Treatment Options for Pulp Disease
Once pulp disease is discovered, your dentist will try to stop the spread of infection and, if possible, save the tooth. The type of intervention depends on the extent of the disease.
Root Canal Therapy
In this procedure, an endodontist removes diseased pulp tissue and seals off the chamber to prevent further infection. The entire process—the root canal procedure itself and restoration of the tooth—takes two to three office visits to complete.
During the first visit, the endodontist injects a local anesthetic and isolates the tooth from the rest of the mouth with a thin sheet of rubber called a dam. The endodontist cuts a hole through the top of the tooth and removes the pulp material; cleanses the root canal of bacteria, tooth fragments, and tissue; and then shapes the root canal. If the tooth has more than one root, the process is performed on all of them. The endodontist injects an antiseptic (and sometimes antibiotics) into the pulp chamber to kill remaining bacteria. Then he or she dries the root canal and places filling material (usually a rubber-like material called gutta-percha) in the chamber and root canal. Finally, he or she will place a temporary restoration in the access hole of the tooth. This completes the actual root canal portion of the therapy.
While most endodontists will try to complete this procedure in just one visit, occasionally it requires two visits. The gutta-percha can be placed only if the root canal is dry and free of infection. If this isn’t the case (for example, pus or blood may still be present), then the endodontist will delay this step. Instead, during the first visit, he or she will pack an antibiotic paste into the root canal and close the pulp chamber with a temporary filling. On the second visit, your endodontist will remove the temporary filling and fill the chamber and canal with gutta-percha to prevent the tooth from becoming infected again. He or she may also insert a plastic or metal post into the root canal to give the tooth extra support.
After the root canal treatment is complete, you will need to visit your restorative dentist so he or she can place a permanent restoration on the tooth. The material used for the restoration will depend on the size of the access hole as well as the type and location of the tooth. Your dentist may choose an amalgam or composite restoration, a crown, or both. Premolars and molars in particular should be crowned after root canal therapy to prevent the tooth from breaking.
In a pulpotomy, your dentist removes the damaged pulp from the crown portion of your tooth, but leaves the pulp that’s in the root intact. This procedure is used primarily in children and young adults because it allows the root to continue to grow. However, it’s suitable only if the inflammation is mild to moderate, and the tooth may still need root canal therapy at a later date.
If decay has penetrated through the dentin, the dentist may try to save the pulp by coating it with a layer of medication and giving the tooth a chance to heal on its own before placing a permanent filling. This is called pulp capping.
Source: Dental Health for Adults: A Guide to Protecting Your Teeth and Gums. Copyright © by Harvard University. All rights reserved.