Root canal: the way to save a decayed tooth

By Frederick Womakuyu

WHEN Mary visited a dentist after suffering from severe toothache, she was told to choose between a root canal and tooth extraction. She chose to extract the tooth because it was cheaper.

A root canal is treatment used to repair and save a tooth that is badly decayed or infected. The president of Uganda Dental Association, Dr. Catherine Kabenge, says the cost depends on the type of tooth and place where it is carried out. “The cost ranges from sh100,000 to 250,000,” she says. However some dentists charge up to sh380,000.

Some people opt to extract their teeth due to the procedure involved in doing a root canal. The process which involves drilling, gagging and filling takes about a month. By the time the dentist is done, many feel like half their face is paralysed.

A dentist at Medik Clinic in Kamwokya, Dr. Samuel Kawuka, says after an anaesthetic has been injected around the infected tooth, a tiny drill is used to remove the top part of the tooth and expose the pulp.

The pulp is made up of nerves, blood vessels and connective tissue. It is found inside the tooth and runs to the jaw. The pulp supplies blood to a tooth and enables one to feel sensations such as temperature.

Kawuka says: “The canals or tiny pathways inside the tooth are cleaned. Medicine is placed in the area to kill germs and prevent further infection.”

Dr. Allan Mugimu, a dentist at Mulago Hospital, says the cleaned tooth area is sealed with a soft, temporary material: “Once the tooth is filled, a permanent crown may be placed on top. You may be given antibiotics to treat and prevent infection.”

When to have a root canal
Mugimu says teeth become infected when plaque erodes the tooth’s outer enamel, allowing bacteria to infiltrate.

“It can also occur when a tooth is damaged or when an artificial crown develops a small crack. If a filling is loose or a cavity poorly cleaned before filling, bacteria can infect the tooth’s core,” says Kagimu. He advises that when a tooth’s nerve centre is badly infected, the pulp must undergo a root canal.”

Failure to have one means the infection will spread to the bone around the tooth and it may subsequently fall out or in extreme cases, lead to cancer of the jaw.

Kawuka says root canal relieves pain or toothache associated with pulp infection. “It rids one of decay that can spread to other teeth. It also restores a smile to those whose teeth have been cracked.”

Dr. David Mabonga, a dentist at AfriMedic Laboratory in Mbale, advises patients to avoid tooth extraction where possible because it leads to gum recession and social stigma caused by missing teeth.

How to avoid a root canal
Mabonga says every six months, everyone should see a dentist who looks at the signs and symptoms of your teeth that could necessitate a root canal and advise you before it is too late.

He says when you feel pain as you eat hot or cold food, it is a sign that there is a serious infection, adding that if you have a toothache, you should see a dentist immediately.

Complications
Kawuka says 95% of root canals are successful and the pain stops.
“However, sometimes, a root canal is re-done if some of the infected pulp was not entirely removed,” he adds.

The Uganda Dental Association which is against the use of paraformaldehyde or sargenti fillings recommends gutta-percha, a resin from the isonandra gutta tree, to fill the cavity and permanently seal the root canal. Gutta-percha is a rubber like, waterproof substance.

Kawuki says dentists should discuss with their patients the entire procedure, risks and complications involved during and after each step of the treatment.

He notes that patients report pain during the operation when the anesthesia fails to completely numb the nerves in and around the infected tooth.

“Anesthesia may be affected by toxins released from pus that forms on the gums or at the roots when there is severe pain,” says Kawuki. “However, dentists are often aware of the presence of the pus prior to the procedure and will minimise its effects.”