You wake up with the worst pain in your life. You’re not sure which tooth hurts, but it feels like your mouth stumbled into a bear trap over night. The pain is relentless, and you can’t think about anything else. If that describes your pain, then unfortunately, you probably need a root canal. I’ve been told by mothers who delivered naturally without an epidural that their tooth pain was worse. One prisoner who had been shot, stabbed, and beaten by a baseball bat, told me none of those things came close to his tooth pain. I’ve been fortunate enough never to experience this pain, and given what my patients tell me, I hope I never do!
What is a Root Canal?
Technically, the root canals are tiny tubes inside the roots of your teeth. Nerves, blood vessels, and other soft tissues live inside of these canals. What most people mean when they talk about a root canal is actually a specific dental procedure called Root Canal Therapy, or RCT for short.
When the soft tissues inside of your tooth become inflamed, there is nowhere for them to go. Like any other part of your body, the inside of your tooth can swell from inflammation. However, teeth are rigid. When pressure builds up inside of the tooth from inflammation, it kills the soft tissue inside of the tooth. As the nerves begin to die, they send off powerful pain signals to the brain.
Often, as the inflammation continues, the nerves inside the tooth will die. At this point, many patients report that the pain they were feeling eventually went away. Though this may seem like a good thing, it actually means that the tooth has died, and RCT must be completed quickly. Once the soft tissues inside the tooth die, they become food for bacteria. There is enough food inside the tooth to fuel an infection for years to come, and bacteria living inside the tooth are sheltered from the body’s normal immune response.
But I’ve Heard That Root Canals Are Bad
As with most things in life, there is a small but vocal contingent of alternative medicine practitioners and activists who believe root canals are harmful to patients. Many of them point to spurious studies from Dr. Weston Price, much of whose research made the most basic of all scientific blunders: no control group. The work of Dr. Price has led to many books and documentaries seeking to expose the dangers of root canals.
I’m no root canal evangelist. If a tooth needs to be extracted, I am more than happy to oblige. Truth be told, extractions are one of my favorite things to do as a dentist. I also happen to love placing dental implants. So believe me when I say this, I would rather pull your tooth and place an implant than save it with RCT. That’s the honest truth.
Now that I’ve cleared the air about my own inherent biases, I will add that my first responsibility is to my patients. My desire to pull a tooth and replace it with a dental implant are less important than the patient’s right to the best treatment option for them. In many cases, it simply makes more sense to save teeth than it does to extract them.
Dr. Price believed in a concept called Focal Infection Theory. This theory, which was more of a hypothesis in practice, is anachronistic. Modern dentistry has come a long way since the 1930s.
Do Root Canal Treatments Last Forever?
Truth be told, RCTs can and do fail. It happens all the time. In fact, any and all dental treatments can fail. This is why we ask patients to see us twice per year, not just to diagnose new problems, but to check on old ones too. So yes, RCTs can fail, and this can lead to further infection as critics will point out. However, dental implants can fail, and this can lead to infection. Importantly, your own teeth and gums can fail, and this can also lead to infection.
Nothing in dentistry is meant to last forever. We do our best, but nothing we can offer is better than what you were born with. That said, root canals should last a very long time. If you consume ~1,000 meals per year, then I would expect a root canal to give you at least 15,000 meals. However, this depends on many things going right. Did you get the crown your dentist recommended? Was the old crown replaced? Are you brushing and flossing? What were the circumstances that led to the RCT in the first place? What’s to stop the same thing from happening again?
Who Should Do My Root Canal?
Any qualified dentist can perform a root canal. However, not all dentists are comfortable performing them. These dentists will refer their patients too a root canal specialist called an Endodontist. Some general dentists are confident and competent enough to perform root canals on any tooth. But, most would rather refer out the root canals they aren’t comfortable with. If you would like to be seen by a specialist for your root canal, you have the right to request a referral to a specialist from your general dentist. In most cases, you can reach out to a specialist directly depending on your insurance requirements.
Why Not Place An Implant Instead?
Tooth pain can be excruciating, and this can lead patients to request pulling the tooth rather than saving it. When something hurts badly, the last thing most people want is to keep it around. But, that would be like cutting off a broken arm just because it hurts. Most times, when teeth are in good enough condition, RCT is the best course of action.
The simple fact is that dental implants, as amazing as they are, still aren’t as good as your natural teeth. You may have noticed that biting on hard objects causes your teeth to shift slightly. Teeth are suspended in an elastic joint that allows them to move slightly in response to forces. Dental implants don’t do this. Although the teeth that contact the implant will move like shock absorbers, the implant itself won’t budge. Because of this, dental implants can create forces that damage other teeth or surrounding bone if not designed and placed properly.
Save Your Teeth
When you have the option to save a tooth with RCT you should do it. If the long-term prognosis is questionable, your dentist or endodontist will tell you. But when saving the tooth will lead to many healthy years of chewing, it would be a mistake to pull it out. There is simply no replacement in modern dentistry that is superior to healthy teeth.