The inflammation
It is necessary to differentiate between inflammation of the root of the tooth, pulpitis, and inflammation of the tip of the tooth (apical periodontitis). In root canal inflammation, it is not the root itself that is affected, but the tissue surrounding the root. This is called periodontium.
The periodontium includes the gums (gingiva), the tooth cement (cementum), the tooth socket (alveolus) and the periodontal membrane (desmodontium/periodontium). In root tip inflammation, the tip of the tooth and the surrounding tissue are affected. Starting with caries, for example, the bacteria spread further and further into the tooth.
First the enamel is only affected selectively, then several parts of the tooth are affected until they attack the dentine and finally penetrate into the tooth cavity. There they attack the supplying vessels and fight their way further and further towards the tooth root, nerve and root canal. They can also spread to the surrounding bone tissue and thus cause an inflammation of the jawbone.
If the inflammation spreads even further, an abscess and/or fistula may develop. Great caution is required here, because if an abscess bursts, the bacteria can spread throughout the body. If the blood vessels are damaged, the tooth begins to die because its supply is no longer guaranteed.
As mentioned above, the pain may suddenly subside in this phase. A dead tooth can be recognized by its dark discoloration and by the fact that parts of it can easily break off. Even a dead tooth must be treated quickly, otherwise it can be lost. Inflammation of the tip of the tooth root is usually a consequence of the previously inflamed dental pulp, from which the bacteria have spread further and further towards the tooth root.
Treatment
If the symptoms mentioned above occur, a dentist should be consulted immediately, because the sooner you intervene, the more tooth tissue can be saved. The dentist will take a close look at the aching tooth and find out about the duration, intensity and nature of the pain. A cold test can show whether the pulp is still alive or whether it has already died.
An x-ray provides more detailed information about the origin of the inflammation or how far advanced it is.The first step is usually the root canal treatment. In this treatment, the tooth is drilled out and the inflamed tissue is cleanly removed. The root canals are cleaned and rinsed with an antibacterial solution.
These steps should be carried out very carefully to ensure that all bacteria are caught and that none are left behind, which could otherwise cause a new inflammation later on. If the canals are infested with bacteria, they are treated with various inserts that inhibit the inflammation and kill the bacteria. After this step, or if the channels are not infected, they are filled with a paste.
This filling can only be checked radiologically to make sure that it is completely sealed. After this procedure, a temporary filling follows, which will be replaced by a definitive one if no symptoms occur. In most cases the inflammation is eliminated and the tooth can be preserved.
Root canals can also be very branched, so that a complete removal of the bacteria is often very difficult. It can also continue in the area of the root tip. If this happens, you can either renew the root filling, but if this is not helpful, a so-called root tip section can be performed.
In this procedure, the gums and also the bone around the root tips are surgically opened. A part of the root tip and inflamed tissue is removed to eliminate the inflammation. This is the last measure to preserve the teeth.
If it is not successful, the tooth must be extracted. Daily cleaning of the oral cavity is the most important prophylactic measure. Plaque (biofilm) that adheres for a longer period of time causes bacteria to develop, which then attack the tooth and begin to destroy it.
To prevent this from happening, you should brush your teeth at least twice a day to remove this plaque, which is caused by food residues. Mouthwashes, tongue scrapers and dental floss should be used in addition. Regular check-ups by a specialist should also be observed. A healthy diet can also reduce the risk of tooth decay.
