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By Lawrence J.T. Reaves
When the pulp of a tooth becomes infected or damaged, it must be removed in order to save the tooth. After the diseased pulp has been removed, the pulp chamber and canals are cleaned and filled in order to seal off the space. This helps to prevent reinfection.
Sometimes, reinfection occurs despite efforts to prevent it. Bacteria may gain entry to the tooth through its root. This article will examine how the situation is handled by general dentists and oral surgeons. To understand how infection regains a foothold, it is important to be familiar with how the tooth is structured, and how it receives nourishment.
How A Tooth Receives Nourishment
The part of the tooth that is observable in the mouth is called the crown. The majority of the tooth lies beneath the gum line, and is anchored to the jawbone by its roots. The number of roots varies; the front teeth have a single root while the teeth in the back of the mouth have at least two roots.
A network of blood vessels and nerves can be found inside the teeth. The blood vessels deliver nourishment through the tips of the roots, helping the teeth to stay healthy and strong. During root canal treatment, the pulp chamber of an infected tooth is cleaned and filled, and the tip of the root – called the apex – is left intact.
When Reinfection Occurs Following A Root Canal
The goal of root canal therapy is to clean away infection, and prevent it from reappearing. Unfortunately, the procedure is sometimes unsuccessful. In some cases, infection may persist in one or more tiny branches that extend off the primary canals. Even though the canals have been filled, infection may spread again. The dentist will perform a retreatment to clean the infected branches in order to save the tooth.
Other times, reinfection occurs by gaining passage through the apex. An abscess forms in the tissue surrounding the root tip, once again jeopardizing the tooth. A dentist may perform root canal retreatment in an attempt to resolve the problem. If it proves to be unsuccessful, the apex may need to be removed. The procedure to do so is called an apicoectomy.
How An Apicoectomy Is Performed
In order to reach the tip of an infected tooth’s root, the dentist makes an incision into the gum line, and lifts the flaps of gum away from the bone. The bone underneath is thus exposed, providing access to the apex. The dentist will first remove the abscessed tissue surrounding the root. Then, the apex itself is removed.
The anatomy of a tooth is sometimes compromised by the infection, or while the dentist is performing the apicoectomy. For this reason, x-rays are often taken to help reveal cracks in its structure. Small cracks seldom present an issue since they are unlikely to spread after the tip of the canal has been sealed. Larger cracks, however, warrant extracting the tooth.
Assuming the tooth is left intact, the dentist will complete the apicoectomy by sealing the remaining portion of the root. The gum flaps are repositioned and sutured in place. The entire procedure can be completed within two hours, though treatment progresses more quickly when it is administered to the front teeth.
Post-Treatment Care For The Tooth
An apicoectomy usually results in some discomfort. Patients are encouraged to apply an ice pack on the area for several hours following the procedure. Pain medications, such as ibuprofen, can be taken to minimize aching.
The bone near the resected apex takes a few months to heal completely. Dentists usually recommend brushing gently during this period to avoid irritating the area. Hard foods are also discouraged.
The stitches that were applied to the gum line are typically removed within a week. In some cases, doctors apply stitches that dissolve on their own. Most of the pain and swelling that result from the procedure disappear by the third week.
Removal of the root tip of a tooth is a complex operation. However, it can be done quickly to provide a permanent solution to infection while saving the tooth.
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