Root Canal Therapy

Some say that all “dead teeth” are bad. It is bad to keep a treated or untreated dead tooth in your mouth that is still infecting your body 24 hours a day. Bacteria, their toxins, and the inflammation products spread from dentinal tubules to the surrounding bone and into the bloodstream to the rest of the body. This is what occurs with traditional gutta percha filling material. It is true that with only the main canal(s) filled; most pain and swelling does subside.

It’s important to use diagnostic imaging and techniques to insure the condition of the tooth as well as the right option to treat the tooth.

Radiograph: an x-ray can show infection in the apex of the tooth. Where there may be unusual shapes and extensions of canal anatomy, a CBCT (3-D scan) may be recommended. Some infections may not be detected on x-rays.

Vitality Test: Electrical or temperature to test the response or lack of response from stimulating the nerve inside the tooth from the surface.
Muscle Testing: Applied kinesiology using the body’s energy reflex and acupuncture meridians to determine if a tooth may be causing dysfunctions within the body.

Review of current medical conditions: A review of current medical and health conditions as well as lifestyle preferences is done to ensure saving a sick tooth with a root canal is the right course of action. For some patients with major health conditions, it may be best to extract the sick tooth.

What remains unstopped is exposure to toxins produced from bacteria still living in the thousands of tiny pore (dentinal tubules) openings that reach from the root surface to the center of the tooth. These pores are too small to access and get into to be cleaned. Lasers may clean in a straight line within the canal. However, only the opening of the tubules that extend to the root surface within a straight line or 90 degree offshoots, but no further. This means the tissue and bone anchoring the root are still chronically infected from these tubules even after “successful” treatment of the root canal.

You should not consider root canal therapy for:

• Cracked root – just because a tooth is cracked, it does not warrant the need for root canal treatment. Only if the nerve itself is inflamed (and cannot be resolved) or the tooth starts to bleed.
• Medical practitioner (including naturopaths or functional medicine practitioners ) finds tooth too disruptive to your body’s overall health
• You simply would rather have it removed and rid yourself of the tooth (always better than keeping an untreated or treated, infected tooth)
• Sensitivity to all types of root canal filling materials

Alternative Treatment:

If it has been determined that the tooth is negatively affecting the body without a good prognosis, it may be healthier for the body to extract the tooth. There are options to replace an extracted tooth including removable appliance, fixed bridge, and nonmetal implants.

Root Canal Therapy

Inflamed or infected teeth are the most common reason for root canal therapy. This can be caused by deep decay, repeated dental procedures on the tooth, or accident/damage to the tooth. If pulp inflammation or infection is left untreated, it can cause pain, lingering sensitivity to hot or cold, and/or lead to an abscess.

• A digital x-ray may show the extent of the decay or abscess. It may be necessary to take one to fully diagnose.
• For your protection, a small protective sheet or “dental dam” is placed over the tooth to isolate and keep the area free of saliva during the procedure.
• A small hole is made in the tooth to access the inside of the tooth
• Dental files are used to remove pulp tissue and shape the canals to a point at the end of the tooth (apex).
• Continuous irrigation with ozonated water kills all bacteria inside the tooth (especially accessory canals). We never use chlorine bleach
• Some teeth have additional canals that may need to be treated at a subquencial visit.
• When a tooth is left untreated, calcification within the canals can occur. This creates blockages that are hard to remove and may require more time or visits.
• Once the inside of the tooth has been filed and cleaned, the tooth must be filled or sealed from the inside.

Re-treatment

The most common reason a tooth needs to be retreated is the return of bacteria inside the tooth. Because teeth have accessory canals or “dentinal tubules” bacteria can seep inside of the tooth.. This lingering bacteria can reinfect the tooth, especially if the seal is defective. However, retreatment can be the best option for some patients.

Retreatments are a labor intensive procedure. It includes:

• Tedious dissection and removal of pre-existing root canal filling material
• Removal of metal posts, if placed
• Removing additional calcified blackages
• Goes through the same irrigation and sterilization process

Root Canal Filling Material – EndoCal 10

• Again, the paste does not expand by volume, but moves linearly. Once in the tubules it sets up and seals the tubules. If it can be predetermined that cracks are present that extend to the roots, then root canal therapy will not be started or at least you will be informed of a decreased chance of successful treatment. You can then weigh the risk involved before proceeding. No matter what root canal filling material is used, if there are vertical cracks extending to the roots, it is a matter of time until they fail.
• Fill with Endocal 10, which is heavy calcium oxide. This wet paste is drawn into the tubules before it hardens from the main canal by “wicking” as in a kerosene lamp. This results in a very clean tooth then filled quite thoroughly both vertically and horizontally. This isn’t a perfect tooth but has the best chance to not contribute to the downfall of your teeth.

Restoring a Tooth after Root Canal Treatment