Endodontics. Endodontic therapy
Author: George Ghidrai, MD
Endodontics is the dental speciality concerned with the study and treatment of the dental pulp. The word comes from the Greek terms endo, meaning "inside" and odons, meaning "tooth." Basically, Endodontics is concerned with the treatment of dental pulp infections and its complications in the periapical tissue.
Endodontic therapy or root canal therapy is the sequence of treatment for the pulp of a tooth, which results in the elimination of infection and the protection of the decontaminated tooth from future microbial invasion.
Root canal therapy is one of the most common procedures. If the dental pulp or the periapical tissue becomes diseased or injured, endodontic treatment is required to save the tooth.
What are the main goals of endodontic therapy ?
1. Eliminate infection
The first goal of an endodontic treatment is to eliminate the causative agents. Normally, all dental pulp infections are a secondary development of tooth decays that penetrate through the enamel and dentin to reach the pulp.
However, in some cases, the pulp tissue can be injured as result of trauma, such as thermal insult from repeated dental procedures.
Regardless of the nature of the agent, dental pulp tissue (like all human tissues) will try to respond to these insults. The biological response of natural tissues to harmful stimuli is called inflammation.
Inflammation and infection
There is a distinctive difference between inflammation and infection and the therapeutic approach will largely depend on that.
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Inflammation
Inflammation is a complex biological response of various tissues to harmful stimuli, such as pathogens (bacteria, viruses, fungus and others), damaged cells, or irritants (toxins produced by infection agents, very hot agents, harmful chemical agents etc.)
The classical signs of acute inflammation are pain, heat, redness, swelling, and loss of function. Basically, inflammation is a protective attempt by the organism to remove the injurious stimuli and to initiate the healing process.
When the dental pulp becomes inflamed, pressure begins to build up in the pulp cavity. Unlike other parts of the body where pressure can dissipate through the surrounding soft tissues, the pulp cavity is surrounded by hard tissues that do not allow for pressure dissipation.
For these reasons, pulp inflammations create intense pressure on the tooth nerve (located inside the dental pulp) which can sometimes cause a severe toothache.
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Infection
Infection is the invasion of host tissues by disease-causing organisms such as: bacteria, viruses, fungus and others. Dental pulp infections are caused by bacteria from dental caries that penetrate through the enamel and dentin to reach the pulp.
Conclusion
In a broad sense, an infection always produces an inflammation of the infected tissue as a protective response (right image).
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On the other hand, an inflammation may occur even if the particular tissue is not yet infected, as a response to toxins produced by the infection agents that are located very close to the tissue or as a response to other irritants (left image).
Clinical application
When the pulp becomes inflamed but the causative agents (bacteria, thermal insults, other irritants) have not penetrated the pulp yet, it is not always necessary to remove the pulp tissue (as a therapeutic approach).
When the pulp is already infected or a future infection is considered likely or inevitable, the removal of the pulp tissue is advisable. In these cases, the treatment involves the removal of the pulp structures and the subsequent shaping, cleaning, and decontamination of the pulp chamber and root canals.
Therefore, before starting the root canal therapy, it is very important to determine the correct diagnosis.
endodontic therapy steps
2. Protect the tooth from future microbial invasion
After the infection (and other irritants) has been eliminated and all tooth's structures decontaminated, it is vital to protect the tooth from future infections. For this, the root canals and tooth are sealed with specific materials.
Root canal filling involves the obturation (filling) of the decontaminated root canals with an inert filling such as gutta-percha and a specific root filling material. After the root canal therapy is concluded, the tooth is sealed with a filling or a dental crown.
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