Root Canal Therapy | Intown Smile Studio

ROOT CANAL TREATMENT:

Lately, root canals have been in the spotlight of controversy. Documentaries, articles, and influencers deliver content pointing to bad outcomes from bad root canals. There is valid information presented in these pieces, and a person studying this information could easily be swayed into thinking that all root canals are bad. Good science does not support that all root canals are bad. Let’s take a deeper dive:

WHAT IS A ROOT CANAL?

PROS AND CONS OF ROOT CANAL TREATMENT:

When a tooth needs root canal treatment, the tooth infection or fracture has involved the nerve of the tooth, and the only way to save the tooth is with root canal treatment. With proper root canal treatment, you can avoid having the tooth extracted, and the tooth can continue to function in a healthy way for many years.

Some opinions say that due to removing the nerve from the inside of the tooth, the tooth is now dead, and root canal-treated teeth are necrotic body parts that we leave in the body. The nerve inside the tooth is not the only vital supply to the tooth. There is a periodontal ligament (PDL) surrounding the roots of all teeth, and the PDL is made up of thousands of nerves, blood vessels, and soft tissue fibers that continue to nourish the tooth even after root canal treatment.

ALTERNATIVE TO ROOT CANAL TREATMENT:

If root canal treatment is not an option, the alternative is extraction of the infected or fractured tooth. When a tooth is extracted, the bone in the jaw / socket around that tooth starts to dissolve. In addition, the teeth around the missing tooth can shift and lead to instability in bite alignment.

Dr. Estep’s $0.02
Having nerded-out about many aspects of dentistry throughout my career, this hot topic of root canals intrigues me. When information like this goes viral, it’s important to dig in to find the science.

Historically, root canal treatment success is in the range of 86%-98% over the first 10 years post-treatment. Success is defined as the tooth being free from infection and symptom-free. To evaluate for infection requires examination of the tissues surrounding the tooth as well as using imaging (x-rays, CBCT, etc) to examine the soft tissue and hard tissue that cannot be examined with the naked eye. Being symptom-free means that the tooth does not give the patient sensitivity or discomfort, and the tooth functions and feels like the other teeth.

Failure-rate of root canal-treated teeth is low (3%-15%) and can happen if the tooth fractures or if the tooth has a recurrent infection. A fracture is more likely to happen if the tooth is not fully restored and strengthened with a crown or onlay to fully cover the tooth after the root canal treatment. Recurrent infection is the most common cause of root canal failure. Recurrent infection is almost always caused by the initial root canal treatment being incomplete (the operator missed a canal or did not fill the root properly). When this happens, an infection can re-enter the tooth through the root and cause re-decay of the tooth. Often the tooth can be re-treated (making certain that nothing is missed) – and at that point, the tooth can still have a good prognosis and can remain infection-free and symptom-free after that point.

The root canal failures that are in the spotlight of hot topics are the teeth that were treated improperly from the first root canal. This is where my opinion shifts from the popular feed on social media. Many social media “news” outlets suggest that ALL root canals are bad. They are focused only on failed root canals and not successful root canals, and in doing so they throw the baby out with the bathwater. This mis-information is causing patients to take drastic measures without contemplating the negative health effects resulting from these measures. I have new patients coming to my office asking me to pull all of their root canal-treated teeth. These patients might have multiple teeth that had root canals in the past. When I ask the patient what they plan to do to replace the missing teeth, they are unsure. Many of these patients also refuse to have dental implants placed to replace the extracted teeth. Removing these teeth results in losing the supporting bone and structures around the missing teeth and the neighboring teeth. This could open a whole new can of worms as the patient now has more extensive and expensive issues to address.

Ultimately, choosing dental treatment is a very personal decision. A person has to weigh all of the treatment options, all of the material and information about the treatment they have seen or absorbed, their past experiences, and their current health in order to choose the best treatment path. At Intown Smile Studio, we help our patients weigh their treatment options with their personal variables to choose their optimal treatment.