Introduction
Root canal inflammation generally affects the tip of the tooth root (apex) and is therefore also known as root apex inflammation (apical periodontitis). It is usually treated with a root canal treatment. This can also be repeated if symptoms persist.
This is called a revision of the root canal treatment. If there is no improvement of the inflammation after the revision, a new revision does not make sense. If necessary, a root tip resection must be performed in this case. In this case the inflamed root tip is removed in a surgical procedure, whereby the remaining tooth is preserved.
Therapy
The treatment of root canal inflammation consists primarily of ordinary root canal treatment. If necessary, the dentist will first anaesthetize the affected tooth and then drill it out. In the course of this he will remove carious defects, if any, and create an access to the tooth pulp and the nerve fibres stored in it.
In the past, a so-called cofferdam was placed before the actual treatment. This means that a metal clamp, around which a tension rubber is placed, is attached to the tooth to be treated. The cofferdam serves to shield the tooth so that no saliva and bacteria present in it can enter the tooth.
However, the attachment of the rubber dam is very uncomfortable. For this reason, more and more people are now resorting to relative drainage of the tooth being treated. The tooth is only protected by absorbent cotton rolls and by sucking out the saliva.
The preparation of the tooth is so painless, but there is a greater risk of saliva entering the root canals. The dentist will then remove the pulp from the root of the tooth, including the nerve fibres within it. This is done with the help of root files of different lengths and thicknesses (reamers, Hedstrom or K-files).
The root is now prepared, i.e. hollowed out and freed from dead and/or inflamed tissue. Then a disinfecting alternating rinsing with different solutions is performed. The solutions used are hydrogen peroxide (H2O2), anti-inflammatory, antibacterial chlorhexidine (CHX) and sodium hypochlorite.
The further course of the root canal treatment depends on the condition of the tooth. If the root of the tooth is less inflamed, the root can usually be filled in the same session. In the case of a severely inflamed tooth, the dentist will usually first introduce an antibacterial, anti-inflammatory drug into the root and let the tooth rest for a few days (approx.
3-5 days). As soon as the inflammation has subsided and the root canal is dry, it is filled with so-called guttapercha points and a dense cement. An X-ray is then taken to check whether the root is filled to the tip (apex) and the tooth is then sealed.
If the inflammation of the tooth root occurs on teeth that have already been filled with root, more extensive therapy is necessary. This can happen, for example, if the root of the tooth is very crooked or not completely drained. The treating dentist will probably perform a so-called root tip resection or remove the existing root canal filling and prepare and fill the tooth again.
The solutions used are hydrogen peroxide (H2O2), anti-inflammatory, antibacterial chlorhexidine (CHX) and sodium hypochlorite. The further course of the root canal treatment depends on the condition of the tooth. If the root of the tooth is less inflamed, the root can usually be filled in the same session.
In the case of a severely inflamed tooth, the dentist will usually first introduce an antibacterial, anti-inflammatory drug into the root and let the tooth rest for a few days (approx. 3-5 days). As soon as the inflammation has subsided and the root canal is dry, it is filled with so-called guttapercha points and a dense cement.
An X-ray is then taken to check whether the root is filled to the tip (apex) and the tooth is then sealed. If the inflammation of the tooth root occurs on teeth that have already been filled with root, more extensive therapy is necessary. This can happen, for example, if the root of the tooth is very crooked or not completely drained.
The treating dentist will probably perform a so-called root tip resection or remove the existing root canal filling and prepare and fill the tooth again.In a root tip resection (apectomy), the root tip of an inflamed tooth is removed. This is a surgical procedure that should be performed by a dental surgeon. The removal of the root of the tooth may become necessary in the course of an inflammation of the root if the attempt to preserve the tooth by means of a root canal treatment has failed.
The chance of saving the tooth by such a root tip resection is 90 – 97%. During the operation, the gum is opened in the area of the diseased tooth, after which the surgeon opens the jawbone with the help of a so-called ball cutter (osteotomy). This gives the surgeon a good view of the tissue to be treated and allows him to separate and remove the inflamed tip of the tooth root.
A so-called retrograde root filling is then performed. Retrograde means that the filling of the root canals does not start from the crown of the tooth, as is usually the case. The insertion of the guttapercha points is done starting from the separated root tip.
This has the advantage that the root canal filling starts exactly at the end of the tooth roots. The jaw must then be closed again, for this purpose 2 – 3 stitches are sutured. During a surgical apicoectomy, the nerves can be damaged, which is manifested in the patient by loss of sensitivity in the lip area (numbness).
In addition, as with any operation, bleeding and/or wound healing disorders may occur. The patient is therefore strongly advised to avoid alcohol and nicotine after the operation. In the case of root canal inflammation, the pain can become so acute and intense that the only option is to remove the inflamed tissue from the pulp.
The dentist numbs the tooth, drills a hole into it and manually removes the nerve from the root canal with hand files. This treatment can still cause pain as it is difficult to anaesthetize inflamed tissue. In case of inflammation, the pH of the gums is acidic and the anaesthetic cannot work well in this environment, which can cause pain during the treatment.
Even if the nerve has been completely removed from the inside of the tooth, the patient may still feel pain during the following root canal treatment. When treating root canals, the length is measured and the tooth is prepared along this length. If the dentist comes to the measured end of the root tip, the patient may feel an unpleasant pulling sensation.
Although the nerve tissue has been removed from the inside of the canal, there may still be nerve tissue directly underneath the root tip that is intact and causes discomfort to the patient if the slightest irritation occurs. In this case it is necessary to anaesthetize the tooth. It would make sense to anesthetize directly into the root canal, which does not cause the patient a long lasting numbness of the cheek and lip, but only locally anesthetizes the nerve tissue.
This form of anaesthesia is often completely sufficient for the treatment. In the treatment of an inflammation of the root of the tooth, a supportive drug administration of an antibiotic is certainly debatable, but in which case is it useful? Acute root canal inflammation, which is symptomatically accompanied by an accumulation of pus or a developed abscess, is almost always treated with antibiotics as a supportive measure.
In the case of an abscess, there is a risk that this swollen, encapsulated accumulation of pus will spread to surrounding vessels and thus enter the cardiovascular system. In order to prevent the bacteria from reaching the heart and damaging it, it is advisable to administer the antibiotic to kill them as quickly as possible. Further the prescription of an antibiotic should take place, whom a weakened immune system, as well as previous illnesses of the heart and primarily the heart valves (see: Heart valve illnesses) are present.
But which antibiotic class is best suited for this? Antibiotics can be roughly classified by their mode of action. All subgroups fight bacteria, but one group only prevents the proliferation of microorganisms, they are called bacteriostatic, while the other, bactericidal antibiotics, inhibit the cell wall growth of the bacteria and thus actively destroy them.
Antibiotics that have been proven to be effective in dental root inflammation are mainly aminopenicillins, which are bactericidal antibiotics and belong to the class of penicillins. Aminopenicillins include amoxicillin and ampicillin.These are broad-spectrum antibiotics, which means that many different bacteria are fought simultaneously. Since one does not test in advance which bacterium is individually responsible for the inflammation, the aminopenicillins have proven to be the most important antibiotic in the treatment of dental root inflammation.
However, as with any antibiotic therapy, there are some side effects that can occur. It is possible that also the intestinal bacteria that are “good” for the human body are destroyed by the antibiotic and that diarrhea and digestive problems occur. Overdoses cause seizures, so the exact dosage must be strictly adhered to.
Furthermore, a relevant part of the population is allergic to penicillins and administration of one of these subspecies can lead to an allergic shock which can be life-threatening. In order to avoid this so-called anaphylactic shock, all allergies must be stated in the doctor-patient consultation. If new ones are added, they must be reported to the dentist immediately.
In the case of allergic patients, the dentist must order a substitute preparation. Clindamycin is often used for this. Clindamycin belongs to the group of bacteriostatic antibiotics and inhibits the reproduction of bacteria, but does not kill them.
It is effective against the bacteria that cause tooth root inflammation and has been tried and tested as a substitute for infections in the tooth and jaw area. Clindamycin also causes nausea, vomiting and diarrhea more often due to the weakening of the intestinal bacteria and can rarely lead to liver damage. Despite these side effects, the dentist has to weigh up whether surgical treatment or root canal treatment alone is sufficient to kill the bacteria, or whether there is a risk that the bacteria could quickly infect the cardiovascular system and thus lead to serious heart damage.
It is extremely important that the patient adheres strictly and dutifully to the dosage in order to maintain the effectiveness of the antibiotic and to leave no chance for intolerances and allergies. The so-called resistances frequently develop as a result of the antibiotic being taken off too early or the patient taking the wrong dose, since not all bacteria are destroyed in this way and those that survive can get used to the antibiotic, remain in the body and multiply. Therefore, an antibiotic can quickly relieve the symptoms if taken correctly, but can also have bad consequences if taken incorrectly.
Household remedies are often the first opportunity to take something yourself before consulting a doctor. Whether the best-known household remedy is clove oil or others like rosemary leaves, all household remedies are suitable for local application, for rinsing the mouth or for chewing. Rubbing them into the mucous membranes can relieve pain and improve redness in case of swelling.
However, these household remedies do not reach the actual location of the problem below the root tip. They can only soothe the gums from the outside and are therefore not advisable for the sole treatment of root canal inflammation, as they do not fight the bacteria at the root tip. Nevertheless, the calming effect of clove oil and rosemary juice has been known for centuries and a supportive rubbing in of the swollen, reddened gums can certainly alleviate the symptoms.
Nevertheless, the use of home remedies should be discussed with the dentist, so that the use of home remedies remains healing-promoting and contributes to a quick recovery. Homeopathy is becoming more and more popular these days and for some people it is the new all-purpose weapon against any kind of pain. Naturopathy is also often used to fight tooth pain caused by inflammation of the tooth root.
But is homeopathy alone sufficient to cure the disease completely? The wonder weapon in homeopathy are globules. The small globules are supposed to help against many diseases and are even harmless for small children, which is why many mothers fall back on them.
Globules consist of cane sugar and are put into a herbal tincture. In dried form, they can also help to counteract the inflammation process, relieve pain and reduce the swelling of the gums. The globules can speed up the healing process, but as the only therapy they cannot completely heal the inflammation of the tooth root, which is why root canal treatment is often unavoidable.In the case of root canal inflammation, globules with a potency of D12, which stands for a medium intensity of action, are mainly taken.
Preparations such as Belladonna, Arnica montana or Apis mellifica are only a few examples of globules that are used especially in the treatment of dental root inflammation. Homeopathy can be credited with the fact that the weakened immune system is also treated with globules and the body is thus restored to complete health more quickly. Although globules can be considered as a support for dental treatment, their use should be discussed with the dentist in advance so that the dosage can be individually adjusted.
