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To Root Canal, or Not To Root Canal

My Philosophy Of Dental Care: Part 1
By R.S. Mayberry, DDS
General Dentist

Thirty-seven years ago, when I was in dental school, we were taught to go to lengths to save teeth. Often this meant dreaded, more than one visit root canal treatments where the area around the infected tooth is numbed with Novocain, and then the tooth is filed as clean as possible and filled with a bacteria killing medicated filling.

Then on another visit the area around the tooth is numbed again with Novocain and the tooth is ground and shaped for a crown, a messy impression is made of the tooth and an uncomfortable temporary crown is made and placed on the tooth for two weeks while the permanent crown is being made at a dental lab.

Then another visit is required, where more Novocain is used to numb the area around the tooth and the permanent crown is tried on and if fits is cemented with permanent cement over the remaining tooth. This kind of treatment can be a pain for everyone involved, dentist and patient, but it usually saved the tooth for some years to come for chewing and smiling.

Much of this has changed today with CEREC one visit, no gooey impression crowns, but other aspects described have remained the same.

In all of healthcare, dentists are the only health care providers that try to preserve a dead body part in the patient after completing their treatment. Root-canaled teeth are dead teeth, and all have a number of germs left inside when the treatment is completed. It makes little difference who or how an acceptable treatment is done; the main concern is how many germs are left inside the dead tooth when treatment is finished.

This is often not under the control of the dentist, but is a matter of when the tooth undergoes treatment. The inside of a tooth root has a main root canal, but to the sides of this main canal are millions of micro canals big enough to harbor germs, but too small to be filled like the main canal(s). These micro canals, or the main canals, are where these germs can begin to grow and multiply, eventually spreading and reinfecting the tooth causing an abscess or pus pocket in the jawbone. So, what happens when the tooth becomes infected again?

Often the recommended treatment is to start over with another root canal treatment; repeating the same multi visit regiment of numbing, grinding, filing and so on. Re-treatment sometimes buys more time for this dead tooth, but often it will become infected again sometime later with an unpredictable prognosis. When a tooth like this becomes re-infected again the next step is to surgically cut off the end of the infected root tip, what is called an apicoectomy. Sometimes this procedure buys more time, but often problems return and the offending tooth is finally removed.

There are patients who have invested close to $20,000 over a decade trying to save a single tooth like this. Situations like this are the reason I no longer recommend root canal treatment for the majority of my patients, especially when there is a much more permanent, successful, and lower cost option available.

To be continued…