Dr. Mercola, nationally known expert in holistic approach to well being explains the dangers of the root canal procedure…
Often we find that the earlier we tackle a problem, the easier it is resolved.
This is certainly so with cavities in teeth – they hardly ever go away, if we just wait, even though we might at times be tempted to believe that.
Fortunately most parents of small children are eager to handle any cavities they discover in their children’s teeth. But these teeth are often so small and cavities can not be easily discovered by the naked eye, especially if they develop between teeth – and flossing the teeth of a four-year old is not an easy task.
An additional factor in baby teeth is that cavities can develop rather quickly and virtually undetectable under the enamel. Only when this fragile outer shell collapses do they become obvious.
This might then look like this baby molar…
If this is a tooth that would fall out very soon it could be removed to save the child from any possible tooth ache, but if this tooth is still needed to keep the space open for the permanent tooth to grow into, it need to be saved. Extracting the tooth and then using a spacer to maintain the opening for the new tooth would probably the more costly and way more inconvenient solution.
If we are in the fortunate situation that the majority of the pulp and nerve are still savable, a pulpotomy can be performed (see the graphical explanation).
The following sequence of images shows how this procedure is performed.
Cavities in baby teeth progress faster and affect the nerve sooner than in permanent teeth. Long before a cavity becomes visible in a baby molar, it grows inside the dentin. Only when the overlying enamel collapses a “hole” in the tooth is revealed. The true extent of the cavity at this stage is usually three times as large as what it appears to be from the outside.
The following graphics by Dr. Sarkissian show this development and the treatment of this condition. A permanent tooth would require a root canal treatment at this stage, but for a primary tooth a laser pulpotomy is indicated which keeps the tooth alive.
You can read the article about a real-world pulpotomy to see this procedure performed on a child’s primary molar.
You can find more information on Dr. Sarkissian’s web site under
Services ->Laser Pulpotomy.
The old school of dentistry considers a tooth saved after a root canal procedure has been performed. It is true that a tooth can survive this procedure for many years, maybe even the rest of the life.
But looking at it a bit closer this perspective does not quite hold true. Although the outer shell seems to be hard as an inanimate object the tooth is a living part of the body. Fact is that the inner parts of the tooth contains living tissue that needs to be nourished to stay healthy. Once the root canal procedure is performed, removing nerve and blood vessels and filling the now empty cavity with an inanimate substance, the tooth indeed becomes an object that is no longer connected to body fluids that make it a functioning part of the body. It has become a dead object that is no longer renewed and protected by the body’s defenses. Bacteria entering through the tiniest cracks might cause persistent infections because there are no blood vessels any longer that would bring white blood cells to fight that infection.
Therefore a root canal should be only a very last resort and every effort should be made to save the inner living part of the tooth – the root canal.
The direct cap procedure is such an effort. The following illustrations by Dr. Sarkissian demonstrate this procedure.
1. HEALTHY TOOTH: A healthy tooth is covered by a shell of enamel, the hardest substance in the body. It is a complex organ comprised of all three embryological layers.
2. CAVITY FORMATION – EARLY STAGE: A cavity starts when bacteria in plaque produce acids which eat away at the surface of the enamel.
3. CAVITY FORMATION – DENTINE INVASION: As the cavity penetrates the softer dentine, it spreads like a wave and infects the microscopic tubes of this live tissue.
4. CAVITY FORMATION – DEEP DECAY: Very soon it approaches the nerve chamber, or the pulp, causing an inflammation which at this stage is reversible. This is when one feels mild pain or heightened sensitivity to sweets and cold.
5. DRILLING OUT GROSS DECAY: Treatment is initiated by removing the outer layers of decay with a slow drill.
6. LASER EXCAVATION AND DECONTAMINATION: The deep layers of decay are removed with the Waterlase® at lower settings, to avoid trauma to the nerve. There is no mechanical insult to the nerve, such as vibration, smearing or heat, which is the case when using drills. The infected dentine is thus removed completely, resulting many times in an exposure of the pulp.
7. EXPOSED PULP: If the nerve (pulp) is still healthy, it may bleed slightly. At this stage the exposure is treated like a wound. It is gently irrigated with hydrogen peroxide, followed with an isotonic homeopathic remedy.
8. DIRECT CAP: The exposure is gently covered with MTA, a cement well known for its biocompatibility and ability to preserve vitality of tissues with which it comes into contact.
9. CORE BUILDUP: The remaining cavity is then lined with a self-priming bonding agent without disturbing the MTA. After drying, the whole dentine surface is built up with a core of a flowable composite or compomer.
10. FINAL RESTORATION: The tooth is restored with an esthetic, tooth-colored bonded restoration, preferably an indirect porcelain inlay or onlay. The biomimetic principle is followed, which means that each part of the tooth that was restored, functionally mimics the biological tissue it is replacing.
It is obvious that at the first sign of a problem with your teeth we should go to the dentist and have him check the cause for this problem. Usually the hope that ‘it will go away’ does not come true – and the opposite happens – that things get worse and it might then be too late for a cure.
Tooth ache usually means that the nerves in the center of the tooth – the pulp – are being attacked by an infection. This is mostly caused by a cavity that remained too long untreated so that it penetrated the enamel, the underlying dentin and is now approaching the pulp.
The following illustrations show the progression and treatment of this condition.
Root canal treatment is carried out on a tooth which has a dead nerve, an abscess of the roots, or a painful and irreversible inflammation of the nerve. It involves making an access hole on top of the tooth, and removing the nerve tissue within the canals with special files. These canals are then widened and irrigated to remove any remaining infected tissue, after which they are dried and ultimately filled with a special paste, which is intended to seal the canal space.
There is a common misconception that because of the controversy surrounding root canals, many people avoid treatment of dead teeth despite the fact that these dead nerves act as a mini gangrene made up of the utmost toxic material. These teeth have to be treated at all costs.
Alternative treatment includes extraction of the tooth, which then necessitates the placement of a bridge or an implant to cover the space of the missing tooth and to restore the bite.
Root canal risks:
- Some roots, which are thin, bent, flat, or decayed may be perforated or fractured by the root canal procedure. This compromises the outcome of the treatment and the tooth might need to be extracted.
- Root canalled teeth are more brittle because they are dead and do not receive nutrition from the pulp. This makes them more vulnerable to fractures.
- Vertical fractures may develop in a root canalled tooth due to the propagation of an existing micro-fracture already present in a tooth that has had a previous root canal, due to a post placed to build the tooth up for a crown, or due to a heavy bite. Because a root canalled tooth is dead, the ligament surrounding it and suspending it in the bone is prone to inflammation, which may cause long-standing tenderness to biting.
Disinfection and canal treatment protocols:
- Laser disinfection by the Waterlase laser
- Ozone injection into the canals
- Irrigation with antiseptic liquids
Materials: We rarely use gutta percha in our office. The permanent filler materials we use are one of four options (three general and one special):
- ENDOREZ: a resin-based material. This material is known to seal the canal systems thoroughly and even bond to the walls with resin tags.
- ENDOSEQUENCE: A bioceramic material that is also very biocompatible and sets to a hard consistency.
- MTA: Mineral Trioxide Aggragate is extremely biocompatible, but we only use it for canals that are of certain size and accessibility.
- ENDOCAL: a calcium-oxide, zinc-oxide based material. Highly biocompatible, and known for diffusing through the canal systems and disinfecting large portions of the root structure. Due to its multiple drawbacks, however, Dr. Sarkissian uses it only in special circumstances, or only for the purpose of medicating the canals for 2-4 weeks prior to being replaced by another material.
Drawbacks of Endocal: it is not as visible as Gutta percha in x-rays, making it harder to distinguish between filled vs. non-filled portions within the root canal complex. This means that future dentists may mistake it as an insufficiently filled root canal, and many insurance companies may deny claims for reimbursement. The American Association of Endodontists disapproves of its use due to claims of a higher incidence of root fractures.