‘You need root canal treatment.’ Could there be a more dreaded sentence? If you’ve been in that situation, you probably remember that feeling walking out of the dental surgery. All you’ve heard are bad things. Your tooth had been hurting and you had a sneaking suspicion that you had a problem with your tooth. But when your dentist delivered the bad news the reality hit home.
Root Canals: a confusing and scary topic
Root canal treatment is subject of much conjecture. Do you really need them? Are they safe? Can they cause disease elsewhere in the body? Are they really painful?
There’s no doubt that root canals are controversial. If you think you might need a root canal treatment, there’s no right or wrong answer as to whether you should get one or not.
That’s why you should know as much as you can so that you can make an informed decision.
Why do I need a root canal?
Inside each of your teeth is a live blood and nerve supply. This is called the pulp of the tooth. The hard outer shell of your tooth (enamel) is designed to protect your pulp. The pulp supplies nutrients, immune response and sensation with a bundle of vessels.
When your tooth gets damaged, like when decay burrows down close to the pulp, microbes can infect the pulp. An immune response is then set off in your tooth, which usually consists of a roaring tooth ache.
Root canal treatment is designed to treat the damaged and infected pulp inside your tooth.
If your tooth is infected, the only alternative to root treatment offered by a dentist is extraction. This resolves the source of infection and allows the bone socket to heal. But it has the obvious downfall of losing a tooth.
Diagnosis of root canal
Irreversible pulpitis refers to when the nerve inside your tooth is inflamed. It will present in the form of sensitivity to hot, cold, throbbing or just plain agony. The name itself implies that it is going through the process of dying. If you have one, your tooth will feel sensitive to hot or cold and painful to bite on.
Dentists will perform a number of tests to determine whether they think you have an irreversible pulpitis or not.
This is the difficult part about assessing the pulp of a tooth. Every case is different and sometimes it’s impossible to tell exactly what the symptoms are suggesting.
That’s the challenge that every dentist will go through before root canal treatment. It’s a process you are involved in, because it’s your tooth in the end.
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If you do go through with root canal treatment, there are a number of ways this can occur. Depending on the shape of the tooth before, the first session is usually when the dentist will drill an access cavity to the pulp of the tooth.
From here they will use long instruments to clean the infected material from the root chamber. This can involve use of a sodium hypochlorite solution (bleach) to disinfect the canal systems.
They then put a medicament (can be a mix of antibiotic and anti-inflammatory medication) inside the tooth and seal it up.
Dentists use different techniques to complete root treatments. Before undergoing root canal treatment, you should ask your dentist what treatment techniques they use and why.
How long will a root treated tooth last?
So, if you decide to go through with root canal treatment, will you keep the tooth for life? The short answer to this is no. Complications of root treated teeth are relatively common. These include re-infection (swelling and abscess), and fracture of the tooth.
Root treated teeth have varied prognosis. This can depend on the initial condition of the tooth, treatment outcome and final restoration. A tooth that has no previous infection will have a success rate of 98%. Teeth with an infection before treatment have a much lower success of 43%.
There are many other factors that can complicate a root treatment. The nerve canal inside a tooth can be a vast network. Currently, dentists are only able to fill 1-2 canals per root. This may leave infected parts of the pulp inside the tooth to cause reinfection.
Do you really need root canal treatment?
In the majority of pulp infections, infection and tooth pain continue due to the tooth losing its ability to mediate an immune response. This can result in constant and debilitating tooth ache.
Does that mean that every tooth that loses its nerve supply becomes infected?
Some teeth for instance will remain silent without pain and infection even through the nerve dies. If your tooth hasn’t had symptoms, it’s reasonable to wait and see if the situation changes before commencing root canal treatment.
Are there side effects of root canals?
There are many controversies surrounding root canals. Some include whether they have the potential to cause infection all over the body.
The most common side effect of root canal I see are recurrent infection. That’s where a failed root-canal gathers chronic infection around the roots and jaw bone. This will certainly have systemic burden for the patient and perhaps could link to other conditions.
The majority of root-treated teeth usually allow a person to keep their tooth for a number of years. I’ve seen patients have radiographic infection before treatment that resolves for many years. But it’s not all the time and the failures are hard to pick.
In terms of root-treated teeth that cause infection or other conditions of the body. I haven’t seen this to be the case. There are also many cases where root-treated teeth need to be removed due to re-infection
Should we be looking at potential toxicity of medicaments and components of root canal treatment? Absolutely, this should always be the case. Dentists will normally perform root canal treatment under rubber dam. This will improve isolation to any of the medications being used in the procedure and it should also increase the success rate of the treatment. However not all dentists use rubber dam for root canal treatment.
The final word
If there’s one main point to take from this article – it’s that a root canal treatment isn’t a black or white topic.
Firstly, you’re faced with root canal treatment, the good news is you do have some time on your hands. You have the option of weighing up your options for the short term at least.
When the pulp in your tooth becomes infected it means it can become a chronic infection risk. Root canal treatment may allow you to keep your tooth and avoid future toothache.
The most important thing is that an infected pulp is a long-term disease. Once a pulpitis arises, you and your dentist are left with very few, less than ideal options.
Always remember prevention and nutrition are the best way around root canal treatments!
Once the pulp in your tooth has died, the body has lost its immune control to stop infections in the tooth. Here are some ways that may help to manage or prevent your tooth from becoming infected. It requires having balancing your oral microbiome and your immune system.
- Eat plenty of prebiotic fiber.
- Take an oral probiotic to balance the oral microbiome
- Vitamins A, D, and K2 for mineral balance.
- Magnesium, Zinc and Vitamin C to balance the immune system
- Clove oil to manage and soothe the tooth infection
- Essential oils such as peppermint oil for anti-bacterial action.
- Plenty of fresh herbs full of digestive enzymes
Dr. Steven Lin is currently the Principal Dentist at Luminous Dentistry, a dental practice on the Central Coast of New South Wales, Australia, that strives to give individuals of all ages the best possible smile.
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