Root Canal treatment: Common misconceptions

The purpose of this month’s post is to talk in depth about a commonly misunderstood procedure, the Root Canal!

1) “When you do a root canal on my tooth, I will be left with a dead tooth, right?” 

This belief about a “dead tooth” resulting from a root canal is a very common belief. However, it is not true. According to Clifford Ruddle, one of the leading authorities in the dental world regarding root canals: anybody that’s even been remotely involved in dentistry, would know that any “dead” tooth would be exfoliated and rejected by your own immune system. An endodontic tooth is a vital tooth because the body perceives it as vital because there is a PDL attachment, a suspensory ligament that slings the tooth from the cementum to the surrounding bone.  So, the tooth is vital, interpreted as an integral member of the arch, and it can function in complete health.”

So, a properly root canal treated tooth is still a functional and living tooth, because the body doesn’t reject it, and because it can still sense pressure sensations, but not pain sensations.

2) Aren’t root canals needed before you do crowns?

I get asked this by patients at least a few times per month. The answer is that if a tooth needs a crown, that doesn’t mean it a needs a root canal automatically. However, the reverse is true sometimes. If a tooth (a back tooth in particular) needs a root canal, it will sometimes need a crown.

3) Just when exactly are root canals needed? Only when there is pain?

Root canals are needed for the following reasons:

  • When the tooth has severe nerve pain that shows no signs of improving
  • When there is evidence of an abscess forming around the root as seen on an x-ray or in the mouth
  • When there is a large cavity that looks like it is right up against the nerve, as seen on an x-ray.

Of the three reasons above, the first one involves pain. There may or may not be any pain associated with the second and third reasons, although those reasons are just as equally valid as the first one. A way to think about it is this, sometimes heart surgery is needed because a patient is feeling pain, and the doctor finds out that this is being caused by heart disease. However, sometimes a patient will need heart surgery even if he doesn’t feel any pain, especially when his cardiologist finds that he has severe heart disease. Pain is not the only indicator of when something is wrong.

4) My tooth has a large cavity that is close to the nerve. The other dentist says I need a root canal. I don’t understand why I can’t just have a filling. After all, it doesn’t hurt.

Again, pain is not the sole indicator of whether or not to do a root canal. When you have a cavity that is right up on the nerve, there is a significant chance that during the filling procedure, the nerve may get irritated irreversibly. Whether or not this will happen cannot be predicted, although we can say that the chances of it happening are significant. If it doesn’t happen, then you are lucky, as the filling will be enough for the time being. But if the nerve does get irreversibly irritated, there will often be immense pain that doesn’t go away, and, a root canal will be the only cure (besides extracting the tooth). So you will end up paying for a filling, a root canal, and a crown, as opposed to just a root canal and a crown.

5) I’ve been told that root canals take a long term and are extremely painful. Is this true?

Root canals can take anywhere from 1-2 hours. True, it is one of the longer procedures we do. But stories of root canals taking 5, 6, 7 hours are greatly exaggerated. Furthermore, with modern anesthetic techniques, there is no reason for you to be in pain during the procedure. In fact, modern root canals are painless.

After the root canal, you may have some pain and possible swelling, but we often prescribe medication to deal with these issues if needed.

6) Aren’t root canals expensive?

Most insurances cover Root canal procedure so that your out of pocket expense is low. We at Queen Anne Dental also offer flexible payment plans to help our patients get the treatment that they deserve. We have helped out many patients who do not have insurance, who otherwise would have chosen to have their teeth extracted due to not being able to afford root canals. If you need a root canal, but are not able to afford it, call our office at 425-947-2727 and ask about your options.


Chew gum to prevent cavities?

Is Xylitol Really the Ultimate in tooth Decay Prevention?

The effectiveness of Xylitol products (such as gum and candy), in preventing tooth decay, has now been commonly accepted by the public. Very often I get patients telling me “I should never again get a cavity because I chew Xylitol gum.” But how effective is Xylitol at preventing decay?

It’s important to understand that in the realm of science, belief does not always coincide with reality. An example: my mother used to tell me as a young child not to play in the cold, as the cold weather will cause me to get sick. We now know that it’s the Rhinovirus that causes the common cold, not a drop in temperature. It’s always important to re-examine our beliefs, no matter how deeply ingrained, and to cross check them against what the current research says.

So what is the conclusion regarding Xylitol? According to this recent scientific article (linked below), the following conclusions were made:

1) There is insufficient high-quality evidence to prove that xylitol prevents tooth decay, 

2) The best evidence for preventing tooth decay is still brushing with fluoride toothpaste and eating less sugar,

3)  There are side effects for Xylitol that are often not reported such as bloating, diarrhea and laxative effects.

The upshot is that brushing, flossing, and proper use of fluoride is still the gold standard for preventing decay. The study is not saying that Xylitol does not work, but merely stating that so far, the research and statistics are insufficient, and more investigation is warranted. So the next time your friend tells you that she quit brushing and flossing because she now chews Xylitol gum, you will now know what the proper response is!