Holistic Root Canal Procedure
Are all root canal treatments bad?Interestingly, there is almost universal agreement within the dental profession regarding root canals about an important point everyone should be aware of, including every patient and health practitioner advising their patients about this complex issue: are all root canal treatments bad?.All dentists would agree; some root canal treatments are excellent………. and some are not.Some teeth lend themselves to doing a technically excellent root canal and others do notTo say all root canal treatments are ‘bad’ and should be extracted is an easy thing to say…. But it’s far more complicated than that, and the implications can be too.After 40 years of holistic dental practice, in my opinion to do what is considered a technically excellent root canal treatment is one of the most challenging procedures in our already very challenging professionIn one statement, not only have you eliminated what is arguably the most technically challenging procedure a dentist can do…. If done well. At the same time leading a patient into some very extensive and often very expensive dental treatment.Cost is another issue… both financial, biological and emotional.In my opinion if patient is concerned about either having or what to do with an existing root canal treatment:Assess whether there is any chronic infection present in the mouth, which includes tooth decay, gum disease or infections surrounding a tooth or in the jaw bone. NOTE: almost all chronic oral disease has NO PAIN associated with it.has healthy bone surrounding a tooth, evidenced by both 2D and 3D x-ray assessmentthe periodontal ligament, which attaches the tooth to the bone is intact, evidenced by both 2D and 3D x-ray assessmentthe patient has no local symptoms of pain or tenderness to touch or chewingthe patient is in otherwise good health with a healthy immune system.. then I would advise the patient to keep the tooth, make them aware of the potential problems, ensure that both their health and the health of the root canal treatment are monitored for their entire life…just as a comprehensive monitoring of all potential oral health disease (tooth decay, gum and periodontal disease and oral cancer) should be regularly monitored throughout life.I include financial cost too. Let’s say that patient keeps their tooth. The cost is zero. Let’s say that tooth, (or all) teeth with root canals should be extracted and an implant placed. The cost will be anywhere from $5000-10,000 per tooth.It gets even more complicated than that. Occasionally, within the same patient, with multiple root canals that by x-ray appearance seem in perfect health, the patient still feels ‘something is not right’. I will share with you examples of a patient where one seemingly perfect root canal needed to be removed, while the other seemingly perfect root canal treatment was left in place, and the patients’ health improved and remained that way for many years.I’ve often said, I wish I was more dogmatic; it would have made my professional life much easierIf you are already a bit confused you’re not alone.The point I want to make in this book ‘Root Canal Exposed’, is the complexity of the issue.There are many factors to consider. There are many ways of improving a person immune system which are far less invasive and costly. There are many health practitioners who know very little about oral health in general and even less about this issue, They are seductively drawn into a very simple message…”all root canal treatments are bad”.Some root canal treatments do need to be removed but some are fine.Weston A Price is often quoted as the source of this issue having done experiments on rabbits in the first half of the 20th century. Human teeth that were infected were extracted from the patients and then implanted under the skin of rabbits. The rabbits developed the same illnesses as the humans.A book was written “Root Canal Coverup”… I know the name is similar, I couldn’t resist… where the former found of the American Society for Endodontists (root canal specialists) George Meinig, after over 35 years of practice as a specialist, ‘discovered’ the work and wrote a book which reignited the issue that has been going on for over 80 years.Weston A Price divided groups of people into three categories: susceptible, not susceptible and acquired susceptibility. But there was an important point made by Meinig towards the end of the book. It was easy to miss but actually rather significant:... Price found that 25% of patients with family histories free of degenerative diseases who had excellent immune systems could expect to have and retain root canal fillings and to live without complications arising therefrom through old age\nThat was in the 1920’s and 30’s. I know what you are think… who in today’s world has a family history free of degenerative diseases? Not many of us, if the evidence is anything to go by.But this is where is gets interesting, and again is a direct quote from Meinig…“ Bystrom, Claesson and Sudquist reported in 1985 on the ability of camphorated paramonochlorophenol, camphorated phenol, and calcium hydroxide to kill bacteria that infect root canals ...............none of these three medicaments were mentioned by Price in the over 100 medicaments he studied”The ‘calcium hydroxide’ referred to is the most common medicament dressing used in root canal treatments for over 40 yearsSo In answer to the question…”are all root canal treatments bad?” the short answer is ‘it depends’.It depends on quite a lot as it turns out. If you are drawn to quick and simple messages, don’t bother reading on.But if you want to get a better understanding of the complexity then read on. I’ll cover some basics, go into of the literature that is used to defend root canal treatment… even that’s not so straightforward and give you a couple of examples of some amazing health recoveries from a more nuanced, less dogmatic approachIn order to answer the question…’are all root canals treatments bad?’ … it’s worth considering a similar but equally important question…’are all root canal treatments good?’.Put simply, every dentist would agree there is a very big difference between a root canal treatment that is technically excellent and one that is poorly done with residual chronic infection in place.How do we know if a root canal treatmentis needed in the first place?Inside a tooth there is nerve and blood vessels, called the ‘pulp’…its how the tooth grows in the first place, and offers some protections to the tooth, keeping it bathed in fluid.The pulp in the tooth can become infected from decay, or it can be traumatised from an accident or blow. Eventually the pulp (nerves and blood vessels within the root canal) dies and becomes gangrenous. Infection then spreads. There may be absolutely no pain, or it may be very painful. Pain is not the main indicator.Dead tissue sits inside the tooth and the bone surrounding the tooth, including the periodontal ligament that attached the tooth to the surrounding bone is lost. This appears like a shadow on an X-ray. Where health bone and periodontal ligament once was there is now pus and infected material…it shows up as a shadow at the tip of the root.To treat the infection, you have basically two alternatives:Root canal treatment: Locate the main canals > measure the length to the point at which it exits the tip of the root> enlarge the canals enough to use antiseptic solutions and dressing> then seal off the canals > review in 6 and 12 months> monitor long-term health of tooth and patient.Extraction: Extract the tooth and replace with a denture, bridge or implants….see “What are the alternatives to root canal treatment?”How do we judge if a root canal is successful?After the root canal treatment has been completed to a technically excellent level, an x-ray will be taken 6-12months after the treatment. Where there was a shadow, indicating loos of bone and periodontal ligament, the X-ray should show regeneration of both bone and ligament.It is generally accepted, and actually does seem quite logical that the regeneration of bone and ligament, which has a normal and healthy appearance, particularly when compared to adjacent healthy bone and periodontal ligament, is an indication of success.It is assumed that that bone and periodontal ligament regeneration is a good thing.It’s important to note that if the tooth is still sensitive or sore then there is probably some residual chronic inflammation and infection present, but it is the regeneration of bone and periodontal ligament that is the key to judging success.Patient 1: Left: X-ray of dental abscess, showing shadow around the root of the tooth( red arrows) indicating infection in the jawbone around the tooth.Right: X-ray of the same tooth 12 months after root-canal treatment, showing normal bone appearance.Patient 2:What is the difference between a technically good root canal treatment and a failed root canal treatment?Dentistry is extremely challenging technically. Working in the mouth, on a patient that is awake, trying to breathe and swallow is challenging enough. Root canal treatment, done well, takes it to another level and is one of the most challenging procedures in the dental world, if done to its highest standards. Many dentists refer the treatment to a specialist endodontist.Locate the main canals – this varies according to the type of tooth; A front tooth typically has one main canal. As we move further back in the mouth the anatomy of the root canals becomes more complex with 3-5 main canals. One of the challenges is that there are branches from the main canal and the challenge is to access these or reduce the bacterial load enough to promote healing. 3D cone beam x-rays are now routinely used to assess the anatomy of the canal in three dimensionsLocating the end of the nerve canal is important, to ensure getting antiseptics throughout the tooth/root structure. Now this is done with using an ‘apex locator’. Apex locators are electronic instruments used in endodontics that measure the impedance, frequency and resistance of the surrounding tissue (tooth vs periodontal ligament vs surrounding bone or infection) in order to locate the working length of the root canal to be treated. Correct determination of tooth length is a crucial factor for the success of endodontic therapy.Cleaning dentine – another challenge is that the tooth anatomy is even more complicated. The dentine (below the tooth enamel) is made up of millions of tubules, wide enough to house bacteria. As the canal is enlarged it is continuously washed out with a strong chelating agent (EDTA), which opens up the tubules, and a strong antiseptic (sodium hypochlorite – Milton’s) is used to wash out and clean the root structure. At the end of the first appointment more EDTA is placed to wash and open the dentine and another dressing, a powerful antiseptic, calcium hydroxide is vibrated through the tooth and sealed in place with a temporary filling. It is usually left for 1-3 weeks, or longer.Filling the canals – at the second appointment a few weeks later the dressing is washed out and again irrigated with EDTA and Milton’s, and then a root canal filling is placed with a calcium hydroxide cement sealing off the main canals to the apex (tip) of the tooth.Examples of poor root canal treatment are shown below:Example 1: Accessory canal unfilled and with infection still evident in the boneExample 2: Unfilled root canals with infected material still presentSame tooth from two different angle – unfilled canals and residual infection in the boneAre all root canals treatments bad?THE CASE FOR: If technically well done and healthy bone and periodontal ligament are visible on X-ray and 3D cone beam then root canal treatment is an excellent long-term solution which requires regular monitoring, as with all your teeth.Root Canals are safe provided they are done technically well done. Not all root canal treatments are the same. Root canal treatment is technically challenging BUT the measure of success is the regeneration of healthy bone and periodontal ligament, indicating that the infection has resolved and the immune system is working well. Bacteria exists throughout the mouth, in the gum crevice and in periodontal pockets. A healthy immune system together with a nutrient-dense diet, excellent oral hygiene and regular dental checks ensure good oral health is maintained.THE CASE AGAINST: Root canal treatments harm your health and compromise your immune system. No matter how well a root canal treatment is done there is always some residual bacteria and toxins left within the tooth and this poses a challenge to the immune system.Extraction of the tooth and thoroughly curetting the infected bone is the best option.In ConclusionTo effectively do an excellent root canal treatment is technically challenging.Not all root canals are the same. Some are excellent, some are not.By traditional dental standards the measure of success is the regeneration of bone and periodontal ligament.A patient’s symptoms and immune system still need to be considered even when there may be no obvious sign of infection.The alternative to a root canal treatment is extraction., followed by either removable denture, fixed crown and bridge work, or implant supported crowns.
