Root Canal Treatment (RCT)
As a biological dentist a lot of people ask me what my thoughts are on root canal treatment. I have done many root canal treatments in my career and I continue to do so even though there is controversy from some quarters on the practice. The origin of the controversy lies in the question of remnant populations of microbes in the dentinal tubules in root canal treated teeth and whether or not endodontic techniques adequately disinfect them or keep them disinfected.
The American Dental Association position on RCT is: "The effectiveness of root canal treatment is well-established. However, misinformation continues to circulate on the Internet that may cause patients to question the safety of endodontics." The IAOMT position is more nuanced, and asks t whether alternative materials and techniques can yield a more biologically acceptable outcome for those that wish to keep their teeth through RCT. Either way, it is important for a dentist to provide informed consent about the benefits and risks of RCT.
I work with each patient to find the right treatment for him/her and always start with the question: "How important is for you to keep that tooth?" I ask that question because each individual has different values. Decisions will affect people's emotions, and emotions affect people’s health.
When the nerve of a tooth is damaged, there are only two options: RCT or Extraction. An extraction is an amputation, the person can be affected emotionally if for them it is important to keep their teeth. On the other hand, there are some people that don’t care and would rather have the tooth extracted and replaced with a bridge, whether removable or an implant. I educate my patients about both procedures and their pros and cons and then let them choose the best treatment for their needs.
What is a root canal?
The root canal is a natural chamber inside of the tooth that houses the dental pulp, which is known as the tooth nerve. The pulp is responsible for nourishing the tooth and transmitting pain and sensitivity signals to the brain.
When do you need a RCT?
- Deep dental decay exists near the pulp or pulp is exposed.
- Traumatic tooth injuries have created fractures or cracks and compromised the root canal.
- The pulp or nerve is infected.
- Previous dental work, such as deep fillings, have created irritation.
Once the nerve is irreversibly damaged and you want to save the tooth, a RCT should be performed. There are different ways to clean the canal and different options on which material (gutta percha or calcium oxide) to use to fill the cleaned canal.
What does root canal therapy involve at our office?
A root canal procedure requires at least two appointments to be sure that the infection is fought properly. While the tooth is numb, a rubber dam (a sheet of rubber) will be placed around the tooth to keep it dry and free of saliva. An access opening is made on top of the tooth, and a series of root canal files are placed into the opening with constant irrigation comprised of ozonated water and a sterile solution. Canals are dried and ozone gas is inserted inside the canals. Ozone is a disinfectant that goes deep inside the tubules of the dentin. If tooth decay is present, it will be removed with burs and dental instruments. Once the tooth is thoroughly cleaned, it will be sealed temporarily with Calcium hydroxide (an alkaline material), and a temporary filling will be placed. At the next appointment, usually a week later, calcium hydroxide is rinsed with ozonated water. Ozone gas is inserted inside the canals and the roots are filled and sealed with special dental material (Calcium Oxide, pH of 10, which is an alkaline quicklime). A temporary filling is then placed to cover the opening on top of the tooth. One week later, if there is not evidence of infection, a crown (cap) will be placed. This will protect the tooth and prevent it from breaking, and restore it to its full function. After treatment, your tooth may still be sensitive, but this will subside as the inflammation diminishes and the tooth has healed. Many times the patient will need to take antibiotics and analgesics. You will be given care instructions after each appointment. Good oral hygiene and regular dental visits will aid in the life of your root canal treatment. Ozone gas for maintenance is recommended.
Complications. There are many things which can compromise the result, including:
- Resistant bacteria
- Unknown factors, that nobody can explain
- Fracture in the root
- Microscopic accessory canals impossible to reach or clean
- A broken instrument lodged in the root canal (a rare occurrence)
Further treatment could be necessary which means repeating the process of cleaning and filling the root, or it can involve surgery to treat the ends of the roots directly (Apicoectomy). On rare occasions, the tooth must be extracted.
If you decide to have a root canal at my office, I will explain the procedure in detail. If you want to have the root canal with gutta percha instead of calcium oxide, I will be happy to refer you to a specialist.
Recourses on RCT: