Biocompatible Root Canal Therapy
A discussion of common misconceptions, alternatives to traditional procedures, & our philosophy on this treatment
In the past year, root canal therapy has certainly made a splash in mainstream media. While some find this to be quite the hot topic, we find this to be a great opportunity to connect with our collaborative, like-minded healthcare providers to advance patient education on alternative therapies with the ultimate target being treatment of disease in a predictable, holistic way that supports optimal systemic wellness.
So where did this new interest come from?
Well we would attribute this to two things:
1) The public's growing dissatisfaction with the current healthcare system (or what we prefer to call "sick care system") that is focused on treating symptoms instead of addressing the root causes of these diseases
2) Netflix's documentary Root Cause
While many of our dental colleagues have bemoaned the deleterious effects of the biased stance on root canal therapy as presented in this documentary, we choose to see this as having an overall positive impact. No, we do not agree with all of the information in the is documentary. However, we find it immensely valuable that this film has prompted patients to take a more proactive role in questioning recommended care and getting alternative opinions to restore and maintain their health. For many years, this has been the initiative of patients who have invested time and resources partnering with integrative medicine doctors, but this has been the minority of patients in the system for the most part. But we are noticing that that is starting to change, which we think is a really great sign for the future of our society's philosophy on health and the system which has been created to maintain that health. So here's our view on root canals...
First and foremost, the BEST option is to prevent the need for a root canal in the first place.
This may seem obvious, but a common misconception among many patients is that they are "born with bad teeth" or they "inherited their family's bad genes and everyone gets cavities". This just isn't true. Unless you are amongst the ~0.0067% of the population (or 1 in 14,000-16000 children in the US) who develops this genetic abnormality of the dentition that makes you predisposed to decay, then you are not "born with bad teeth". More surprising than this might be the fact that brushing your teeth and oral hygiene is not the main determining factor as to whether someone will be prone to develop cavities or not. But in fact, one of the biggest determining factors is your nutrition.
This conclusion was originally proven in the 1930's with the work of Dr. Weston Price who travelled to both indigenous and civilized populations. His observations proved that people who ate a whole foods diet yet did not have access to modern day oral hygiene programs had drastically fewer cavities than those in port towns who were educated on the practices of dental care yet were living on the westernized, cariogenic diet.
For more information about this, we recommend his book Nutrition and Physical Degeneration, which provides a detailed account of his research.
In addition to good nutrition to prevent decay (that could ultimately lead to the need for a root canal), a patient's malocclusion can also be a contributing factor to premature tooth fracture and can also lead to the compromise of a tooth's nerve, inevitably necessitating root canal therapy or extraction.
The other main leading cause of potential need for a root canal would be trauma; in some instances, this can be prevented. For example, athletes in contact sports should be encouraged to wear a mouthguard to prevent trauma to the dentition and jaws. Children should be instructed to be careful. But we understand that sometimes trauma to the mouth cannot be prevented; so we need to have a well delineated plan to restore health and function.
Ok. So now that we are ideally on the same page about the best thing to do is prevent the need for a root canal in the first place, let's discuss what happens when we're at the point of no return: the nerve of a tooth has been compromised by trauma or bacteria.
Many holistic dentists have taken the stance that leaving nonvital tissue is always a compromise, and therefore, they unequivocally recommend extraction (or "removal") of the tooth and replacement with an implant, a removable appliance, or not restoring the space at all. Traditionally trained dentists and endodontists discredit this approach and think it is an ill advised approach to disease control and restoration of function.
Here's a little background on how we have developed our philosophy related to biological root canal therapy....
We are consistently staying updated in the most advanced research and publications related to this matter. And while root canal therapy has been shown in some cases to be a contributing factor to chronic systemic inflammation, we agree with the stance from The International Academy of Oral Medicine and Toxicology that there is currently insufficient data to support the complete abandonment of this therapeutic option.
However, we also do not agree with the traditional approach to this therapy, as we recognize the limitations of and risks associated with the materials most frequently used for this procedure.
What is our approach?
We discuss a custom plan with each of our patients. We take into account all variables when advising our patients; these variables include overall systemic health and lingering systemic inflammation, function of current dentition, history of oral therapy, occlusion, material sensitivity, nutrition, and commitment to managing ongoing health.
With this in mind, we discuss with each patient the risks, benefits, and alternatives associated with both biological root canal therapy and extraction (and potential replacement) of the tooth in question.
What is biological root canal therapy?
This procedure involves use of laser and ozone therapy in the cleaning of the root canals instead of the traditional use of sodium hypochlorite (bleach) and EDTA (ethylenediamine tetra-acetic acid, a chelating agent). The use of the laser and ozone allows for deeper penetration of the dentinal tubules and accessory canals, thus providing an enhanced bactericidal impact in the tooth with biocompatible materials.
Once the canals have been cleaned, a traditional root canal would include the placement of an inert, gutta percha filling material that is warmed prior to placement. The concern with this warming, is that once it is cooled, it shrinks and can create a void between the canal and the filling material: ultimately, a breeding ground for gram negative, anaerobic bacteria. (see the Figure 4 above where there is a void between the dentin and gutta percha, labeled "pulp chamber", as well as Figure 5 showing how the accessory canals have direct communication with the surrounding bone). This is where bacteria can exist and can be a source of chronic inflammation that gets into the bloodstream and affects other parts of the body.
As an alternative to the gutta percha filling material, we use EndoCal10, which is a biocompatible material that has a well-established track record of being a reliable and durable canal filling material with the key-added benefit of its immediate and long-term bactericidal properties. (source for this material: EndoCal)
There is no other root canal preparation technique that can fully guarantee the sterility of the canal before the obturation. One of the key advantages of EndoCal 10 is, that its physical and chemical properties allow it to penetrate areas the endodontic instruments and solutions can't, disinfecting those areas and, hence improving the treatment outcomes.
Literature demonstrates that the heavy calcium oxide-based material EndoCal 10 penetrates dentinal tubules better than other materials, and that it reduced the unmineralized extracellular matrix material to a minimum.
EndoCal 10 transformed calcium oxide (heavy calcium oxide) offers prolonged released of calcium hydroxide inside the canal, which penetrates the dentinal tubules stimulating and isolating any remnant vital cells of the endodontium, causing a chemical lysis of necrotic cells and residual bacterial. This material is easy to handle and apply, and has a versatile use in a variety of endodontic procedures, such as canal obturation, sealing of perforations, apicformation, or as a retro-filling material in apical surgery.
A holistic approach in Dentistry promotes health and wellness instead of the treatment of disease. It uses a variety of modern, traditional and revised techniques and material to deal, not only with the oral cavity, but also with the patient's overall well-being and health. Key objectives of this approach are using the most biocompatible materials, while avoiding and eliminating toxins.
This biological root canal therapy isn't over once we restore the tooth. Instead, the patient continues to come in to have this tooth monitored and injected with ozone to manage any potential focal inflammation in the area. If we are monitoring regularly and the patient presents in the future with some inflammatory symptoms with an undiagnosed source, then we may need to reevaluate that tooth. There is no "guarantee" that this tooth (or an implant) will last a patients' lifetime. Both of these are suboptimal options relative to maintaining a person's natural dentition. Our goal is simply to educate our patients and guide them on the best choice for their own health. In some cases, that includes biological root canal therapy. And in others, it includes removal of the tooth.
The benefits & risks associated with root canal therapy and extraction and implant...
The benefit of this approach is that it is less invasive and it allows more time with this tooth. If the patient is generally healthy, then he or she likely has the immunity to manage any potential inflammation with this tooth along with the ongoing treatment with local ozone treatments.
Additionally, what is often not discussed when a holistic doctor recommends removal of teeth that need root canals is that tooth extraction and implant placement are NOT risk free procedures. For example, a tooth needing a root canal can be removed properly, but a cavitation can develop and be a chronic source of inflammation or pain just like a root canal treated tooth could be. But once a tooth is removed, you can't go back and treat it with a root canal.
Even if a tooth is removed successfully with no complication of cavitation, placement of a ceramic implant can include complications such as paresthesia, pain, implant failure, poor esthetics, or suboptimal occlusion.
Now it is important to note that we are not discrediting the value of the dental implant procedure. We think this is a great option for many patients, and we recommend it quite often. We work with oral surgeons and periodontists who have advanced training in this type of procedure, which helps diminish these potential risk factors. But the purpose of discussing this is that too often patients think in extremes or in black and white terms, and they don't understand that each option needs to be weighted appropriately to determine what the best option is for them and for their longterm health.
If you have questions about biological root therapy, please contact our office to schedule a complimentary diagnostic work up and consult.