"Why You Should Never Get a Root Canal!!!...unless, of course you need one."

"Why You Should Never Get a Root Canal!!!"

 

    Well, except for maybe a few reasons, that I explain below.  I will later explain why my title mocks a lot of other blogs or circulating articles on social media.  A quick word of advice to those individuals:  Don't use an excessive amount of punctuation.  It's juvenile and unprofessional.  Also, the God Father of dental research, Gordon Christensen, DMD, warned me about "W.A.F."

 

Worry.

 

Anxiety.

 

Fear.

 

    Any "doomsday" or mellow-dramatic title may clue you into the fact that you may not be reading a reputable article from a reputable source.  They are aiming for shock value, more clicks, more advertising money, etc. What are reputable sources?  Shockingly enough, Wikipedia is not one.  The Mayo Clinic, the American Dental Association, the National Institute of Dental and Craniofacial Research or other peer-reviewed articles utilizing evidence based dentistry or medicine are reputable sources.  The only way we can all have professional discussions is if we all pull knowledge from fair, unbiased sources.  Googling a bunch of blogs that favor one's opinion isn't a viable debate.  If you have distrust in the aforementioned organizations, I cannot debate some of these issues.  We will be like Mars and Venus!  It is good to be skeptical and raise concerns over certain issues.  But anecdotal occurrences and random blogs do not make a talking point.  I say this respectfully, and urge you to seek second opinions if you do not agree with a first opinion. 

 

 First up, what is a root canal? 

 

    When bacteria infiltrates a tooth and it goes deep enough, it may reach the nerve or pulp.  This deep infiltration cannot just be eradicated by systemic antibiotics.  Why?  The nerves, blood vessels and fluid operate on a one way street in a tooth.  Once bacteria invade the nerve, even in very small numbers, the tooth will eventually become painful or symptomatic.  It's like a closed pressure cooker of bacteria spreading.  The only way to make the tooth pain free yet functional at that point is to remove the nerve inside the tooth, disinfect it, and seal the chamber with a rubbery, bio-friendly material called gutta percha. The term "root canal" describes the anatomical area or tunnel inside the roots of a tooth that houses the nerve.  The presence or absence of a nerve will not adversely affect the day to day functions of a tooth.  Hot and cold thermal sensations will no longer be functioning from within the tooth.  A root canal tooth can still get decay -- so brush and floss. 

 

How successful are root canals?

 

Most studies show a 95% success rate for people of average health, non-smokers, while under regular dental care.

 

1. Decay has spread so deep that you are having unbearable symptoms: throbbing, chronically dully ache, sporadic sharp pain, lingering cold pain (more than just a few seconds) or the feeling of a very "hot" tooth that only ice cold drinks will resolve. In this case, a simple filing won't suffice.  As long as there is enough of a "shell" of tooth left, it will most likely be worth saving.
2. You want to be out of pain, but choose a more conservative, less invasive procedure.  The alternative to doing a root canal is getting a tooth extracted.  This is not always such a easy, painless procedure.  Especially if the tooth is acutely abscessed and you are swollen, etc.  There is an extended period of healing for bone and soft tissue versus getting a root canal.
3. You want to preserve your jaw bone. The only reason you have alveolar bone or jaw bone is because of the presence of teeth.  If no trees were on the side of a river, the soil would wash away, right?  Unfortunately, I see some elderly patients who had lost all their teeth by age 40 or 50.  As you can imagine, there is virtually no ridge of bone left on the lower jaw.  So even the most expensive "Cadillac" of all dentures won't be comfortable.  Eating and chewing with something that moves constantly and has no retention isn't a lot of fun.  I used to work in a nursing home periodically, and it  was very sad to see frail, elderly patients lose weight due to loss of teeth and poor fitting dentures.  Just get them some implants, you say? Depending on their medical status, that may be risky.  Also, implant overdentures are excellent compared to conventional dentures, but are very expensive.  Families have to pay out of pocket for these procedures at a surgeon's and dentist's private office.  They also have to pay for transportation of immobile patients.  Finally, there just may not be enough bone height and width to even do implants on an atrophied jaw.  The World Health Organization recognizes edentualism or loss of teeth as a physical disability.  This is especially true in our elderly population.
4. You want to choose a more economical option in the long run. Replacing a tooth via a dental implant or doing a bridge and cutting into teeth that may be perfectly healthy, is always more expensive than doing a root canal. Depending on the situation:

• Root canal plus a filling: $800-$1200.  If you need a crown, that may be an additional $1,000.
• Extraction at a surgeon plus sedation: $300 - $700.  If you have lost a lot of bone: a bone graft can add additional cost, but is a necessary procedure.  Placement of an implant, sedation again by a surgeon: $1,800 - $2,000.
• The fee from a general dentist for fabricating an abutment (what the "tooth" or implant crown sits on) and a crown: $1,600 or more.
• A partial denture to replace the teeth or tooth: $1,200 - $1,500.
• Brushing, flossing, keeping up with regular check ups every six months and periodic x-rays to hopefully avoid these scenarios: priceless.

Keep in mind that maximums per year for most dental insurances are $1,000 to $1,500.  So this money gets eaten up quickly with any of the above options. The fees I quoted are a generalization.  They may vary highly depending on the region, specialist, quality of work and needs of each patient.  I'm not getting into "fee wars" but feel free to call offices with general quotes for procedures.

 

 But I will be fair and say that there are a few reasons why you may not get a root canal. 

"I may not need a root canal if..."

 

1. The tooth is not restorable.

    Sometimes there just isn't enough solid foundation to build a house.  Would you spend a lot of money building a house near a sinkhole? No.  If you have a tooth that has had many fillings or the decay has gone far below the gum line, rendering only a sliver of natural tooth remaining, it is not wise to invest heavily in a root canal and a full coverage cap or crown.  Also, sometimes an endodontist will see a rather large internal crack in a tooth.  Most endodontists use powerful microscopes which allow them to see down the tiny canals of teeth.  If a tooth is restorable, it needs to have a cap or a crown placed (usually, not always) on top of it.  Studies have shown that if the tooth is sealed properly with a full coverage cap or crown, this is the best way to ensure longevity and success of a root canal treated tooth.

 

2.  There is significant bone loss compromising the tooth.

    Remember the house we were building?  What if we had a solid foundation, but the wood being used to build the house was hollow?  Still not a great long term prognosis.  Your periodontium, or your soft tissue and alveolar bone, is something we always need to address.  You could have no cavities, but if you have periodontal disease that is untreated, the teeth become prematurely mobile and eventually are lost because of lack of support. 

 

3.  You have rampant, uncontrolled decay.

    Now, let's build our house.  It's a wonderful, beautiful functional house.  However, all of the other houses in the neighborhood are foreclosed and vandalized.  So our property value is decreased exponentially.  In some patients who have gone through chemo and radiation treatments, or engaged in methamphetamine abuse, etc., we find extensive "wrap around" decay on nearly every tooth.  Every clinician must work with each patient individually to weigh whether or not one should invest money into saving certain teeth.  If the patient has been in and out of the hospital or has a nomadic lifestyle, they may not necessarily commit to long term follow through care.  So doing a more definitive treatment like an extraction or a denture, is wise.  This leads me to  the last point...

 

4.  You cannot or you have no intention of engaging in routine, preventive dental care.

    I can't tell you how many times I have seen patients who presented to our office with the chief complaint of "my root canal went bad."  Surely, there are times where the quality of work on a root canal can vary and can contribute to a root canal failing prematurely.  But this very rarely occurs.  As a side note, most root canals treatments at our office are referred out to endodontic specialists.  I do smaller anterior teeth and lower premolars.  I firmly believe that if you are a restorative dentist, you ought to spend most of your time doing restorative dentistry.  Of course this philosophy of care may differ if I were in a very desolate area and no other dental care providers could be found for hundreds of miles.

 

    Usually with the root canals that have "gone bad," there is untreated decay that grew and grew over months or years.  This decay spread to the root and caused an abscess or a fractured, non-restorable tooth.  Or sometimes the patient may still have a temporary filling with sterile cotton in the tooth.  We recommend getting a permanent filling in those root canal treated teeth within several weeks after the procedure.  A temporary filling is just that -- temporary.  So after months or years, I'm not shocked to see that it has worn down, or completely worn away.  Then you have a compromised tooth, unprotected, collecting food and debris, causing decay from within an already root canal treated tooth.  This is almost always a bad scenario for patients.  They either have to spend the money to have a re-treated root canal, or spend money for an extraction an implant replacement. 

 

    I'd be remiss without mentioning the importance of preventive and proactive careversus reactive care.  Except for trauma or severe cracks, root canals are not pure "destiny" for everyone.  At one time, an infected tooth was a tooth with a small, manageable cavity.  A relatively easy procedure would have been detected if routine dental care and exams had been done every six months.  A routine filling may be $200 - $400.  Now, a root canal and a crown may be about $2,000 and entail several longer appointments. Like any branch of medicine -- proactive care and preventive care is preferred over reactive care.

 

    And a final segment on what spun me into writing this article. 

 

    A few weeks ago, you may have spotted an article circulating.  The article was written by a Dr. Mercola.  He is a physician of osteopathy.  He is not a dentist.  I will save you the thirty minutes or so that I sacrificed to read it by summing it up.  He says that 97% of terminally ill patients have had root canals.  So by inference, we should believe that all root canals cause terminal illness, or at the very least, are bad.

 

    Please DO NOT google this guy or give him any more hits on the article.  I will re-capitulate a few things about who he is and why his main points are baseless and a bit reckless.

 

•    Dr. Mercola is an alternative medicine proponent.  He is a doctor of osteopathy, not a dentist or endodontist.
•    His main business venture seems to be the "Dr. Mercola Natural Health Center" in Illinois.
•    He was featured on Quackwatch.com due to FDA warnings (2005, 2006, 2011) for "unsubstantiated claims that clash with those of leading medical and public health organizations..."  Specifically, he suggested nutritional supplements could cure or treat cancer.

    So who is this modern day Henry David Thoreau?  A real cowboy of civil disobedience at its best?  Or self serving financial gain?  It's your call.  I'm not into name calling.

 

    One thing is for sure.  He has created quite a following by questioning established norms in medicine.  He's also created wealth and fame along the way. 

 

A few of the extreme claims from his article are listed below.  I may paraphrase, but I'm saving you from trudging through all the minutia:

 

    "Root canal teeth become one of the worst sources of chronic bacterial toxicity in your body."

 

    A root canal treatment debrides the infiltration of bacteria into the vital pulp.  It's a physical removal of the organic tissue within a tooth.  By removing the affected tissue, the bacteria have no "food" and are thus, obliterated.  A diluted solution of bleach is used to eradicate any remaining tissue and bacteria.  An aseptic, biological compatible, material called gutta percha is used to fill the canals, along with an aseptic sealer.  If words like "all natural" or "organic" get you excited, then this material is a party starter.  It's derived from the sap of a tree which produces a rigid, natural latex.

 

    Another newsflash: our bodies normally harbor tons of bacteria.  Most, kept in a delicate equilibrium, are favorable and necessary.  Your gut, colon, and mouth are homes to many bacteria.  They are necessary to the homeostasis of your metabolism and body.  So, my question is: what specific strain of bacteria is exacerbated by a root canal?  If said bacteria is proven to be present in significantly higher amounts in someone's jaw bones, has this bacteria infiltrated other tissues?  How can you accurately test this in vivo?  And what are the specific diseases or conditions that may arise from these chronic bacteria?  Until any of those questions are answered by a double blind placebo non-biased and reputable study, I'm kind of a skeptic.

 

    "93% of women with breast cancer have had root canals."

 

        Wow. Okay, that's a staggering statistic.  However, which study is he referring to? How many women were surveyed or studied? 10? 100?  With a disease that affects so many thousands of women each year, 1,000 or 10,000 aren't enough subjects to draw a general consensus. 

     If a cancer patient has had chemo and radiation, their salivary glands have been obliterated. That means they have no saliva, and no protection against buffering acids. The result? Decay spreading quickly and necessitating a root canal.

 

    If this were such a pervasive and daunting statistic, why have we not seen it studied by the many independently operated non-profit breast cancer research foundations?  These organizations certainly have no motive to sabotage or cover up true concerns like this. 

 

    Additionally, according to the National Cancer Institute, the average age of a woman with breast cancer is 61.  So the average woman with breast cancer is a baby boomer.  One thing that I can tell you anecdotally is that there are many, many baby boomer patients with root canals.  The older one gets, the more likely he or she is to have had a root canal.  What if I said an arbitrary statistic (even if it were proven by a reputable study) like:

 

    "50% of people with a hip replacement have deep fillings."  Therefore, by Mercola's logic, hip replacements must cause teeth to really decay at a fast rate.  No. 

 

    You cannot arbitrarily draw unrelated correlations like this.  I call it "selective statistic editing."  Making the foot fit the shoe instead of the other way around.

 

    "Leaving a dead body part in your body is not a good idea."

 

    We finally agree!  Except that, well, a tooth that has a root canal is not quite "dead."  We don't need to argue about the moral status of the dental pulp here.  However, without the pulp or nerve tissue in a tooth, it becomes more brittle, less hydrated, and lacks sensory ability to hot or cold.  It still "feels' and functions like a real tooth.  True, it is clinically "non-vital." 

     It is actually held in place by a ton of vital, connective tissue and ligaments while in the jaw bone - which are all vital.  Your hair is non-vital protein.  So, my wonderful locks should be plucked out of my head because they are a "dead body part?"  Sinead O'Connor must be INCREDIBLY healthy and progressive in her thinking then.

 

    On a serious note.  Mercola compares the "dead" tooth to leaving a non-vital fetus in the womb forever.  This is so offensive and wrong on so many levels.  I respect teeth - they are my livelihood.  But to compare a complex, ethical, and palliative dental treatment to a lost child in pregnancy, is no comparison at all.  For women who have gone through that sort of awful experience, the mere comparison takes advantage of deep seeded emotions.

 

    I really do believe that Dr. Mercola believes these accusatory statements.  I also believe that he realizes that he has found a cash cow in the industry of dietary supplements.  He is afforded the "luxury" of flying under the radar of the FDA.  But thankfully, he has been appropriately reprimanded for making claims that are a bit too egregious.  I respectfully disagree with him and wish that he would speak with respected and qualified endodontists before spreading more W.A.F.

 

"Rather than love, than money, than fame, give me truth."

Henry David Thoreau

 

 

 

 

 

Jacquline R. Owens, DMD, MBE