Cleaning the tooth canal: how is it done, the consequences of what is done after

Cleaning the tooth canal is a dental manipulation, which is performed when the infection enters the root canals. This procedure can have different options for implementation depending on the diagnosis, anatomical features of the root canals and the body's overall somatic status. If you need this treatment, you need to be prepared for the fact that this process is not fast and most often lasts from two to ten visits.

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Indications for the procedure

Indications for cleaning the canals of the tooth are acute and chronic pulpitis and periodontitis. Pulpitis is an inflammation of the neurovascular bundle of the tooth, which is located in the root canals. This disease can occur as a complication of caries or be the result of a tooth injury. In the event that a complication of the carious process occurs, the infection enters the pulp chamber, where an inflammatory process soon occurs. This response of the body is directed to the destruction of infection in the cavity of the tooth. However, the side effects of a severe inflammatory process can be the appearance of pus in the pulp cavity. Purulent exudate spreads into surrounding hard tissues, and also can penetrate the apex of the root canal. In this case, we are talking about periodontitis, which is also accompanied by the release of purulent contents. If there is an inflammatory process in the periodontal tissues, cleaning the tooth canals is extremely necessary. And if you do not seek help in time, the disease can become chronic.

Injury of the tooth, although not an infectious process, as previous diseases, but after it may also need cleaning the tooth canals. When the integrity of tooth structures is impaired, pathogenic microorganisms penetrate into pulp tissues through damaged areas of hard tissues and provoke the onset of inflammatory processes. Also, the factor of infection is the violation of metabolism in damaged dental structures. The fact is that when a periodontal injury occurs, it is damaged, which disrupts the stability of the metabolism. Thus, the body tries to compensate for these malfunctions in the periodontal work, which causes a weakening of the protective factors. This leads to the fact that the nearby infection begins to lead active life and spread to neighboring areas.

[3], [4], [5], [6]

Technique of the cleaning of tooth canals

The technique for cleaning canals is a series of sequential manipulations, during which endodontic instruments are used. After removal of the damaged tissues of the tooth, the doctor proceeds to extract the pulp and cleanse the root canals from the remains of the affected tissues. Before each manipulation it is important to rinse the tooth cavity with antiseptic solutions to reduce the spread of infection. The next step is cleaning the canal walls with cutting tools that remove the infected dentin and give the channel the desired shape. Correct bending and tapering of the root canal play an important role in the sealing phase. After the mechanical instrumentation, treatment of the end channels with aggressive antiseptics should be followed, the drying of the channels and their sealing. At the key stages of treatment, the dentist must monitor the position of the instrument in the canal with the help of an apexorocator or an X-ray. Apexlocker is an instrument that shows the location of the instrument in the root canal. This moment is very important, since without visual control there is a risk of moving the cutting tool over the tip of the root, and in the treatment of periodontitis, there is a possibility of excretion of the material beyond the apical opening (the apex of the root).

Open tooth after cleansing channels

After carrying out the above manipulations, the further therapeutic plan may be different. If the treatment was carried out for pulpitis, then after cleaning the root canals, they are usually sealed and perform restoration of the tooth. As for the filling of channels, this manipulation can be carried out according to various methods. Sometimes, sealing materials are used without any support structures. If the tooth requires a more reliable restoration, combinations of composites and pins can be used. If the crown of the tooth is severely damaged, it is proposed to put a solid metal insert (an intracanal microprosthesis on which the crown is mounted). If the treatment was carried out for periodontal disease, the treatment tactics will be completely different. After cleaning, the channels are left open for 1-2 days to create an outflow of purulent contents. The extraction of pus is accelerated thanks to the rinses that the patient regularly performs. At the time of eating, open the tooth is recommended to be covered with a cotton ball, and after eating - actively rinse with warm antiseptic solutions. And only after the symptoms subsided the periodontitis proceeds to a temporary, and then to a permanent filling of the canals.

Cleaning channels in the wisdom tooth

Cleaning channels in the wisdom tooth is carried out according to standard rules, but there are a number of difficulties in accomplishing the task. Root canals in the wisdom tooth often have many branches and are themselves very twisted, which makes it difficult to carry out their machining. Wisdom teeth can also be tilted in different directions, which creates difficult conditions for working with their root canals. Large strands of the mucous membrane and the impossibility of wide opening of the mouth prevent the doctor from working with these teeth. In addition to these nuances, remember that the root system of eighth teeth often passes in the mandibular canal. This is the canal in the bones of the lower jaw, which contains the mandibular nerve. It innervates all the teeth of the lower jaw, as well as some areas of the facial skin, the gingival mucosa, muscles and tongue. Damage to this nerve entails a violation of the innervation of these areas, and in the treatment of wisdom tooth canals such a danger exists.

Despite all the troubles with which the doctor encounters when treating the root canals of wisdom teeth, it is quite possible to carry out qualitative treatment of them. To do this, the doctor must have theoretical knowledge, practical experience and the necessary set of quality tools.

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Nerve removal and canal cleaning

To carry out qualitative treatment of pulpitis, the doctor needs to remove the nerve and clean the tooth canals. This is necessary to eliminate the infectious inflammatory process. Before starting treatment, the doctor decides on the choice of method of treatment. Among them, the vital and devital methods are distinguished. The essence of the first method is that the pulp (nerve) is removed alive. Pre-medication, anesthesia in the area of a sick tooth. Then remove the nerve of the tooth and clean the root canals. The second method is the removal of pulp with preliminary devitalization. This method is longer and involves a number of visits. At the beginning of the treatment, the devitalizing substance (arsenic or paraformaldehyde) is left in the tooth and after a certain time (from 2 to 7 days) the nerve is removed. In modern dentistry, the first method is most often used because of its speed and less pain.

Contraindications to the procedure

Absolute contraindications to cleaning the root canals do not exist. There are only contraindications to the specific methods of treatment of pulpitis, namely to the vital method. First of all, we are talking about the severe stages of general somatic pathologies (for example, grade 2-3 hypertension, uncompensated diabetes mellitus, hepatitis, etc.). Also in this group should include allergic reactions to anesthetics, because in this case it is impossible to perform anesthesia of the tooth.

In the case of an unstable mental state or mental illness, it is not recommended to perform vital treatment. In the case of severe pathologies of the nervous system, anesthesia treatment may be necessary.

One of the main reasons why this type of therapy is not used is the anatomical features of the canal structure. If they have a curved shape, then processing such a channel will be very difficult. Your doctor should always understand whether he will be able to perform the treatment of this tooth qualitatively. If you leave nerve fragments in the channel or do not completely fill up the channels, then there is a possibility of various complications.

Often the vital method is not used in the elderly. Most often this is due to the fact that the anesthetics contain vasoconstrictor substances. With the instability of the cardiovascular system of elderly people, anesthetics can cause serious damage to the body.

As stated above, all of the above contraindications are only relative. This is due to the fact that in modern dentistry there are hypoallergenic forms of anesthetics, drugs with a minimal dose of vasoconstrictor substances. Also, the creation of comfortable conditions for the patient, the work of a doctor with an assistant, make it possible to perform all manipulations as quickly and efficiently as possible.

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Consequences after the procedure

Pain in the tooth after cleaning the canals can indicate many conditions. The most common is a complication of the disease, in respect of which the treatment was carried out. Incorrectly treated pulpitis can go into periodontitis, and acute periodontitis - into a chronic form. 

Why does the tooth hurt after cleaning the canals?

In the treatment of pulpitis, it is very important that the injured tissues, aggressive antiseptic solutions and other substances are not removed at the apex of the root canal. In view of the fact that the canal in the apex region contracts very strongly, the gap between it and the periodontal gap remains very small. It has the name apex hole. If the dentist extends it, then the treatment can be ineffective, since the inflammatory process will pass to periodontal tissue.

If treatment of acute periodontitis or pulpitis has been performed, chronic periodontitis may appear after a while. The reasons for these outcomes are not always clear, sometimes it is a banal hypothermia and a decrease in body defenses. In some cases, the cause is increased load on the tooth. And sometimes complications arise in connection with the incomplete removal of infection from the canals. Regardless of the cause of the complication, you should immediately contact a specialist who can stop the spread of the inflammatory process.   

If, after cleaning the canals, the tooth hurts when it is pressed against it or onto the gum, this may indicate the development of periodontitis or the relapse of a chronic disease. With periodontitis, the purulent exudate accumulates in the periodontal gap and exerts pressure on the tooth. Symptomatically, this can manifest as a feeling of a "grown tooth." In this case there will be a constant pulsating pain, especially when biting on this tooth.

In case there is pain when pressing on the gum near the previously treated tooth, then most often the cause is chronic periodontitis, or periodontitis. With chronic periodontitis, a large amount of pus accumulates in the periodontium, which causes it to look for ways out. As a rule, pus moves in the direction of the gums from the side of the lips and cheeks. This is due to the fact that the bone of the socket from the buccal side is thinner than with the palatine. Therefore pus makes a canal in the bone and gum, "eating away" hard and soft tissue. This process is accompanied by reddening of the gums, a sharp pain when touching it. As a result of the release of pus on the gums, a small hole (fistula) is formed through which the contents flow into the oral cavity. The presence of the fistula is one of the most visible signs of exacerbation of chronic periodontitis.

Sometimes the cause of pain when pressing on the gum in the area of the treated tooth is periodontitis. Periodontitis is an inflammation of the ligament of the tooth, with the progression of which the bone around the tooth is destroyed. As a result of this chronic process, the tooth gradually begins to loosen and eventually falls out. In this case, to confirm the diagnosis, you need to take an X-ray image, as well as a series of studies that are performed in a dental clinic.

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How much tooth does it hurt after cleaning the channels?

After cleaning the canals there should be no pronounced pain. There may be unpleasant sensations in the tooth, a slight tingling, the tooth may be hypersensitive. Sensitivity when biting on a treated tooth up to two to three weeks is considered the norm. This is due to the fact that after removal of the nerve, some of the nerve fibers remain behind the apical foramen. In connection with the recent treatment, the remaining nerves are in a stressful and irritated state. Therefore, even a slight masticatory load, the use of hot and cold food, can provoke unpleasant sensations. However, it is worth to be attentive to your body! If the pain is constant, pulsating, tearing, the duration of which is more than two weeks - this is an obvious reason to contact a specialist.

Complications after the procedure

Due to the complexity and duration of treatment of the canal can develop some complications. They can be associated with the inexperience of the doctor, lack of technical equipment, missing visits to the patient, etc. As a result, the infectious process spreads to neighboring areas and causes various diseases.

The most common complication after cleaning the canals is residual pulpitis and periodontitis. These diseases occur after incomplete extraction of pulp from the root canal or ineffective treatment of an inflammatory disease. As a result, the tooth feels constant pain, which can last several weeks and months. The only way out in this case is repeated cleaning of the canals, which will remove all affected tissues and stop the inflammatory process.

In cases where the body's immune system is weakened, the residual periodontitis can quickly go into periostitis. Periostitis is an inflammation of the periosteum in the tooth region, in the common people it is a flux. Its main symptoms are: symptoms of intoxication (headache, weakness, fever), edema in the buccal region, tenderness of the skin in the area of swelling. If the cheek is swollen after cleansing the tooth canals, you should immediately see a doctor. Even if your attending physician is on leave, business trip or for other reasons absent from the workplace, you should urgently seek dental care. In this case, it does not really matter which clinic to visit. The main thing is to do it as quickly as possible. If you do not perform a surgical procedure on time and do not undergo anti-inflammatory therapy, this disease can be complicated by more severe conditions.

If inflammatory processes do not stop in time, then development of acute or chronic osteomyelitis is possible. This disease can be described as an inflammation of bone tissue. A severe pathological and often unfavorable pathological process, predicted, can lead to a breach of the integrity of bone tissue, the formation of bone defects that disrupt the functional and anatomical integrity of the solid tissues of the oral cavity. This condition is rare, and usually in people who lead a disorderly lifestyle.  

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The prognosis after cleaning the canals is usually favorable. Qualitatively treated tooth serves for years and does not cause any complaints. A competent doctor and a conscious patient can achieve colossal results in complex treatment together. Reviews of people about the cleaning channels are different. Some consider this method ineffective and useless. However, a qualitatively carried out cleaning of the tooth can keep the tooth in a working condition for many years. Be healthy!