Root Canals

root canals

In the past, if you had a tooth with a diseased nerve, you'd probably lose that tooth. Today, with a special dental procedure called root canal treatment, you may save that tooth.

Inside each tooth is both the pulp and the nerve. The nerve is the vestige of the tissue that originally formed the tooth. Once the tooth has been in the mouth for a time, the functioning of the nerve is no longer necessary.

When a tooth is cracked or has a deep cavity, bacteria can enter the pulp. Germs can cause an infection inside the tooth. Left without treatment, pus builds up at the root tip in the jawbone, forming a "pus-pocket" called an abscess. An abscess can cause the pulp tissue to die. When the infected pulp is not removed, pain and swelling can result, though sometimes no symptoms occur despite the presence of disease. Certain by-products of the infection can injure your jawbones and your overall health. Without treatment, your tooth may have to be removed.

Treatment often involves from one to three visits. During treatment, your general dentist or endodontist (a dentist who specializes in problems of the pulp) removes the diseased pulp. Next the pulp chamber and root canal(s) of the tooth are cleaned and sealed. Posterior teeth (premolars and molars) that have endodontic treatment should have a crown placed in order to strengthen the remaining structure. Then, as long as you continue to care for your teeth and gums with regular brushing, flossing, and checkups so that the root(s) of the restored tooth are nourished by the surrounding tissues, your restored tooth can last a lifetime.

Most of the time a root canal is a relatively simple procedure with little or no discomfort, involving one to three visits. Best of all, it can save your tooth and your smile!

The following myths/truths in a similar format can be found at the American Association of Endodontics website. They are provided here for your educational benefit:

Myth #1—Root canal treatment is painful.

Truth—Root canal treatment doesn't cause pain, it relieves it.

The perception of root canals being painful began decades ago but with modern technologies and anesthetics, root canal treatment today is no more uncomfortable than having a filling placed. In fact, a recent survey showed that patients who have experienced root canal treatment are six times more likely to describe it as "painless" than patients who have not had root canal treatment.

Most patients see their dentist or endodontist when they have a severe toothache. The toothache can be caused by damaged tissues in the tooth. Root canal treatment removes this damaged tissue from the tooth, thereby relieving the pain you feel.

Myth #2—Root canal treatment causes illness.

The myth: Patients searching the Internet for information on root canals may find sites claiming that teeth receiving root canal (endodontic) treatment contribute to the occurrence of illness and disease in the body. This false claim is based on long-debunked and poorly designed research performed nearly a century ago by Dr. Weston A. Price, at a time before medicine understood the causes of many diseases. 

In the 1920's, Dr. Price advocated tooth extraction—the most traumatic dental procedure—over endodontic treatment. This resulted in a frightening era of tooth extraction both for treatment of systemic disease and as a prophylactic measure against future illness. 

The truth: There is no valid, scientific evidence linking root canal-treated teeth and disease elsewhere in the body. A root canal is a safe and effective procedure. When a severe infection in a tooth requires endodontic treatment, that treatment is designed to eliminate bacteria from the infected root canal, prevent reinfection of the tooth and save the natural tooth. 

  • Different types of bacteria exist.  The presence of bacteria in teeth and the mouth has been an accepted fact for many years. The mere presence of bacteria does not constitute "infection" and is not necessarily a threat to a person's health.  Bacteria are present in the mouth and teeth at all times, even in teeth that have never had a cavity or other trauma. Specific types of bacteria are associated with pathology.  Others are completely harmless.
  • Tooth extraction is a traumatic procedure and is known to cause a significantly higher incidence of bacteria entering the bloodstream; endodontic treatment confined to the root canal system produces much less trauma and a much lower incidence and magnitude of bacteria entering the blood stream in general.  When enough healthy tooth structure remains, saving the tooth with a root canal therapy procedure is a great course of action.  When inadequate healthy tooth structure remains, other options are likely to have a better long-term prognosis.  Trust Dr. Gifford to advise you.  If you want further confirmation, Dr. Gifford encourages you to see a specialist for a second opinion before seeking definitive care.  You should always feel comfortable with the decisions you make about your oral health.

But what about Dr. Price? This is a good example of how the Internet can give new life to long-dispelled theories. Believe it or not, the misinformation about roots canals that is found on the Internet is still based on Dr. Price’s century-old, discredited research. Dr. Price’s research techniques were criticized at the time they were published, and by the early 1930's, a number of well-designed studies using more modern research techniques discredited his findings. In 1951, the Journal of the American Dental Association (JADA) took the extraordinary step of publishing a special edition reviewing the scientific literature and shifted the standard of practice back to endodontic treatment for teeth with non-vital pulp in instances where the tooth could be saved. The JADA reviewed Dr. Price’s research techniques from the 1920's and noted that they lacked many aspects of modern scientific research, including absence of proper control groups and induction of excessive doses of bacteria.

As recently as 2013, research published in JAMA Otolaryngology—Head & Neck Surgery, found that patients with multiple endodontic treatments had a 45 percent reduced risk of cancer.

References