When the nerve in a tooth dies, its waste products cause inflammation in the surrounding jaw bone. You often notice inflammation in the bone due to pain (even if the tooth is “dead”) at the exact location of the inflammation. In some cases after some time swelling of the gums occur next to that tooth. A bulge may develop on the swelling that pops open, causing pus to drain. That bump (fistula) usually remains, sometimes without you noticing it.
This is why the canal in the tooth where the nerve used to be needs to be cleaned and closed with a filling up to the root tip. This procedure is called a root canal treatment. The dentist will perfomr this treatment of will refer you to an endodontist, a dentist who specializes in root canal treatments. Simply put, an endodontist performs (complex) root canal treatments. If the complaint persist after a root canal treatment has already been performed, the dentist (or endodontist) can decide to redo the treatment or to refer you to a dental surgeon for a root end surgery.
Treatment
A root end surgery is performed under local anaesthetic. During the treatment you will feel some discomfort, but you will not feel any sharp pain. Next, an incision is made in the gums and the gums are pushed aside. The inflamed root tip is then removed, and the root canal is cleaned. A filling is then placed at the root of the canal. Finally, the wound is sutured usually with dissolvable stitches. An X-ray is often taken to check the result of the treatment. If root end surgery does not help or cannot be performed, the tooth will be removed. To fill the gap, an implant with a crown or a bridge can be used. The disadvantage of a bridge is that the jaw bone no longer has support and will shrink. An implant, however, assures that the jaw bone does retain its normal thickness and height.
