Root Canals

Root canals are often the result of a series of poor choices in dental care.

Decay is allowed to grow until it infects the nerve, or in many cases a very large fillings is placed where more protection of the nerve is required.  The result is a failure of the filling with a compromise of the nerve.  This is often a very painful emergency that requires a root canal with a new crown, or extraction of the tooth. Trying to hang on to a dead tooth without treatment is a very poor choice that results in an infection in the jaw bone and the risk of a life threatening infection.  These will virtually never heal without treatment.

It is a better choice to be proactive and protect the tooth with a crown placed in a timely way to prevent the root canal treatment, which is, at best, a compromise to your health.  It is important to note that not all root canals are successful.  Many of these teeth remain sensitive to chew with and just don’t feel strong. About ten percent fail to control the gross infection, and the tooth needs to be removed anyway.

Fractured teeth are another common cause for root canal treatment.

Similarly, these root canals can also be avoided if the fractures are noted by your dentist and the teeth are stabilized, or splinted with a restoration that prevents the uncontrolled fracture.

Root canals are becoming more and more controversial.  Not because ten percent fail, but even the successful treatments are not perfect. A root canal treatment removes the neurovascular bundle from the pulp chamber, or core of the tooth. The nerve serves a many crucial functions that are no longer fulfilled. It does more than feel hot and cold or pain.  We have recently learned there are many more types of nerve fibers than we previously thought.  Some serve as strain gauges, to give feedback on how heavily the tooth is loaded, others respond to different frequencies of vibration to alert us to different consistencies of the food we eat, to allow us to chew carefully if the food is gritty or too hard, and protect our teeth.

More importantly the the nerve keeps the root supple and free of bacteria.  It produces the nutrients, immune system components, and fluids necessary to nourish the root structure and keep it flexible, strong, and sweet. It pumps these fluids through a very intricate array of dentinal tubules to distribute these fluids throughout the root structure.  Dentinal tubules are very, very small and there are about a million per square millimeter of root surface.  Even the very best root canal cannot fill these tubules which then become stagnant and act as a sponge for bacteria. There is always inflammation associated with the roots of root canal treated teeth, even in successful treatments.  This inflammation is the source of the controversy over the risks verses benefits of root canal therapy.

A long term consequence of root canal treatment is often root fracture.

Much of the sensory function which allows us to modulate the stress we put on our teeth is gone with the removal of the nerve.  Also, the nerve was necessary to keep the root supple, strong, and free of bacterial infiltration; a root canal treated tooth is more susceptible to decay and dries out with time: it is much more likely to lose its strength. These factors combine to increase the risk of catastrophic root fracture. This explains why you are significantly less likely to have a devitalized tooth in your mouth in ten years.

There are many advantages to avoiding root canals.  It is expensive and not an experience you want to go through.While root canals are not always preventable, the need for this treatment can be significantly reduced with appropriate and timely dental care.