Endodontic Treatment

Is denervation the same as endodontic treatment?

Yes! The well-known denervation is the endodontic treatment!

In the center of the tooth and throughout its length – from the molar to the tip of the root – there is a cavity where the pulp of the tooth is located, also known as the “nerve of the tooth” and because most patients believe that during endodontic treatment it is removed , only, the nerve of the tooth, that’s why they called it “denervation”.

Endodontic treatment is the treatment, which is done with special micro-tools inside the tooth, when the pulp of the tooth is infected or dead in order to avoid the extraction of the tooth and to keep it in the mouth for many years.

Does endodontic treatment hurt? Is it painless?

No treatment, during its duration, does not hurt, since the necessary anesthesia of the area is always done. Pain can occur between endodontic treatment appointments and is often easily tolerated, it is essentially a discomfort when chewing.

When do I need endodontic treatment? What are the causes?

A tooth needs endodontic treatment when the pulp is either dead or infected. These usually happen when:

  1. The caries has progressed so far that when it is removed, the pulp is inevitably exposed or the lower layer is located very close to the pulp so that the microbial toxins have infected the pulp and inflamed it.
  2. A tooth breaks and the break is located very close to the pulp or the pulp has been exposed during the break.
  3. A tooth has been injured causing the pulp to die. A tooth can be “killed” by daily small blows (e.g. hit with a fork), by a strong collision (e.g. falling from a bicycle), by daily clenching of the teeth (bruxism).
  4. When a tooth presents with an abscess, severe swelling and pain. A tooth can swell because it is too damaged, because it is necrotic, or because it needs repeated endodontic treatment.

What are the symptoms that should lead me to the dentist for denervation? Can I also have a fever?

The most severe symptom that forces all patients to visit the dentist is swelling and pain. The swelling can often disfigure the patient’s face. Of course, when the symptoms are intense, a fever can also appear, especially tens . Also, something that should make us hasten our visit to the dentist is the appearance of a fistula. A fistula is a “pimple” from which pus drains into the oral cavity. Finally, pain when chewing and lying down are red flags.

What does a denervation involve? What is the process and stages?

Initially, it is done with special care and as painlessly as possible anesthesia of the area where the tooth to be treated is located. Then, with special equipment, isolation is placed on the tooth that is to undergo the endodontic treatment. Isolation is placed to avoid ingestion of micro-tools and antiseptic liquids, used by the dentist during the treatment and also to achieve maximum antisepsis of the area. Then all the caries is removed – if any – and a cavity is created in the chewing surface of the tooth through which the dentist will be able to seamlessly complete the treatment successfully. Once all the root canals of the tooth have been found,

Upon completion of the treatment, the restoration of the tooth is decided. Usually, endodontically treated teeth are particularly weak, so you decide whether to place a tooth case with or without the placement of an endodontic shaft.

How many appointments are made at the above stages? Can it be all in one?

Endodontic treatment on a tooth with living pulp can be completed in one appointment without any risk. Unfortunately, if the tooth is dead, we prefer to finish it in a second session, which is about ten days away from the first, to leave special drugs inside the root of the tooth so that the maximum possible antisepsis is achieved.

Of course, if the tooth is alive and the choice of restoration does not include the participation of the laboratory, all the above can be done in one appointment.

How long is each appointment?

This question cannot be easily answered because it depends on many things such as the position of the tooth, whether the patient is cooperative… On average, each appointment lasts about 45 minutes .

Will I still have discomfort after the treatment?

Pre-existing tissue inflammation may cause pain or discomfort for a few days after treatment is completed. These symptoms can be treated most of the time with anti-inflammatory or analgesic drugs. It is best to avoid chewing hard foods with the denervated tooth until the final restoration of the tooth is complete. In addition, in the first days after the end of the treatment, there may be some mild discomfort due to the high temperatures of the endodontic treatment materials.

Will I need to take antibiotics before and after treatment?

After the treatment you will not need to take an antibiotic, but the same cannot happen during the treatment in case you come to the clinic with severe swelling. You may also need to take an antibiotic if the inflammation flares up.

I have already denervated the tooth but it hurts, could the denervation have failed and need to be repeated?

If a long time has passed since the end of the endodontic treatment and the tooth still hurts then one of the possible causes may be the need to repeat the treatment. Fracture should also be investigated, which is a common occurrence in crownless (case) treated teeth. If, the tooth hurts while chewing, all of the above are possible, but we also need to check if there is any premature contact of the teeth.

I have a swelling in my mouth, do I really need denervation?

This question is very general and vague! Unfortunately, it can only be answered after a thorough clinical examination.

Can denervation be done without an injection?

The only case where the use of anesthetic is not necessary is when the tooth is dead . However, since an isolator is always used on the treated tooth, the most sensitive patients may need a small dose of anesthetic to avoid the mild tightening of the gums caused by the placement of the isolator gripper.

Can denervation be done in a wisdom tooth?

More generally, endodontic treatment of wisdom teeth is not a daily practice, however, when it is deemed necessary to maintain, for prosthetic reasons, wisdom teeth then treatment is performed on it. Endodontic treatment in a third molar is relatively rare and is done in exceptional cases (e.g. when it is a sole abutment ).

Can denervation in a front tooth be done without it turning black?

Of course, because the materials and techniques we use are such that we almost eliminate the chances of the treated tooth turning black.

If my chipped front tooth turns black, how do we treat it?

There are several ways to deal with the internal whitening of the tooth in a simpler and non-invasive way . Most of the time the result after internal whitening is the desired one. In very difficult cases, some facet or bezel may be needed.

During pregnancy and breastfeeding, can I have a denervation?

Dental work should be avoided during pregnancy or breastfeeding . But on the other hand, we don’t want pain or inflammation at all because serious problems can arise, that’s why we draw attention to women who have entered the process of having a baby to take care before becoming pregnant to have a dental checkup their. In case of need for endodontic treatment during pregnancy or breastfeeding, we intervene because the pain can cause labor and also the pregnant or breastfeeding woman cannot take antibiotics. More generally, because such conditions are easier to treat when there is no pregnancy (even if the patient is breastfeeding) a pre-pregnancy test is mandatory!

What about denervation in a baby tooth? Are they the same as adults?

Of course, the same things as those that apply to adults do not apply. Treatment in young teeth is called pulpotomy and is a completely different procedure compared to endodontic treatment in adults. In young teeth, the pulp is essentially removed from the molar chamber of the tooth only and not from the entire tooth, as in adults. Also, the materials used are completely different. Something to note is that pulpotomy, precisely because it is done in a completely different way than endodontic treatment, has a 50% chance of success and in addition, the new tooth should always be restored with a stainless crown.

I was told that after denervation I would need a shaft and case on top, why? Is it necessary to do this?

Usually, the teeth that need treatment are sufficiently decayed or damaged that they most often require a case and shaft. We can determine what prosthesis a healed tooth will need after the first appointment. If, despite all this, the tooth is not damaged, it can be restored with a filling . In any case, this decision is taken by the doctor after checking how much tooth is left after the end of the treatment and what this tooth is capable of supporting.

I have read that in the past dentists used materials in denervation that have been implicated in cancers, specifically silver (silver cones), what materials do you use in your procedures? Are they safe?

Granted, the silver cones have been retired for several years now, because they caused enough problems, but unfortunately there are still some fellows who use them. The materials we use in our dental office are state-of-the-art and completely biocompatible. They are clearly safe and according to all specifications.

How much does denervation cost? Is the price the same in each case?

The cost of endodontic treatment is not the same for all teeth. It is different because our teeth are also different. A tooth can be single-rooted, bi-rooted or multi-rooted, so the cost of the treatment depends on the number of roots in the tooth. In addition, repeat endodontic treatment costs more than common endodontic treatment. Finally, because each case is not the same as the rest, a treatment may need special materials and not just gutta-percha, so the cost of the treatment increases again. In short, the cost is not the same in every case and as you would understand from the above it depends on several things.