The Truth About Root Canals

Root canal treatment is otherwise known as endodontic therapy and involves the use of a filling to replace the damaged soft inner core of the tooth. As with any filling, the damaged part of the tooth is removed and replaced. Since the soft portions of the tooth reside in small canals within the root, only that portion is filled. Following this, a protective crown, is required to maintain the integrity of the tooth long term.  In the illustration below, notice the peach colored filling in the root canal system. The dark area at the tip of the roots represents a dental abscess which frequently is the reason to perform endodontic therapy.

The idea behind endodontic therapy is that the dead tissue inside the canals is removed along with the bacteria that have invaded the canals. The canals are cleaned and “sterilized” prior to placing the root canal filling material. The result is a canal that no longer contains dead tissue and bacteria and the abscess can then be healed by the body’s immune system. According to Ranya Faraj Elemam and Iain Pretty In their paper entitled “Comparison of the Success Rate of Endodontic Treatment and Implant Treatment”, endodontic therapy has a mean survival rate of 86.02 percent. That is a very good number when it comes to medical interventions.

So Why The Controversy?

Below is a close-up of dentin which makes up most of the tooth structure. We can see that it is quite porous. The holes are known as dentinal tubules, and they can fit bacteria three abreast within them. There are an estimated 3 miles of tubules in a tooth! There have been studies that isolate bacteria from the tubules, some of them produce endotoxins. That sounds pretty scary. But healthy teeth also can have the same bacteria cultured from them!

So What Should You Do If You Need A Root Canal, Or Already Have One?

Since the American Dental Association considers endodontic treatment the standard of care and it has a success rate of around 90%, I have to recommend it as one of your options by law. But let’s look at the situation a bit more closely. Success means no pain, swelling, or evidence of an abscess on an x-ray to the ADA. That does not mean that you have to agree with them. If you are worried that the dentinal tubules may harbor bad germs after you have a root canal, then maybe it is not the best option for you. Luckily, the tooth can be extracted and replaced with an implant, which has an even higher chance of success, and there are no tubules to worry about with an implant.

If You Already Have A Root Canal, What Should You Do?

If you already have a root canal and you are concerned, I recommend that you get the tooth evaluated by a dentist. They should take an x-ray to make sure there is no infection. I have a 3D unit in my office called a CBCT that I can use if there are any doubts that the conventional x-ray missed something. Of course, if the tooth is having symptoms in the absence of any evidence of trouble on an x-ray, I would assume that is a failing root canal in most cases, but there are exceptions. In short, if the dentist finds anything about the tooth such as swelling or pain, that is cause for concern.

There is one more thing that is VERY IMPORTANT, but most dentists are not looking for it. The presence of other chronic problems in the body may lead back to an infected tooth. There are many ways to determine if the tooth is contributing to problems elsewhere in the body. This is where my functional medical training comes in very handy. Suffice to say that if you are the type of person who is in very good health, I would not be so quick to suspect that a root canal is as much of a concern. On the other hand, if you are compromised medically, I would use more caution when deciding whether having a root canal is the right choice for you.

At the end of the day, you have to decide what is right for you, and work with a dentist who is willing to spend the time to thoroughly discuss all of your options so you can make the decision that is right for you.