In June last year,I wrote about Cheyenne,the 4 year-old girl whom I saw for dental fillings.(http://www.ismile.com.my/2006/07/)

Recently,I saw Cheyenne again for her regular dental check up.She has grown and is now a vibrant and talkative 5-year-old.She is no longer fearful to sit on the dental chair.She chats incessantly with me and she willingly opens her mouth for me to check her teeth.

All of Cheyenne’s 8 fillings are intact with no signs of marginal leakage around them and she has no new decay in her other teeth.Her oral hygiene is good,and I complimented her mother for putting in the effort to help Cheyenne maintain her oral health.Of course,Cheyenne was showered with loads of praises.

It brings tremendous satisfaction for me to see that when child and parent take the right advice and put it into action,the end result is always good for all.And in this case,I believe Cheyenne will continue to keep a good oral hygiene,will not have any major problems with her teeth in the future and the best thing of all,she will grow up with the knowledge that she needs to take good care of her teeth and she does not need to fear the dentist!

I am constantly swamped with questions about what a root canal treatment is all about.Endodontic treatment is the other term used for root canal treatment.

In order to understand what it is all about,we need to know the tooth structure and its make-up.Most of you will remember(or do you??) what you learnt in school about the tooth,which is made up of enamel,dentin and the pulp.The enamel is the outermost layer which has the dentin layer under it and in the center of the tooth is the pulp which contains soft tissue like blood vessels,nerve and connective tissue.

When the pulp becomes inflamed or infected,you would need a root canal treatment.The common causes of inflammation and infection of the pulp are very deep decay,repeated dental procedures,fractures and cracks.Sometimes when the tooth is traumatized due to a hard impact,the pulp is affected and it dies.This will show as a discolouration on the particular tooth.Pulp inflammation or infection,when left untreated,can caused severe pain and lead to an abscess.Sometimes,the tooth is just symptomless.

Pulpal pain of these causes are usually throbbing in nature.It may start off with pain which cannot be pinpointed to a particular tooth.It may feel like the entire side of your face is in pain,and it may even lead to a headache.This is called referred pain.An upper tooth infection can present as a lower jaw pain and vice versa.After sometime,you will be able to indentify the particular tooth because it will be very tender to touch,not to mention the fact that you jump when you accidentally bite on it.The pain can be spontaneous and lingering and usually triggered by hot and cold food or beverages.There may be an accompanying swelling on the gums just adjacent to the tooth.In most cases,some sort of pain relief is necessary and most commonly you would need to pop some over-the-counter painkillers for temporary pain relief.

Some of you may be able to indentify with what I have described.In simple English,its a blasted toothache and you NEED to see your dentist desperately.Unfortunately,there are still a large number of people who only visit the dentist when they have pain,and usually by then,the pain is quite unbearable.

When your dentist identify and diagnose the condition as a pulp infection,and the tooth is deemed restorable(your dentist will do all the necessary examination on the tooth and the surrounding tissues),then you will have to have a root canal treatment.The alternative to this,for long term pain relief is, unfortunately,tooth extraction.

During root canal treatment,your tooth will be isolated with a rubber dam,to provide a moisture-free and sterile environment for the treatment to be carried out.In most cases,thanks to the availability of anaesthesia,the treatment will be quite pain-free.Your dentist will then proceed to remove the inflamed or infected pulp tissue from the root canal or canals(depending on the particular tooth being treated).The canals will then be cleaned and shaped carefully to the correct length.Several dental XRays will be taken during the course of the treatment.Depending on the situation,your dentist may place medication in the root canals and you will be instructed to return for a subsequent visit to have the treatment completed.The root canal space will then be sealed and the tooth provisionally restored.

The first few days following the treatment,you may feel some discomfort to biting pressure.Your dentist will usually prescribe some mild to moderate pain killers for you to take when necessary.

Once the treatment is completed,you will need to have the tooth premanently restored.This very important because the long term success of a root canal treatment depends very much on a good seal from the oral environment and the tooth needs to be protected and restored to be fully functional.

Sometimes,when the situation is complicated and more difficult than normal,your dentist may refer you to an endodontist,one who specialises in root canal treatment.

If you read Shakespeare or have watched Hamlet(by Shakespeare),you would have read about or heard perhaps the most famous soliloquy in literature;”To be or not to be,that is the question“.It was Hamlet,the Prince of Denmark ,having found out that his father has been killed by his uncle who now sits on the throne of Denmark and has remarried his mother within a month of his father’s passing,was desperate and contemplating suicide.

Now,I am not about to tell you the story of Hamlet.I am not a literature expert.I have only read a children’s book on this title when I was a schoolgirl.However,everytime Shakspeare is mentioned,inevitably,you hear this famous  quote.

Can we say that for our teeth,”to save or not to save…” in the same desperation and urgency? We are in the age where we do not advocate extraction of the permanent teeth(even milk teeth,we allow them to come out in their own time) unless it is absolutely the last resort or in some cases,the tooth is absolutely non-functional.

We are all aware of the fact that we have only one precious set of permanent teeth which will emerge by the time we are around 12 years old,and they are meant for us to take care and use them till we meet our Maker.

It is imperative that you ask your dentist for options when a tooth is in bad shape and you may potentially need to have it removed.Take your time to think carefully before agreeing on extraction.Almost all the time,when a tooth is saveble,it is more economical to keep it (by having a root canal treatment done followed by a crown) then to have it removed.Once removed,you would need to plan to have it replaced either through a fixed or removable prosthesis.This is because everytime a tooth is removed,there is a space,and the other teeth will start to move.

Unless you opt for a denture,which is removable,any fixed prosthesis that is used to replace a missing tooth will almost always cost more.Examples of fixed prosthesis to replace missing teeth would be a bridge or an implant.

So do think thoroughly before deciding to extract a funtional tooth in your mouth.

Last school break,I went for a week long holiday with my family to Thailand.We had a blast!

We flew to Chiangmai (thanks to Air Asia for making travelling for big families like mine less painful for the wallet!),in-laws included, rented a van and drove towards Bangkok over the week,staying at different towns along the way.Then it was Air Asia again from Bangkok back home.

Here are some pictures to share…

Coffee with mum-in law              and       feeding the elephants

On the highlands of ChiangMai  

With the tribal people

And of course,food! glorious food!!

I am already looking forward to my next holiday