Endodontics (Root Canal Therapy) Is It Safe?

by drbress on January 24, 2010

I am often asked if it is safe to have a root canal done by a dentist and to keep a dead tooth in your mouth. Just hearing a dentist saying the words,  ”you need a root canal”, is enough to send most patients into a fear frenzy. This article will hopefully answer some of your questions, dispel any incorrect information and make your visits for this procedure more comfortable both physically and  emotionally.

Endodontics (root canal therapy) is the treatment in which the pulp (vital organ of the tooth within the internal canals of the roots) containing nerves, blood vessels and lymph vessels is damaged by decay through the hard tooth layers (enamel and dentin) into the pulp or by trauma to or fracture of the tooth. The tissue may become irritated, inflamed, infected and possibly abscessed.

Symptoms may range from sensitivity to hot, cold and chewing to severe pain and swelling. Irritation and inflammation may be reversed by more conservative treatment such as a bite adjustment or a filling.

Infection and abscess of the pulp always require endodontics to relieve the symptoms. The basic goal of Root Canal Therapy is the removal of decaying material, maintenance of dryness, cleanliness and sterility within the root canals and filling and sealing the root canals.

The procedure is usually performed in the following manner.

1.Tooth is anaesthetized.

2.For safety and in order to keep the tooth clean and sterile, a latex rubber dam with a small hole is placed into the mouth exposing only the one tooth.

3.The dentist gains access to the pulp with a hand piece (drill).

4.The exact length of the tooth is established using an x-ray, (preferably digitally taken) and/or a piece of equipment called an apex finder, which measures the value (frequency or amplitude) of electrical conductivity at the narrowest point of the root canal (apical constriction) to locate the apex (end of root).

5.Thin and flexible, files, broaches and reamers, either steel or now the mostly used, more flexible Nickel-Titanium (Ni-TI) either by hand or on a handpiece (rotary instrumentation) will remove the decayed matter, blood vessels and nerve tissue to the apex, then widen or enlarge the canal.

6.Sterile water or Hydrogen Peroxide or Sodium Hypochlorite is used to flush and clean out the debris, necrotic (dead) tissue and bacteria.

7.The canal is dried, then a cotton pellet with/without a medicament (preferably a non-toxic one) is placed in the opening disinfect or sterilize the canal the opening is closed with temporary cement between visits.

8.When the tooth is ready, the canals are permanently sealed by filling or packing with materials discussed later in this article.

This procedure takes one to three visits depending upon the number of canals, position of the tooth, and how damaged the pulp was.

The hard tooth structure of the root remains anchored in the bone. The hard tooth structure that is visible in the mouth is later restored with a filling or a post and crown dependent upon the amount of tooth that remains.

Historically, the safety of endodontics has always been debated. Some research has resulted in the focal infection theory, which states that it’s not possible to sterilize or seal all large and accessory canals. Anaerobic bacteria that remain create a toxic environment in and around the tooth.

The body’s response to the toxins and the ingredients in the root canal materials can be local or systemic, appearing as inflammation, infection, abscess, bone damage, or allergic or immune reactions.

There may be some health-compromised patients who may benefit from the removal of some endodontically treated teeth and there is a small percent of root canals that fail. However, removal of all non-vital teeth is not and should not be a dental or legal standard of treatment.

All root canal materials used have some chemical ingredients that may be harmful to some patients. In order to disinfect or attempt to sterilize the canal, medicaments such as eugenol (oil of clove) and formocresol (formaldehyde-creosote) are used. The latter is more toxic. Often none are necessary. Sterile water, hydrogen peroxide or sodium hypochlorite may be used to flush out canal debris. The former is the least toxic and frequently used , although the latter,used by most dentists is reported to have antimicrobial effects.

The most common materials used to obturate (seal and pack  ) the canal are a zinc oxide/eugenol cement (seal) and gutta percha (pack). Gutta percha is the refined, milky exudate of certain trees. When mixed with substances including zinc oxide, it becomes a pliable rubber. When heated in the thermoplastic obturation technique or in contact with oils such as eugenol, eucalyptol or chloroform, it becomes a moldable plastic or liquid which is packed or injected into the canal and will fill the space left in the canal.

More recently, Bioceramic materials, which include a combination of glasses, composites and silicates, and have been considered by some to be more biocompatible and effective, have been successfully used as a sealer along with Bioceramic coated gutta percha cones.

The least toxic material, calcium hydroxide paste, which is reported to have some antimicrobial effects, is used by some dentists to further sterilize and even to obturate the canal. Biocalex is a product that combines calcium oxide, zinc oxide and an ethyl/glycol/water liquid. Proponents claim that it is the most biocompatible material and that due to its volumetric expansion will most effectively seal the canals. Difficulty in controlling the delivery and placement of the material and the lack of appearance on an x-ray discourage extensive usage of calcium hydroxide products except in deciduous in deciduous ( baby) teeth.

In some of the products, there are stronger antibiotics such as tetracycline and chemicals like formaldehyde, which may cause a more severe physiological reaction. These products should not be used. Chlorhexidine, also reported to have some antimicrobial effects, can be used either alone or in mixture with Calcium Hydroxide, and may have some toxicity. Prior to proceeding  with endodontics, it is very important that you discuss the treatment with your dentist or endodontist and that you are clear about the materials that will be used.

Despite some research about the problems of allowing a non-vital tooth to remain, most dentists, including myself, choose to do the root canal procedure rather than to remove the tooth for the following reason. When you remove a tooth, a space may be left which needs to be restored using an implant or a non-removable bridge. In the second case, adjacent teeth on either side of the space may have to be included in any bridge that is constructed. Therefore, it is possible that further dental and medical problems will occur from the treatment and the the materials that have to be used.

Other than for orthodontic purposes or in situations where wisdom teeth need to be removed, there may be circumstances when a tooth is beyond repair and has to be removed. But, I believe that these situations occur in a small percent of cases and should only happen after careful diagnosis, treatment planning and consultation with your dentist.

  • http://www.kensingtondental.com/advtreat_invisalign.shtml invisalign London

    nice post for providing treatment…Really it is nice post for dentist

  • http://freedomfromdentalfears.com Dr. Dennis W. Bressack

    Thank you so much for your comment. I am glad that the site is a benefit to you.

  • Kevin Corral

    Just had a root canal done, was scared after reading all these posts on how bad it is, but I think i’d rather keep the tooth than take it out and need a bridge. This post settled my fears somewhat

  • Drdennis

    Thank you for your comment. I am happy that this post relieved some of your fears. 

  • Sydney

    First dentist said I need two crowns. Went to second dentist and was told I needed a root canal and a crown. After reading all the stories on root canals and how many fail and have to be redone only to have them eventually extracted. What a waste of money. I don’t know what to do. The first dentist started the crown procedure but couldn’t get my tooth numb. It was so painful. I think I’ll just have it pulled and get a bridge.

  • http://freedomfromdentalfears.com Dr. Dennis W. Bressack

    It is always difficult to answer a question about personal dental issues without doing an examination and having x-rays to look at. So, I will try to be general in my reply. First, it is always possible that you will get different opinions from different dentists. Second, sometimes depending upon factors such as the tooth, its position, root structure, diagnosis, dentist’s skill and patient pain threshold, it may be more difficult to numb a tooth. As far as root canals, it is preferable to do whatever you can to maintain a tooth, including root canals, which have issues, but are pretty successful. Third, If you choose to remove a tooth, an implant is often times preferable to a bridge.

  • http://www.facebook.com/RaynaUmer Rayna Umer

    I’m finishing a root canal tomorrow. These holistic websites have scared me to bits but I trust my dentist. The tooth was already dead and it’s been sitting in my mouth, dead, for acouple of years. (I was not aware of this but the tooth was chipped). My tooth probably was killed when it was shifted by my braces. Anyway, I feel a bit better. I’d rather keep that fron tooth! Especially because we’ve spent so much on braces!

  • http://freedomfromdentalfears.com Dr. Dennis W. Bressack

    Hi Rayna,

    Thank you for your comment. When the information given on “Holistic” webites is about the dangers of Silver Mercury Amalgam fillings or Fluoride, I believe that it is generally correct and true. But, because some information can be non-specific and sometimes presents an alternative viewpoint, it can “scare the average person. One example is advocating that all root canals are dangerous and teeth should be removed instead of saved. That philosophy can cause more harm than good. There are circumstances when a root canal can cause problems, but in the greater percentage of cases it is better and healthier to keep your own teeth. In my opinion, as you can see by my article, your decision was the right one.

  • Patricia

    I am very concerned about my daughter.She has always had weak teeth.Took very good care of them but by age 20 she now has 17 root canals and some do not look good on the x-rays.Minor infections etc.After reading they can cause heart problems and numerous other issues I am extremely worried and expect at some point she will lose teeth to infections.After reading different articles and the dangers of one or two root canals you can imagine my concern for 17.

  • http://freedomfromdentalfears.com Dr. Dennis W. Bressack

    Hi Patricia,
    I appreciate your concern. Without personally examining and diagnosing your daughter’s dental issues, knowing if she has any symptoms like swelling or discomfort, seeing the xrays or being aware of the skill of the practitioners who did the root canals and the technique(s) they used, and whether or not there are just fillings in the teeth or crowns were placed, it is very difficult for me to answer your question. It is possible that at some point, she may lose some teeth, whether due to infection or breakage, but unless her symptoms become severe, I would continue to observe.

  • Kevin

    I just had my last molar drilled to initiate the root canal process. The doctor prescribed amoxicillin (500MG). The DR did not tell me anything about the medication.
    I had a few beers each night and didn’t realize that is would reduce the effects of
    the Amoxicillin. After one week the Dr put in a metal filling to cover hole but my tooth throbbed and the filling was removed and replaced with cotton type material today.
    The Dr didn’t tell me that the tooth is still infected but I believe that is why the metal filling excited the tooth. Would an infection cause that?
    In addition to salt water rinsing, w
    will putting a small amount of hydrogen peroxide (3%) mixed with water and swishing it in my mouth help to kill the infection or will it make things worse?

  • http://freedomfromdentalfears.com Dr. Dennis W. Bressack

    Hi Kevin,
    As I say most often, I would have to see you, do an exam and take an x-ray before I could comment on your specific problem. In general, when a root canal is started on an infected tooth and it continues to throb even after antibiotics and closure, then it is proper to reopen the the entrance and place cotton. I don’t think that it made a difference what material was used to close the opening. The fact that it was closed did not allow proper drainage of infected material. Placing cotton allows drainage while keeping food out of the opening. I would stick with salt water rinsing.

  • SEDC

    thank you for this. i will be undergoing the procedure tomorrow and i’m trying to understand it as much as i can. your article is the most objective one that i’ve read so far. i dislike the articles that have nothing good to say about root canals since i feel that there should be some good in it (not just a money making scheme, as one article claims) considering that it’s a standard industry practice. your article allowed me to calmly understand the merits and the risks (and finally decide to go ahead with the procedure).

  • Julie

    I have a crowned molar (done 13 years ago) that had been sensitive to hot and cold for six months. Decay reached the nerves 4 weeks ago causing horrendous pain. It is now infected and the whole side of my face under the eye does not feel right and I cannot chew on that side at without causing pain. Antibiotics do not seem to be doing the trick. I have had M.E. for 8 years so have an impaired immune system. My dentist wants to do a root canal but I am wondering if the new all ceramic implants may be a healthier option for me. I would be very grateful for your opinion as I am rather worried about making the right decision.

  • jay

    Go to a dentist that will use Calcium Oxide and MTA. Also have them sterilize the roots via laser. I wouldn’t let gutta percha or any of those chemicals cleaners near me. If all else fails and the tooth needs to be removed I would go to a dentist who uses zirconium implant.

  • Ham

    ummmm… so it is safe or no?

  • http://freedomfromdentalfears.com Dr. Dennis W. Bressack

    Any dental procedure can have potential safety issues. In my opinion, the possibility of saving a restorable tooth outweighs potential risk inherent in some materials. Jay’s response below to Julie is a good one. When it comes to cleaning and sterilizing canal, the fewer chemicals used the better. Lasers could be good alternative. As far as obturation of canals, there has been a lot of research and success about using Calcium Oxide and MTA in some Endodontic procedures, but the question still remains whether or not they are long-term alternatives to gutta percha. If the tooth is non-restorable, then an implant is a good choice to replace it. Zirconium implants are a good substitute for the common titanium implants.

    For more information about the use of Calcium Oxide, please read the following article by Stephen Koral, DMD of the IAMOT (International Academy of Medicine and Toxicology).
    http://iaomt.org/wp-content/uploads/article_stragegies-for-biocompatible-endo.pdf

  • Danielle Lane

    My partner saw the dentist today, who suggested she have a root canal. After doing some research, I saw it is a 50/50 question on whether the procedure is safe or not. The question I have is; What is the benefit of keeping the tooth? I can most certainly understand the monetary portion for the buisness, but what is the actual benefit for the person?

  • http://freedomfromdentalfears.com Dr. Dennis W. Bressack

    Hi Danielle,

    Thank you for for question. I have written another article on this website that addresses your concerns.

    http://freedomfromdentalfears.com/to-remove-a-tooth-or-not-remove-a-tooth-that-is-the-question/

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