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RADIOGRAPHS

On radiographs, the differences in the mineralization of different portions of the tooth and surrounding periodontium can be noted; enamel appears more radiopaque (or lighter) than either dentin and pulp since it is denser than both, both of which appear more radiolucent (or darker).[7]

radiographsIn this radiograph, the dark spots in the adjacent teeth show proximal caries.
Proximal caries are the most difficult type to detect.[12] Frequently, this type of caries cannot be detected visually or manually with a dental explorer. Proximal caries form cervically (toward the roots of a tooth) just under the contact between two teeth. As a result, radiographs are needed for early discovery of proximal caries.[13]

REGISTRATION

The Health Practitioner Regulation National Law Bill (2009) will form the basis for a national Registration scheme beginning in 1 July 2010.

Registration Standards

Registration standards define the requirements that applicants, registrants or students need to meet to be registered. The Dental Board of Australia has developed the following registration standards:

ROOT CANAL THERAPY/ENDODONTICS

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If decay is very extensive then the nerve of the tooth may get infected.
Once this happens the only way to safely save the tooth is to remove the nerve. In this way the diseased pulp is removed, while you keep your tooth.

  1. With much decay or deep fractures the “nerve” inside teeth can become inflamed, infected or die and turn into pus. Root canal treatment involves the removal of the “nerve” or pulp inside a tooth in order to stop pain, eliminateinfection, prevent the tooth’s removal or much worse systemic spread
  2. The procedure usually takes one to three visits and is usually performed by a dentist but if very complex may be best treated by an Endodontist
  3. The canals inside the tooth are cleaned, sterilized then filled to seal them from future infection. The standard filling material is gutta-percha, a natural thermoplastic polymer of isoprene.
  4. In order to protect the tooth from fracture a crown is usually recommended. This on average improves the long term success by 600% by preventing fractures-  particularly dangerous are vertical fractures. If the tooth needs to be totally covered then by far the best crowns are gold crowns. This is because gold is extremely tough even in thin sections meaning less drilling of an already weakened tooth. Porcelain and composite can fracture but gold will never fracture and costs the same as porcelain.
  5. Pain. There is usually some fear associated with this therapy but with modern pain control the vast majority of Root Therapies proceed without pain. It may be more difficult to numb the tooth if the infection is acute(“hot nerve”)but there are techniques availableto achieve total anaesthesia. Occasionally there may be some discomfort after the procedure but this is usually due to the treatment and is temporary (one to two days). In such cases an antinflammatory analgesic such as Ibuprofen (Advil or Nurofen and for stronger pain Amcal Ibuprofen plus codeine or Nurofen Plus )
  6. Success rates exceed 90% (see footnote 1.). Failures can be due to:
    1. A canal that is missed - rare
    2. Accessory canal that cannot be accessed – lateral or branch canals
    3. Root fillings too short – canals may be calcified or tortuous
    4. Seperated or broken file tips - rare
    5. Root perforations – rare
    6. Inadequate sealing or packing – rare
    7. Recurrent decay – see oral hygiene
    8. Vertical fractures due to tooth weakness – most common reason
  7. Please note that an acute infection, where bacterial infiltration is minimal, has an excellent chance of success. A chronic infection, where anaerobic bacteria have established themselves within the tubules of the dentine and sometimes in bone may be more difficult to totally disinfect.  This means two things:
    1. Early attention is critical
    2. Alternative or “complimentary” advice (see footnote 2.)that recommends the automatic removal of a tooth without properly assessing the situation at hand should be questioned. Once bacteria is removed and the tooth is sealed there is no more infection. This can be confirmed by:
      1. lack of symtoms (no pain or tenderness)
      2. lack of signs (x rays and percussion testing)

Footnote 1.: “ a properly restored tooth following root canal therapy yields long-term success rates near 97% in this study large scale Delta Dental Study of over 1.6 million patients who had root canal therapy, 97% had retained their teeth 8 years following the procedure, with most untoward events, such as re-treatment, apical surgery or extraction, occurred during the first 3 years after the initial endodontic treatment.[9]
Footnote 2.:   “In the early 1900s, several researchers theorized that bacteria from teeth which had necrotic pulps or which had received endodontic treatment could cause chronic or local infection in areas distant from the tooth through the transfer of bacteria through the bloodstream. This was called the "focal infection theory", and it led some dentists to advocate dental extraction. In the 1930s, this theory was discredited, but the theory was recently revived by a book entitled Root Canal Cover-Up Exposed which used the early discredited research, and further complicated by epidemiological studies which found correlations between periodontal disease and heart disease, strokes, and preterm births. Bacteremia (bacteria in the bloodstream) can be caused by dental procedures, particularly after dental extractions, but endodontically treated teeth alone do not cause bactemia or systemic disease.[10] “

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Root canal procedure: unhealthy or injured tooth, drilling and cleaning, filing, rubber filling and crown

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Lower right first molar (center) after root canal therapy; the pulp chamber and root canals have been cleaned of debris, decontaminated and filled with guttapercha.

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Fractures of endodontically treated teeth increase considerably in the posterior dentition when cuspal protection is not provided by a crown.[6]

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