A root canal (Endodontic) treatment involves removing the damaged or infected pulp from within the tooth. Once the inside of the tooth has been cleaned and disinfected, it is then filled with a material designed to seal the root and prevent further infection. A filling will then be placed to seal the entrance into the tooth through which the pulp was accessed.

Root canal treatment is the only means to save a tooth when irreversible pulp (nerve) damage has occurred. This commonly manifests as pain or tooth ache. However it may also manifest as an incidental finding on X-rays or during a dental examination where a painless blister or swelling is observed on the gum.

The damage to the pulp may have been caused by deep decay, cracks in the tooth, trauma or repeated dental procedures. If the tooth is not treated the pain may persist, an abscess may develop which can be even more painful and debilitating. In the event where there was no pain, the infection can increase in size making the subsequent treatment more difficult.

Contrary to popular belief, root canal treatments should not be painful. The aim is not to cause pain but to relieve it. Dr Browne uses the most effective anaesthetic techniques to make sure you feel nothing during the entire procedure. In fact it is not uncommon for some of our patients to fall asleep during their treatment.

After the treatment has been completed, the tooth may feel a little tender or uncomfortable to bite on for a few days. Occasionally (5% incidence) a “flare-up” can occur which can give rise to significant pain &/or swelling. Should this occur the acute symptoms are usually treated with antibiotics and anti-inflammatories (painkillers). A flare up is an unfortunate and rare occurrence and is related to factors such as host response and bacterial virulence. It does not mean that the tooth has a decreased chance of a successful outcome.

Root canal treatment is a very successful treatment when performed to a high standard. However, it is important to remember that it is impossible to guarantee the success of any medical procedure. Even with the very best treatment healing may not occur due to circumstances beyond the control of the clinician. For teeth without an abscess or an established infection, root canal treatment enjoys a very high rate of success (90%-95% survival at 10-15 years). Once a tooth has become infected the success rate can diminish with the increasing size of the abscess. Success in these cases could be quoted at 70%-85% survival at 10-15 years.

Retreatments (re-doing a root filling for a second time) have a slightly lower success rate, 80% is a reasonable expectation.

It is probably reasonable to expect a slight alteration in colour of the tooth following root canal treatment, particularly where a front tooth is involved. All steps are taken to try and reduce the chances of this happening.

If the discoloration proves to be a problem, there are procedures which can be undertaken to improve the colour and appearance.

This can vary according to the complexity of the root canals, the presence of infection, or if re-treatment is being carried out. Sometimes treatment can be carried out in one session lasting between one to two hours. If the canals are infected or are being retreated it is usually necessary to place an antibacterial dressing in the tooth, which is sealed in for a period of at least a week and bring you back for a further appointment.

Unfortunately the only predictable alternative treatment is extraction of the tooth. Once the pulp is diseased, the damage cannot be reversed and it will not heal spontaneously.

An apicectomy is the surgical removal of the root apex or tip of the root, the preparation of the resected root end to receive a root filling and the placement of the root filling.

Main reasons why an Apicectomy may be required:

1. 1. If the infection fails to clear following a conventional root treatment and redoing retreatment looks very challenging because of complicated root anatomy and previous procedural difficulties then the surgical approach may be justified.
   2. If there is significant overlying dentistry retained by a post/core which is perfectly intact and the associated risks of removing all the dentistry to access and treat the problem tooth are high then the surgical approach may be justified to resolve this problem.
   3. Occasionally despite careful radiographic and clinical evaluation no obvious cause of failure may be identified and surgical exploration of the problem tooth may be justified.

The primary (Baby) teeth are very closely related to the permanent teeth, which are forming inside the bone. Injuries to primary teeth can damage the forming permanent teeth. This damage can affect the aesthetics of the permanent teeth resulting in whitish spots or deformation of the crown when they erupt. The more serious the injury.intrusion iinto the gum in particular, the more damage can occur.

If a baby tooth is knocked out it is important NOT to replace it in the socket as this can also cause damage to the permanent tooth. 

First you must consult your dentist immediately after the accident occurs.

This has many advantages:

• There is more chance of conserving the tooth’s vitality;
• There is a better long-term prognosis;
• Future complications and high cost treatments can be avoided.

If you have Chipped your Tooth:

• try to find the fragment, store it in milk and see a dentist as soon as possible during working hours. The dentist may be able to glue the fragment back on to the tooth.
• Don't worry if you can’t find the fragment, your dentist will be able to use a tooth-coloured filling material to build your tooth up. If part of a back tooth is broken, it may either need a filling or a crown (also known as a cap).
• If the tooth is badly broken and the nerves are exposed, it may be a little sensitive and may even need root canal treatment. This involves removing the nerve and placing a root filling.

If Your Tooth is Knocked Out (Avulsed):

Only Permanent teeth can be re-implanted.

Baby teeth should not be re-implanted.

• Find the tooth. Hold the tooth by the crown (the white part), not by the root (the yellow part).
• Replant immediately, if possible.
• If contaminated, rinse shortly with cold tap water (plug the sink) and put the tooth back in its place. This can be done by the child or an adult.
• Hold the tooth in place. Bite on a handkerchief to hold it in position and go to the dentist immediately.
• If you cannot put the tooth back in, place it in a cup of milk or saline. When milk or saline are not available, place the tooth in the child's mouth (between the cheeks and gums).
• Seek dental treatment. Dr Browne has a special interest in the management of sports injuries.

For further advice go to www.iadt-dentaltrauma.org

Unsurprisingly, one of the most common causes of dental trauma is participation in contact sports (like Hurling, Gaelic Football, Rugby, Boxing, Soccer, Camogie, Basketball). The risk of dental injuries compared with general injuries is low but related costs are high so prevention is key.  Most injuries involve the front upper 4 teeth which are still potentially immature. These teeth tend to be the most challenging clinically and aesthetically to treat.  Ideally any activity where the potential for dental trauma can exist should utilize MOUTHGUARDS to protect these vulnerable front teeth.

A Mouthguard (sportguard, gumshield) is defined as: a resilient device or appliance placed inside the mouth to reduce oral injuries, particularly to teeth and surrounding structures. They considerably diminish the injury to teeth subjected to stress in comparison with unprotected teeth. MG’s act through distribution of the energy from impact, decreasing the likelihood & severity of dental injury and brain concussion. MG’s are now (from 2014) compulsory for all levels of Gaelic Football but we would recommend them for all contact sports.

There are two types of MG available – Boil & Bite and Custom-Made (provided by your dentist). While Boil & Bite are cheaper, they do not last as long or offer the same benefits as Custom-Made. Custom-Made MG’s are more comfortable, better quality, better fitting & properly designed MG’s to prevent dental trauma that do not impact negatively on sporting performance.