In a situation where the tooth poses a threat (due to decay, fissure, etc.) and in which future infection is considered more likely or unavoidable, a pulpectomy, the removal of the pulpal tissue, is recommended to prevent infection. Usually, some inflammation or infection has been found inside or under the tooth. To treat the infection and preserve the tooth, the dentist digs into the pulpal chamber and removes the infected pulp and then removes the nerve from the root canal (root canals) with a long needle-shaped hand tool known as a dental file (Dental H, File K). We start with a small tooth file (sometimes called a ‘root canal probe’) and gradually use a larger file to widen the root canals. This process is used to remove infectious debris and tissue and facilitate greater penetration of the perfusion solution. Next, the dentist fills each of the root canals and chambers with an inert material and seals the open part. This procedure is known as root canal treatment. With the nerves and blood supply removed from the teeth, it is best to have the teeth fitted with a crown.
The standard filling material is gutta-percha, a natural polymer prepared from the latex of the percha tree (scientific name is gutta-percha). This standard endodontic technique involves the insertion of an epidermal cone (“taperaryngeal cones”) into a clean root canal along with a sealing cementum.[5] Another method uses heat-thawed gutta-percha which is then injected or pressurized into the root canal passage(s). However, the gutta-percha shrinks as it cools, making the thermal method unreliable, and sometimes a combination of techniques is used. The gutta-percha are radiopaque, allowing verification afterwards that the root canal passages have been completely filled, without voids. An alternative filler material was invented in the early 1950’s by Angelo Sargenti. I’ve had several formulations over the years (N2, N2 Universal, RC-2B, RC-2B White), but they all contain paraformaldehyde. Paraformaldehyde, when placed in a root canal, forms formaldehyde, which penetrates and sterilizes the passage. The formaldehyde is then theoretically converted into harmless water and carbon dioxide. The result was better than the root canal done with gutta-percha, according to some investigations. However, there is an indisputable lack of scientific studies according to the Swedish Board on Health Technology Evaluation. [citation needed] In rare cases, the putty like any other material can be forced through the root canal into the surrounding bone. If this happens, formaldehyde will be directly converted into a harmless substance. Blood normally contains 2 mg of formaldehyde in every liter of blood and the body regulates this in seconds. The rest of the excess fill will be gradually absorbed and the end result is naturally fine. In 1991 the ADA decided that dental treatment with this method was “not recommended”, and it was not taught at any US dental school. Scientific evidence in endodontic treatment was and still is incomplete.[6] Sargenti’s technique has proponents, who believe that N2 is less expensive and also at least as safe as gutta-percha.[7]
For some patients, root canal treatment is one of the most daunting dental procedures, possibly due to a painful abscess that necessitates a root canal procedure. However, dentists maintain that modern root canal treatment is relatively painless because the pain can be controlled with local anesthetic during the procedures and also pain can be controlled with medication before and/or after the treatment assuming the dentist takes the time to administer one. However, in some cases it may be very difficult to control the pain before root canal treatment is performed. For example, if a patient has an abscessed tooth with a swollen area or a “fluid-filled blister” next to the tooth, the pus in the abscess may contain acids that inactivate any anesthetic injected around the tooth. In this case, the dentist may remove the abscess by making a cut to allow the pus to drain. Removing the pus removes the pressure built up around the tooth. This pressure causes pain. Then the dentist will prescribe antibiotics such as penicillin for a week, which will reduce infection and pus, and make it easier to numb the tooth when the patient returns after a week. The dentist can also open the tooth, allowing pus to drain through the tooth, and can also leave the tooth open for a few days to help relieve pressure.
The root of a treated tooth can be relieved by occlusion as a measure to prevent fracture of the tooth prior to cementation of a crown or similar filling. Sometimes the dentist does a preliminary treatment for the tooth by removing the entire infectious dental pulp and making a dressing and a temporary filling on the tooth. This is called a pulpectomy. The dentist may remove only the coronal part of the dental pulp, which contains 90% of the nerve tissue, and leave the pulp in the root canals intact. This procedure, called a “pulpotomy”, tends to eliminate essentially all pain. Relatively, pulpotomy can be a definitive treatment for infected milk teeth. Pulpectomy and pulpotomy procedures aim to eliminate pain until the next visit for completion of the root canal. More pain may be due to an ongoing infection or survival of vital nerve tissue. After removing as much of the inner pulp as possible, the root canal(s) can be temporarily filled with a calcium hydroxide paste. This strong base is left for a week or more to disinfect and reduce inflammation in the surrounding tissue. The patient may complain of pain if the dentist left a deficient pulp on the root canal and thus increases one visit to the dentist.[8] Ibuprofen taken by mouth is usually used as a QB
