Root Canals Explained
What happens when the pulp inside your tooth is damaged?
When the pulp is diseased or injured, your body will attempt to repair and heal itself. If it is unable to repair the diseased or injured pulp, the pulp dies. This is normally caused by bacteria gaining access to the pulp chamber, either through a fractured tooth or a deep cavity which can expose the pulp to the bacteria found in your own saliva. The presence of bacteria in the pulp causes an infection inside the tooth. Left untreated, this infection can abscess, (a buildup of infectious material (pus) at the root tip), eventually causing the pulp to die and the supporting bone surrounding the tooth will be destroyed.
What does Root Canal involve?
Root canal therapy attempts to save the tooth from having to be pulled by taking out the infected or diseased pulp from the tooth and replacing it with something that will not feed bacteria. The pulp chamber and root canal(s) of the tooth are cleaned, sterilized, and sealed to prevent re-contamination. Although the tooth is now dead, it fills some objectives:
- The tooth fills an otherwise empty space, where near or opposite teeth would shift. Shifting can cause teeth to become crooked or crowded, causing alignment problems that may eventually result in even more teeth being lost.
- Your natural tooth maintains the normal appearance of your teeth.
- You don't need to have a bridge put in. Bridges are normally expensive and also require extensive work on adjacent teeth.
Strengthening the Immune System
- Eliminate immune suppressors - stress, fried fat and processed food diet
- Begin a diet of raw food appropriate to your Metabolic Type
- Include green leafy foods like chlorella, garlic and barley leaf juice - these contain germanium which is beneficial to the immune system.
- The following herbs can help boost your immune system - Astragalus, Goldenseal, Green Tea, Milk Thistle, Echinacea, Hawthorn Extract, White willow (Exsula Iridesca)
Most restored teeth will last as long as your natural vital teeth. The reason for this is that as long as the root(s) of the endodontically treated tooth are properly nourished by the surrounding tissues, your tooth will remain healthy. It is somewhat of a paradox in that the average person thinks that a root canaled tooth is a dead tooth.
However, it is not a "dead tooth" as long as the roots of the tooth are embedded in healthy surrounding tissues that bathe the external surface and offer it nutrition. For this same reason a root canal tooth will only seldom turn black. If appearance does become a prime concern, the tooth may be bleached or veneered (by having a porcelain or composite facing placed over it). Most often, retention of the tooth and bleaching, veneering, or crowning are preferable to extraction and replacement with a prosthetic appliance (artificial tooth).
The Focal Infection Theory
Although there exists a great deal of controversy regarding the success of endodontic therapy, the controversy over endodontic treatment is not new. Beginning in about 1912, there was wide acceptance of the theory of "focal infection" which resulted in the wholesale extraction of both vital and pulpless teeth. It wasn't until well after World War II when improved x-rays, anesthetics, new methods and products lead to publication of first major alternatives to treatment along with the associated risks and benefits. Your record will be annotated, indicating these facts and that you do understand the proposed root canal treatment.
The main purpose of the dental pulp is to supply nutrients to the dentin as long as the tooth is alive. This is done through microscopic tubules in the dentin. To give you some indication of what is meant by microscopic, each tooth contains approximately 1.5 million tubules. As the living cells die and rot within the central pulp chamber of an infected tooth, this same phenomenon is happening within the tubules. In theory, root canal therapy attempts to completely obliterate and fill the main pulp chamber and canals. However, it is impossible to fill the millions of microscopic tubules. Once inside, the tooth bacteria can remain within the tubules growing and multiplying.
Dr. Weston Price, during the early 1900's, devoted most of his brilliant career to the investigation of the focal infection theory. His research, involving thousands of patients and rabbits, formed the basis for the over 220 articles and 3 major books. In essence, the focal infection theory researched by Dr. Price holds that it is not the bacteria that causes systemic problems, but rather the toxic chemicals produced from the necrosis and decay within the tubules, whether the tooth had been endodontically treated or not. As a consequence of the fact that there was no way to completely seal the apex (tip of the root) and the tubules, the need to extract both vital and pulpless teeth, when an infection was evident, became the effective treatment.
Further enhancing the beneficial effects of using these materials, calcium hydroxide is ultimately converted to calcium carbonate creating a wall of calcification at vital tissue, thereby sealing root apices and vital dentinal tubules. Moreover, in a 1993 study Georgopoulou and his colleagues demonstrated that calcium hydroxide was more effective than paramonochlorophenol (PMCP) in killing anaerobic bacteria isolated from infected root canals. As further confirmation of the tremendous bacteriocidal ability of calcium oxide, Cavalleri and associates in 1990 found that calcium oxide was more effective than calcium hydroxide for sterilization of the root canal and also for decreasing the recovery time of the lesion before final filling of the root canal. In their evaluation of 58 teeth, they found that calcium oxide resulted in perfect asepsis (absence of any germs) in the root canals.
The Calcium Oxide Option
Biocalex is a product that has been used in Europe for over 15 years in the treatment of infected dental pulp. The Food and Drug Administration (FDA) has given Future Dentistry, Inc. permission to market Biocalex in the United States. Similar, authority to market Biocalex in Canada was provided to Biodent by the Canadian Government. Biocalex is a product that uses calcium oxide (CaO), zinc oxide (ZnO) and a special ethyl glycol/water liquid. The calcium oxide's affinity to fluid, in this case endodontic liquids, results in a volumetric expansion (not volumetric increase) that causes penetration of the most inaccessible canals. Furthermore, when calcium oxide combines with water calcium hydroxide is formed.
Calcium hydroxide has been repeatedly demonstrated to be the most biocompatible material used in endodontic therapy. The change of calcium oxide + water to calcium hydroxide is due to the affinity of the calcium oxide for water. The reaction travels to the water and is therefore expansive. This results, amazingly, in a penetration of devital dentinal tubules, a phenomenon that does not occur with the initial use of calcium hydroxide by itself.
For a chemically sensitive person, endodontic treatment presents some very special problems because of the toxicity of the existing materials used in the treatment. In this regard, Biocalex has been evaluated and found to be highly biocompatible, by an independent testing laboratory (unpublished data). As no toxic chemicals or cements need to be used to sterilize or seal the canal(s), Biocalex offers hope to the patient with multiple chemical sensitivities (MCS) who might otherwise need to have the tooth extracted because of an inability to tolerate the materials that would be used to endodontically treat the infected tooth. If you should require any root canal treatment, this office uses Biocalex whenever possible as part of its standard endodontic treatment protocol.
We do have adequate science to substantiate the calcium oxide expansion protocol.
One problem with Biocalex is that it is not radio-opaque (does not show up on x-rays). Although Biocalex, with the zinc oxide added, can be seen on an x-ray initially, after conversion to calcium carbonate, it will look no different than the normal tooth structure. You won't be able to tell whether the tooth has been endodontically treated unless a gutta percha point was used as part of the final filling. It is important that your records show that Biocalex was used as the root canal treatment and that it is not radio-opaque after setting. A new dentist might look at an x-ray of your teeth and think that a root canal was never done.
Because microbes can change their form and function in response to a changed micro-environment within the tubules, they can go on living in spite of the altered oxygen and food supply. As they do so, they begin to produce various toxic chemicals, which have been shown to be harmful, sometimes being especially toxic to specific organs or organ systems. This phenomenon was confirmed in a recent 1987 study by Tronstad and associates demonstrating that anaerobic bacteria (bacteria not requiring oxygen to survive) were able to survive and maintain an infectious disease in periapical lesions of nonvital teeth. In a 1991 follow up study of endodontically treated teeth, these authors recovered microorganisms from periapical lesions of all examined teeth.
This raises an immediate question: If there are bacteria present from every endodontically treated tooth, why doesn't every root canal treated tooth become abscessed and fail? An oversimplification of the answer is that your own body's immune system is able to contain and neutralize the bacteria.
If Biocalex is so good, how come all endodontists aren't using it? It is slow in gaining acceptance because the protocol for its use departs dramatically from the way endodontics is taught in dental school. In dental school, students are taught to "compact" the root canal filling material into the canal to the greatest extent possible. The objective is to completely fill and seal the canal(s) and apex using filling material and chemical sealers and cements.
The use of Biocalex is diametrically opposite of this procedure. Because of the volumetric expansion and penetration of the calcium oxide, you cannot fill to the apex of the root canal. In fact, the recommended procedure is to only fill to within 1.5 millimeters of the apex, thus allowing room for the calcium oxide to expand to the apex and seal it and all the other lateral accessory canals. As a consequence, dentists, especially post graduate highly trained endodontic specialists, are very skeptical and find it very difficult to accept the concept, even though there is There are now a group of dentists around the country who are openly advocating the extraction of every root canaled tooth on the basis of the research done by Dr. Price. This is certainly a radical approach to solving a problem that appears to be limited to only about 10% of the total number of root canal treatments done. Furthermore, it certainly does not take into consideration the use of calcium oxide as a root canal medication in the treatment of infected root canals.
Much of the current confusion in the minds of the public about the efficacy of root canal therapy has been precipitated by the book "Root Canal Cover Ups" written by George Meinig, D.D.S., past president of the American Association of Endodontists. Dr. Meinig extensively cites the work of Dr. Price and concludes that there is a serious problem with root canal therapy and teeth that have had root canal treatment. This of course, is a major break with his own previous training and the policies of both the American Association of Endodontists, and the American Dental Association. Patients going to an "establishment" endodontist or dentist who does not subscribe to the focal infection theory are given a much different picture on the efficacy of root canal treatment. Here again, establishment protocols for endodontic treatment rely heavily on the use of some very toxic chemicals and cements. And although there is a 90% success rate formost endodontic procedures, it is still a scientific fact that using the existing endodontic materials and techniques, there is no way to totally seal the apex of the tooth and the dentinal tubules.
Using the word "existing" may be a misnomer because there is an existing product called "Biocalex" that is offering new hope in resolving difficult endodontic problems.
Endodontic treatment using Biocalex may be completed in one appointment or two. Endodontics has some mandatory minimum documentation x-ray requirements. You will likely get a permanent crown. If you are re-treating an existing root canal, whether to eliminate toxic materials or infection, the procedures and protocols remain the same.
During the first appointment, the infected dental pulp will be removed and the canal(s) may be filled, short of the apex, with only a mixture of calcium oxide and the ethyl glycol/water liquid. You will be scheduled for a second appointment within 8 days of the first appointment. Not adding the zinc oxide to the mixture at the first filling insures that the calcium oxide will not harden prior to the second appointment. However, this in no way affects the ability of the calcium oxide to do its job. It will expand within the canal(s), effectively eliminating any bacteria that may be present and insuring a sterile canal when the final filling is placed at the second appointment.
A temporary crown or covering will be placed at this time so that your bite is functional. At the second appointment, the material placed at the first appointment will be removed and the condition of the canal(s) checked. The final mixture of calcium oxide, zinc oxide and ethyl glycol/water will then be placed in the canal, once again ensuring that the canal(s) are only filled to within 1.5 millimeters of the apex.
You should be aware that, dependent upon the dentist's evaluation, a decision may be made to use gutta percha points inserted into the root tips.