Young Bui
 |
PRIMARY PURPOSE for performing a root canal procedure is to relieve the
patient of dental pain. Unfortunately, certain aspects of the root
canal procedure sometimes introduce post-operative pain in the same tooth
that we are trying to repair.
The most common type of post-operative pain is hyperocclusal
pain. Fortunately, this is also the easiest type of post-operative
pain to prevent. Before initiating the procedure, reduce the occlusion
on the suspected tooth at least 2 mm or completely out of occlusion.
This reduction of the occlusion is very important if the tooth is a vital
one or if the patient has positive percussion pain at the start.
If that tooth is not going to be restored by a crown, then perform the
root canal procedure and reduce the hyperoccluded area, using space occlusal
paper to minimize tooth removal.
Another post-operative pain that can be prevented
is caused by stripping or perforating the apical constriction upon instrumentation
of the canal. By using an apex locator, you can easily detect the
anatomic apex and not perforate through it. In a vital tooth, perforating
the constriction will cause trauma and inflammation to the periodontal
ligament. In a non-vital tooth, perforating the constriction will
make it more likely that you will accidentally push the debris through
the apex and cause post-operative flare-ups.
A related type of pain is caused by excreting cement
or gutta-percha through the apex upon filling. If you use the SET
method along with the SafeSider® files, you can develop a greater-taper
canal. The taper will prevent the gutta-percha from extending past
the apex upon lateral condensation. If you then use the EZ-Fill method
of coating the wall with cement, you will prevent cement from excreting
out of the apex and thus prevent irritation of the apical tissues.
No matter how good your technique is, there will
always be inflammation of the periodontal ligament from any root canal
treatment because the tooth is constantly being disturbed in the socket
during instrumentation of the canal. This movement of the tooth puts
a lot of tension and stress on the periodontal ligament, causing it to
become inflamed.
Many of us prescribe analgesic medication for post-operative
pain, but we tend to forget about the inflammation. Analgesics will
provide comfort to the patient, but they will not reduce the inflammation
caused by instrumentation. This inflammation can be managed with
anti-inflammatory medications, such as ibuprofen. Six hundred mg
of ibuprofen together with 1 g of acetaminophen will provide both analgesia
and anti-inflammation for up to eight hours. This dosage is both
economical and effective.
May-June 2001
|
Unfortunately,
certain aspects of the root canal procedure sometimes introduce post-operative
pain in the same tooth that we are trying to repair.
|
