Although anyone would prefer not to have a root canal, most people understand that it is a necessary treatment to save a tooth when an infection reaches the "nerve" of a tooth. However, some people have reservations and concerns about root canal therapy. These concerns are discussed further below. Before discussing these concerns, I want evryone to understand that I do everything possible to prevent a root canal from being done in the first place. I prevent and avoid root canals for my patients in the following ways:
- Thorough examination to detect tooth decay before it infects the "nerve"
- Placement of medicated-herbal sedative fillings to attempt to
resolve pain and inflammation
- Placement of a well sealed and bonded permanent filling
- Removal of all decay and microscopic fracture lines in the tooth
- Use of ozone to disinfect the tooth
- Adjust the bite or occlusion on the tooth to attempt to decrease the
pain and inflammation
Even though I have avoided many root canals for my patients with the above therapies, the need for a root canal cannot be avoided if the tooth has either one of the following conditions:
- the infection from a cavity reached the "nerve" of the tooth
- the nerve of the tooth is irriversibly inflammed ("dying")
When one of these two conditions does not exist, simple conservative therapies as described above will allow the tooth to heal itself and avoid the need for root canal therapy. Being patient and conservative is the key to avoiding root canals when it is possible.
When root canal therapy is needed for a tooth and a patient refuses to do a root canal, the only option is to remove the tooth. The tooth can then be replaced with one of the following options:
- a titanium implant
- a non-metal implant
- a non-metal bridge
- a removable partial denture
For those who are concerned about root canal therapy (see below), you should know the following:
- I thoroughly clean the canals with state-of-the-art computerized
equipment and techniques (see below).
- I fumigate the canals with oxygen/ozone gas (see below).
- I fill the canals with biocompatible materials (see below).
Concerns About Root Canals:
Some people (a definite minority in the general population) feel root canals are bad for the health of the body and that they should never be performed. These people feel that if a tooth needs a root canal, the tooth should be extracted. People with less extreme opinions feel that root canals are acceptable as long as a "biological root canal" is completed. The arguments against root canals include:
Here is my take on the root canal controversy: First, there is a strong argument to remove a tooth that already had a root canal if it has become re-infected. But if a root canal is needed on a tooth for the first time, I would prefer to do the root canal. The techniques and equipment that we use are far superior to the equipment and techniques used for root canals years ago.
We no longer use manual root canal files for cleaning the canals, but rather computerized hand pieces that more efficiently clean the canals. In previous generations, root canal files where stainless steel. Today they are nickel titanium. These new files are sharper and more flexible. Even with all this new technology, problems remain concerning the tubules in the root canal.
Each root canal of a tooth has a main canal. The wall of the main canal has millions of microscopic tunnels that lead to the outside of the root. Bacteria can remain in these tunnels or tubules after a root canal procedure. We cannot get our files in each one of the tubes, and disinfecting solutions cannot penetrate all the tubules. To help reduce infection in these tubules I use ozonated water and oxygen/ozone gas in aditional to traditional antimicrobial agents. Ozone is a powerful antimicrobial and since it is a gas; it can better penetrate those tubes. I also apply oxygen/ozone gas on the outside of the root to sandwich the tubes from both sides for better infection reduction.
I still fill my root canals with gutta percha. Gutta percha is a very stable material. It does not break down at a level of any consequence to your health. No matter what material is in your body, if it is not breaking down on a molecular basis at any appreciable rate, it cannot hurt you (chemical stability). Fortunately, most traditional dental materials are extremely chemically stable and are therefore biocompatible.
In addition, gutta percha is inside the canal of the tooth. There is no blood circulation inside a root of a root canal tooth. With no blood circulation, the body cannot interact with the material. Also, before placing the gutta percha in the canal, I apply a sealer. The new sealants in dentistry are calcium-hydroxide based, so they are very biocompatible.
The argument that a root canal tooth is dead and will rot if left in your body is not true. The outside of the tooth is innervated with vital nerves, blood vessels, ligament and healthy cells that allow the tooth to function properly.
I want to make a comment about a filling material that is supposed to replace gutta percha as a more biocompatible material. It used to be called Biocalex and is now called Endocal. (Why the name change?). Endocal is calcium oxide combined with zinc oxide in a solution of ethylene glycol and distilled water. The concept with Endocal is that it is biocompatible, bacterialcidal and it expands in the root canal as it sets. Theoretically, the material will expand into to tubules and kill bacteria. First, there is no evidence showing how effectively it goes into the tubules. Second, Endocal fractures a significant quantity of roots when it expands (J Endo. 200 Mar;30(3):159-62). This results in the tooth having to be extracted. Needless to say I do not offer this root canal material in my office. Finally some dentist will fill root canals with calcium hydroxide as a final root canal filling. Calcium hydroxide does not harden and washes out of the root so it does not seal the root canal from the body. This will leave the tooth susceptible to re-infection.