp), this pain is temporary, and appears upon stimulation (hot, cold, when biting), and disappears when the cause is removed. However, in irreversible inflammations of the tooth (tooth pulp), the pain is spontaneous and almost always present. Other symptoms of tooth inflammation can be enlarged lymph nodes near the affected tooth, leakage of fluid from a fistula on the gums, loosening of the tooth, swelling around the tooth, fever, and generally feeling unwell. When the tooth inflammation is not treated, the infection can spread through the root canal into the surrounding bone, creating a granuloma. The granuloma destroys the surrounding bone, and the infection can even spread through the blood to the rest of the body.

How is tooth inflammation treated?

Tooth inflammation orinfection is treated depending on the cause. In reversible inflammation of the tooth pulp, it is sufficient to remove the cause (caries, excessive contact between teeth, stripped tooth tissue) and to fix the tooth with a filling. After this, the symptoms should subside.

For irreversible inflammation of the tooth pulp, it is not sufficient just to fill the tooth, and endodontic treatment is required

What is endodontic treatment?

Endodontic procedures (also called endodontics) is the treatment of the root canal of the tooth, for the purpose of preserving the tooth in the oral cavity. The procedure of treating the root canal implies the removal of the tooth pulp (also called extraction of the tooth nerve), and cleaning and rinsing out the tooth canal using special manual or power instruments, and fluids for rinsing out the canal to remove any remaining bacteria or inflammatory products, and to disinfect the canal. Following this, the root canal is filled with the appropriate fillers. Treating the root canal requires a dry and sterile work area in order to prevent the penetration of bacteria from the oral cavity into the bone. The foundation for any further treatment lies in the proper treatment of the root canal. Following endodontic treatment, the tooth can also serve as an anchor for minor prosthetics, which can result in a long-term delay for the need for larger prosthetic work or implants. Wherever possible, it is always best to try to save the tooth, as the natural tooth is always the best solution.

Itis our duty to ensure that endodontic procedures are painless, and this is achieved using local anaesthetic. Depending on the complexity of the condition, several visits to the clinic may be necessary to ensure complete treatment of the tooth. Only properly executed treatment at every step will ensure the success of the endodontic treatment. Following the completion of endodontic treatment, the tooth will be sensitive to pressure for a while, which is a typical side effect of the treatment, though it is important that the pain and sensitivity of the tooth will gradually subside. If necessary, take painkillers. The symptoms should subside within a few days.

Our clinic is equipped with the most modern devices that allow us to precisely measure the length of the canal, and to perform machine treatment of root canals. The final filling of the root canal is verified using x-ray imaging. In this way, we can ensure that your tooth is fully treated in the shortest possible time period, to avoid any unnecessary trips to the clinic.

Endodontic instruments, Nickel-titanium instruments

The endodontic procedure is the treatment of the root canal of the tooth, which requires the extraction of the tooth pulp (i.e. tooth nerve), followed by cleansing, expanding the rinsing out the root canal using special hand instruments with fluids for rinsing out the canal. The success of endodontic treatment is directly associated with the effective biomechanical preparation of the tooth root canals. Mechanical tooth root cleaning is not enough on its own; chemical rinsing is also required using a special fluid that can remove material from the canal, including organic and inorganic debris. This will allow the fillers to better adhere to the walls of the tooth root, sealing it closed to prevent any further inflammation of the tooth. The root canals are filled with a combination of gutta-percha and cement. This is the final step of the endodontic treatment. Finally, the tooth is sealed with a filling or a crown, depending on the amount of tooth tissue lost.

Endodontic instruments can be made of stainless steel or a nickel-titanium alloy. Both hand and power instruments in endodontics, if performed in accordance with the rules of the profession, can be equally successful in the treatment of teeth, though with the advancements in technology, hand endodontics is increasingly making way for power instruments that have numerous advantages for patients. Endodontic instruments are a contemporary dental technique for the cleaning and expansion of root canals, and the canals are then cleaned using both hand and power instruments. The procedure using power instruments is similar to manual endodontics, i.e. once the tooth is open and the pulp removed, it is necessary to measure the length of the canal using an endometer, and then the cleaning and shaping of the canal is possible using different attachments of the instruments. Cleaning and shaping the root canal is an essential part of the endodontic treatment. Power instruments for endodontics mimic the work of hand instruments, but are much faster and more effective. Cleaning and expanding the root canal using hand instruments can be demanding and is often a long-lasting phase of endodontic treatment. Power endodontics is painless and more comfortable for the patient, as it reduces the duration of tooth treatment. It shortens the time of each individual visit and the number of visits needed for endodontic treatment. There are various techniques of power endodontics, depending on the construction of the instrument used. Instruments may have two types of motion: rotary or reciprocal. Nickel-titanium instruments used in power endodontics vary in their design, construction and mechanical properties, and are present on the market under various names, depending on the manufacturer and product line, e.g. ProTaper Universal, ProTaper Next, HyFlex CM, etc. The use of nickel-titanium instruments in power endodontics has resulted in a revolution in the treatment of root canals, thereby accelerating the process of cleaning and shaping the canal, and reducing the likelihood of error, such as straightening the canal shape or perforation of the canal. Nickel-titanium instruments are flexible and elastic, and easily follow the natural shape of the root canal. They are quite resilient against breakage (breakage incidence in clinical practice ranges from 0.3–23%) and after use return to their original shape (e.g. memory effect). Due to their elasticity, they can enter into the narrow and bent sections of the canal and expand them, to give them a more regular shape, thereby facilitating the subsequent filling of the canal. Power endodontic nickel-titanium instruments enable constant rotation at a low rotation speed. This reduces the possibility of instrument breakage and allows faster and easier shaping of the canal in comparison to hand nickel-titanium endodontic instruments. Power or hand endodontic instruments enable the cleaning, expansion and shaping of the canal, making subsequent filling easier, and treatment of the tooth faster. The advantage of power endodontics is the faster and easier procedure, and the lower possibility of error during use of the instruments in the canal, which increases the success rate of endodontic treatment.

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