墨尔本根管治疗 | 根管问题解答
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- 外吸收： 病理过程起于影响牙齿外表面的牙周组织。外吸收可根据部位进一步分为：牙颈、侧面或根尖吸收，或根据类型分为：表面、炎性或替代性吸收。
- 内吸收： 病理过程由牙髓内部的牙本质损失引起，有时伴随着牙骨质的损失。此类内吸收可能会或不会穿过牙根外表面。
- 炎性吸收： 牙根部的骨质、牙骨质与牙本质的病理性流失。
- 表面吸收： 引起牙骨质与牙本质内小型表面损坏的生理条件，通常可由损坏内的新牙骨质的堆积作用进行自我修复。
- 内漂白: 医师可以在接受过根管治疗的牙齿上进行无髓牙（内）漂白术。将化学氧化剂涂于牙冠部分内来去除牙齿着色。根据牙齿的着色情况，这项诊疗可以通过在诊所内的一或两次预约中完成。该诊疗还被称作“诊室漂白”，医师将漂白药物涂于牙齿内部，一段时间后再清除。另一种方法被称为“诊间漂白”，是将漂白药物涂于牙齿内部，在其中保持几天。这些诊疗一般由牙髓病医生进行。
- 外漂白： 外漂白：活髓牙（外）漂白术是一项由全科牙医在牙齿外部、活髓牙或未接受过根管治疗的牙齿上进行的诊疗。外漂白术包括不同疗法，如激光或化学药剂（30%过氧化氢与过氧化脲）。该诊疗中，医师通常需要取牙印模，制作可以盛药剂的牙齿托盘。患者需要每天几个小时或睡觉时戴着该托盘。其他方法无需托盘，但会使用漂白带。
Root Canal Treatment FAQs
Is a root canal for you?
Do you have any of the following symptoms?
- Sensitivity to hot or cold that lingers
- Pain when chewing or biting
- Dull ache
- Spontaneous pain
- Throbbing or pulsing pain
- Pain that wakes you up at night
- A bubble or pimple on your gum that when pressed may release pus or blood (most likely, not painful)
- Pain that persists four to six weeks following a filling or replacement of a filling
- Chronic pain and/or pressure that may extend to the ear, eye or neck
- A tooth that feels loose
- One tooth is distinctly and consistently more sensitive than the other teeth
- Your dentist has diagnosed the need for root canal therapy, either by clinical exam or x-ray
If you answered yes to any of the above, you might very well need a root canal.
Please call and schedule for an evaluation.
Be aware not all teeth that ARE in need of root canal therapy will cause pain. It is possible to be pain-free and still need a root canal.
What is Endodontics?
It is a branch of dentistry that deals with the cause, prevention, diagnosis and treatment of diseases of the human dental pulp and the surrounding tissues.
What is the Dental Pulp?
It is what we commonly know as the “nerve” of the tooth. It is a soft connective tissue that is highly vascularised (tiny blood and lymph vessels), and innervated (nerve fibers). It is located inside the dentin of the tooth in the pulp chamber. Its main function is formative, nutritive and sensory.
What is a Root Canal?
ROOT CANAL is a “lay persons” term for endodontic therapy or root canal therapy. Root canal therapy is necessary when the nerve inside the tooth becomes irreversibly damaged or infected. This is usually due to the entry of bacteria into the center most part of the tooth called the dental pulp (“nerve”). Root canal therapy involves the removal of the entire nerve system, as well as cleaning, shaping and filling 3-dimensionally the canal system with gutta-percha and a dental sealer.
What is Gutta-Percha?
Gutta-percha is the purified coagulated exudate from a tree, commonly called the “mazer wood” tree, of the Malaysian archipelagos. The substance is similar to that of the rubber tree, which is then processed to obtain the dental compound. This is the only ADA approved material to be used as a filling in root canals.
What Happens at an Endodontic Consultation?
Your doctor will review your past dental and medical history. A dental x-ray will be taken even if you have one from your referring dentist. Different x-ray angles are necessary to reveal possible problems such as decay or an abscess. Also, a series of test, such as hot, cold, biting and percussion (tapping) can be performed on several teeth. Through these tests the dentist will attempt to reproduce your symptoms that will enable him/her to make a proper diagnosis and decide if you do, or do not, need a root canal.
How Does the Dental Pulp Become Damaged or Infected?
The reason is bacterial contamination. Bacteria are a normal host present in the mouth and saliva, but when it gets inside the tooth and enters the pulp (through decay, or a fracture in the tooth, broken down old filling, or a gap between your tooth and an existing crown), then it becomes pathologic. The time frame for this to occur can vary significantly. Sometimes it is very fast and usually painful, but also, it could be a very slow process in which the patient is unaware and no pain is manifested until it is significantly advanced.
Is the Root Canal Procedure Painful?
Usually not. With modern technology and local anaesthetics, the procedure is usually much faster and more painless than it has ever been. A similar anaesthetic, as the one used in the general dentist office, will be used for a root canal. The main difference is the quantity. A deeper level of anaesthesia is necessary for this procedure to be painless. In many occasions, it can be a completely pain-free procedure. Painkillers are usually recommended for a few days after treatment, in order to control normal post-treatment discomfort.
How Much Time Will A Root Canal Take?
Root canals can be done in one, two or multiple appointments, depending on the tooth, how many roots there are, the current conditions of the tooth, the accessibility to area, the canals, and time available. Each visit or appointment can take from under 1 hour, to over 2 hours.
What is an Abscess?
An abscess is a localized collection of pus (infection) within a tissue or a confined space.
Does Every Abscessed Tooth Hurt?
No. Some abscessed teeth can be pain-free, which are most commonly found and diagnosed accidentally by a dentist, usually through a dental x-ray and exam. Whenever possible, the recommended treatment is a root canal.
What Happens When an Infected Dental Pulp is not Treated?
The infection will continue its progress, extending from the confines of the dental pulp and involving the surrounding tissues, such as the root, the bone, the gums etc. A progressing infection could easily involve facial spaces and the patient would then start observing swelling of the face. Such condition could become life threatening if left unattended.
What is a Cellulitis?
Cellulitis is a painful inflammatory process that spreads through the connective tissue and is characterized by swelling and oedema. It is usually associated with a bacterial infection.
Will My Tooth Discolor After Root Canal Treatment?
No, with all the new materials and modern technology used during the procedure, your tooth should not discolor after the treatment. If you have a tooth that has had a root canal and it has discolored, it is best to have your dentist take a look. It may be that germs (bacteria) have penetrated underneath the old filling, and it is time for a new one.
What is involved in a Root Canal Procedure?
After the tooth is properly numbed, a rubber dam will be placed, and then the dentist will open a small cavity on the chewing surface (back tooth) or the back of the tooth (front tooth), to get into the nerve chamber. The nerve will be manually removed using small dental instruments called files. The canal(s) will then be completely cleansed using some hand and/or mechanical instruments, alternating with different irrigants. Once the canals are adequately shaped, then they will be filled with gutta-percha and an endodontic sealer. The small cavity on the tooth will then be closed with a temporary filling material.
What Follow-Up Care is Involved in a Root Canal Procedure?
Avoid chewing on the tooth. It will most likely feel very tender and sensitive to pressure or touch. There should not be any discomfort upon drinking hot or cold fluids. Follow any instructions given by your dentist in reference to drugs such as painkillers and anti-inflammatories. Any of these, or the combination of them, usually provide excellent results to alleviate the normal post-treatment discomfort. If your pain does not respond to the initial medicine, then you should call your dentist. Sometimes, there will be a need for stronger painkillers and/or antibiotics. Finally, once your tooth is pain free, you must see your general dentist who will complete the necessary dental reconstruction of the crown. This last item is very important and should happen as soon as possible after completion of the root canal.
Do I Need to Take Antibiotics Every Time a Root Canal is Done?
Not always, today we are very conservative in determining the need for an antibiotic. It is usually determined by the dentist on an individual basis, per case, per tooth. Usually, if there are systemic signs and symptoms such as swelling, fever, generalized sense of malaise (ill feeling), and/or lymph node tenderness, then an antibiotic will be prescribed. The common toothache even when it is associated with a minor localized infection or abscess will not automatically require an antibiotic. Since a high number of cases will respond favourably to the dental treatment, antibiotics are not prescribed on a preventive basis.
Will I Feel Anything After Root Canal Treatment?
In most cases the quantity and quality of pain will subside dramatically within the first 24-48 hours. Any sensitivity to cold, hot or even breathing air “in” will be gone after the first visit. Nevertheless, you will experience mild to moderate pain that will last for several days after treatment. This pain is usually relieved by taking over the counter medications such as aspirin, Advil, Motrin, or Aleve. Tylenol has been proven not to be as effective as aspirin, etc., because it does not have the anti-inflammatory component as these other medications. The most common complaint is tenderness to touch, bite, tapping or chewing on the tooth. It is recommended to refrain from any of the above until your tooth is permanently restored. You should realistically give yourself 2-4 weeks to fully recover.
Since Treatment Was Done, My Tooth No Longer Hurts. May I Start Chewing On It?
It is not recommended to start chewing on the tooth immediately after the root canal treatment. Most times it will be very tender, but even if it is not painful to chew, you should avoid chewing on it until the crown of the tooth is properly restored (repaired) by your regular dentist. The sooner you see your regular dentist; the sooner you will be able to re-start normal function on the tooth.
How Long Should I Wait to See My Regular Dentist After the Root Canal is Performed?
Unless otherwise directed, you should see your regular dentist as soon as your treated tooth feels comfortable (about 2-4 weeks). It is very important to see your regular dentist at that time to have a permanent restoration (typically a crown) placed in order to protect the remaining tooth structure. Until the permanent restoration is in place, do not chew on the treated tooth.
What Happens if I Wait Longer Than Recommended to Get the Crown of the Tooth Permanently Repaired?
If the remaining tooth structure is not properly and permanently covered and protected, your tooth could fracture and not be salvageable at all. The bacteria in saliva, as well as food debris, can go between the temporary filling and the tooth surface and contaminate the root canal treatment. This may cause treatment failure. If a re-infection occurs, often, another root canal treatment will need to be done (endodontic retreatment). If the damage is very extensive, extraction should be considered.
What are the Benefits of Root Canal Therapy Versus Extraction?
The single most important benefit of root canal therapy is that you keep your tooth. Extraction may lead to other dental problems. For instance, drifting of teeth, bite problems, TMJ pain, and the need to treat adjacent teeth that do not otherwise need dental treatment in order to restore the missing tooth.
How successful are Root Canals?
Root canal treatment has a high degree of success if done properly by a trained skilled professional. The success of root canal therapy is equally dependent upon the technical skill of the doctor, as well as the follow through of the patient, to have the tooth immediately restored.
What Should I Do if a Medicated Dressing was Placed Under My Filling and it is Still Sensitive to Heat and/or Cold?
Sensitivity to hot and/or cold, which persists, usually indicates that the nerve of the tooth is irreversibly inflamed. The indicated treatment is Root Canal Therapy. Immediate attention by your dentist or endodontist is necessary to prevent severe pain and abscess.
What is Resorption?
Resorption is a physiologic or pathologic condition associated with loss of bone, cementum and/or dentin. There are different types of resorption such as external, internal, inflammatory, replacement and surface. Its etiology is unknown, even though it commonly is associated with trauma.
- EXTERNAL: a pathologic process that initiates from the periodontium affecting the external surface of the tooth. Can be further classified by location: cervical, lateral or apical. Or type: surface, inflammatory or replacement.
- INTERNAL: a pathologic condition that initiates within the pulp causing loss of dentin and sometimes, cementum. It may or may not perforate the external root surface.
- INFLAMMATORY: a pathologic loss of bone, cementum and dentin in the root.
- REPLACEMENT: Also known as ankylosis, it is a pathologic loss of cementum, dentin and periodontal ligament with simultaneous ingrowth and fusion of bone to the tooth surface. A loss of the physiologic mobility is common.
- SURFACE: a physiologic condition causing small surface defects in the cementum and dentin that are usually self-repaired by deposition of new cementum in the defect.
What is an Apicoectomy?
This is an endodontic micro-surgical procedure for a tooth that has had a root canal. The purpose is to remove persistent infection at the end of a root and seal the root end to prevent re-entry of bacteria. This procedure also provides the opportunity to detect possible root fractures.
Why is a Rubber Dam Used During Root Canal Treatment?
The purpose of a rubber dam is to protect the patient from swallowing the small instruments used during root canal treatment and to keep the tooth clean and dry during the procedure. It is for medical/legal reasons that a rubber dam is used for patient safety.
What is Endodontic Retreatment?
Retreatment is a term used to describe a procedure when a root canal has to be redone. The reason for retreatment is because germs or bacteria in the mouth have re-entered the tooth, usually due to decay. A patient may experience pain to biting or swelling. Sometimes, a patient may have no symptoms and your dentist sees something on the x-ray that shows a root canal has not healed and advises a patient to see a root canal specialist for an evaluation.
What is Bleaching?
This procedure is used to lighten a darkly discolored tooth. There are two very different types of bleaching, internal and external:
- INTERNAL: Non-vital (Internal) bleaching is performed in teeth that have had root canal therapy. A chemical oxidizing agent is placed within the coronal portion of a tooth to remove tooth discoloration. It may be performed at the dentist’s office in one or more appointments, depending upon the discoloration of the tooth. When bleach crystals are place inside the tooth and after then removed after a period of time, the procedure is known as “chair side bleach.” Another method is when bleach crystals are placed inside the tooth and are left for several days inside the tooth. This is called “walking bleach.” An endodontist commonly performs these procedures.
- EXTERNAL: Vital (External) bleaching is a similar procedure performed by a general dentist on the outside of a tooth or teeth with vital pulps; teeth that have not had root canal therapy. There are different methods for this procedure, such as lasers, or chemical agents (30% hydrogen peroxide and urea peroxide). The procedure often involves taking an impression of your teeth and the fabrication of a tray that will hold the bleaching agent. The patient wears this tray several hours each day or at night while sleeping. Other methods do not involve trays, but rather bleaching strips.
How Long Will I Be Numb After Root Canal Treatment?
The numbness will last for several hours after your treatment. It is best to avoid chewing until the local anesthesia has completely disappeared to prevent accidentally biting your lip, cheek, or tongue. It is okay to drink or to use a straw to have liquids after treatment.
Will I Be Able to Return to Work After Root Canal Treatment?
Yes. Most patients return to work after root canal treatment. They may keep a light schedule and plan to get rest during the days that follow treatment.
Why Do I Still Feel My Tooth if I Had Root Canal Therapy? I Thought My Tooth Was Dead.
A tooth that has had a root canal is not “dead”. It is still considered a “live” or vital part of your body. There are nerve endings that are present in the jawbone underneath the tooth, as well as nerves that attach from the jawbone to the tooth. This is why there is still feeling in a tooth that has had root canal therapy.