Root Canals

Of all the procedures we routinely perform, root canals seem to prompt the most worry and the greatest number of questions: Do they hurt? Are they effective? Are they safe?

A few myths about root canals come up again and again:

  • Myth 1: Root canals are painful.
  • Myth 2: Root canals don’t work.
  • Myth 3: Root canals are dangerous.

Before discussing these myths, we should first answer the question: what is a root canal? A root canal is a procedure that is done when a tooth is infected or abscessed. If you are experiencing pain in a tooth or pain when biting or chewing, have a “pimple” or swelling in the gums next to a tooth, suffer severe pain in response to hot or cold liquids or food, or have a tooth that is much darker than the others, you may require a root canal. During a root canal procedure, the area is carefully numbed, and the infected inside of the tooth is removed using specialized files. A series of rinses is used to ensure that the infected nerves, blood vessels, and bacteria are removed, after which the inside of the tooth is filled in with a rubber material called gutta percha. Root canals allow people to keep their natural teeth that would otherwise need to be removed. A root canal is typically less invasive and less expensive than removing a tooth and replacing it with a bridge or dental implant.

Now, onto addressing the myths.

Are root canals painful? No, root canals are typically painless. The myth that root canals are extremely painful procedures stems from that fact that many people experience pain before a root canal is done. A toothache is often a sign that the nerve within a tooth is diseased or dying and can be extremely painful. However, the procedure itself is most often painless. As mentioned above, there is often some tenderness after the root canal treatment, but it is usually much less than the original pain of the toothache. Unfortunately, people tend to associate the severe discomfort that takes place before the root canal as part of the whole process, and thus, root canals have gotten a seriously bad reputation.

Do root canals work? Yes, most of the time. While the vast majority of root canals are successful, as with any medical procedure, complications can certainly occur…and people tend to talk more about the failures than the successes. According to a large-scale retrospective study completed in 2009, roughly 88% of root canals are successful within a 10-year period. To put this into perspective, that’s around the 10-year success rate for a total knee replacement surgery. Furthermore, with increasingly advanced cleaning and filling materials, the percentage of success is certainly improving.

Are root canals safe? Yes, ABSOLUTELY! You may have heard about the so-called documentary “The Root Cause,” which was recently removed from Netflix after concerns about misleading content. The film chronicles one man’s journey to treat his vague symptoms of depression and chronic fatigue through a variety of fringe medical practices (including drinking his own urine!). Eventually, his explorations take him to a self-described group of “holistic” dentists, who suggest that his problems are being caused by a root canal that he had as a young man. The offending tooth is removed, and his symptoms resolve.

While the movie’s premise is certainly scary, its claims are based a handful of studies that were conducted more than a 100 years ago and that were definitively debunked in the 1950s, once modern scientific standards and appropriate controls were introduced. The “experts” interviewed in the movie suggest that root canals cause everything from cancer and heart diseases to chronic fatigue and anxiety. However, according the senior scientific director of epidemiology research at the American Cancer Society, there are no studies showing that people who get root canals have a higher risk of cancer.

In fact, large-scale population-based research actually shows that people with root canals have a lower risk of cardiovascular mortality or death from a cardiovascular condition. While this is almost certainly a simple correlation – people who see a dentist routinely and can afford to have a tooth treated rather than extracted are also more likely to be caring for their health more generally – it at least suggests that root canals are not harmful to health.

In summary, root canals are typically painless, generally successful, and extremely safe procedures that allow people to keep their natural teeth longer. They are less expensive and less invasive than removing the offending tooth and replacing it with an implant or a bridge. About 25 million new root canals are performed in the United States every year.

If you have any questions or concerns about this procedure, or any procedure that has been recommended to you by your dentist, please just ask us!

 References

  1. Easlick K: An Evaluation of the Effect of Dental Foci of Infection on Health. JADA 42:615-686, 694-697, 1951.
  2. Grossman L: Are Oral Foci of Infection Related to Systemic Disease? Dent ClinN Amer,749-63, 1960.
  3. Ehrmann E: Forcal Infection: The Endodontic Point of View. Oral Surg 44:628-34, 1977.
  4. Wu M, Moorer W, Wesselink P: Capacity of Anaerobic Bacteria Enclosed in a Simulated Root Canal to Induce Inflammation. Int Endodon J 22:269-77, 1989.
  5. Lockhard, PB, et al. Periodontal Disease and Atherosclerotic Vascular Disease: Does the Evidence Support an Independent Association? Circulation 2012; 125:2520-2544.
  6. Tezal M, et al. Dental Caries and Head and Neck Cancers. JAMA Otolaryngol Head Neck Surg 139(10): 1054-60, 2013.
  7. Fonzar F, et al. The Prognosis of Root Canal Therapy: A 10-Year Retrospective Cohort Study on 411 patients with 1175 Endodontically Treated Teeth. Eur J Oral Implantol. 2009 Autumn; 2(3):201-8.
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