Over the course of my thirty-five-plus years of practicing dentistry, I have been asked many questions concerning the safety of various dental agents and materials, most notably silver fillings and fluoride. Undoubtedly, the internet has provided the masses with a plethora of sound information at their fingertips. Conversely, accompanied by its social media counterpart, it has become the primary gateway to the spread of misinformation and conspiracy theories. Dentistry, being an evidence-based profession, is not immune to the dissemination of pseudoscientific claims promoting alternative treatments 鈥渘ot taught in dental school.鈥� Typically advocated by so-called 鈥淗olistic鈥� and 鈥淏iological鈥� dentists, these therapies fly in the face of conventional dentistry. 聽
Perhaps the most egregious claim made by some of these practitioners is regarding root canal treatments. While representing only a minority, these dentists argue against the use of conventional endodontic therapy, opting instead for extraction and replacement by implants. Others advocate extracting asymptomatic root canal-treated teeth. Not only is this approach scientifically unfounded, but it also violates a dentist鈥檚 Hippocratic oath to 鈥渄o no harm.鈥� 聽
The Maligned Root Canal, So Misunderstood聽
So what exactly is a root canal, a term that strikes fear in the heart of so many? Some people think it involves removing the roots of teeth, but most have no clue. Many have heard horror stories from friends about how painful they are, but like many other myths attributed to dentistry, this is generally false. Essentially the teeth that are visible in our mouths are just the tip of the iceberg, for lurking far beneath the gum line anchoring them into jaw bone are the roots. Typically, front teeth have a single root, while the ones further back have two or three. Filling the hollow inner chamber of teeth and traveling down through the roots via canal systems is the spongy pulp, comprising a tooth鈥檚 blood and nerve supply. It allows us to sense temperature, or let us know when a dentist's freezing hasn't taken effect! When a pulp gets inflamed, often due to a deep cavity or trauma, a tooth can become sensitive and if irreversibly harmed, extremely painful. Left untreated the pulp can die, becoming necrotic with bacteria potentially exiting the end of roots into the jaw causing a dental abscess. A root canal treatment removes the diseased pulp from the tooth, disinfects, and then seals the hollowed-out canal spaces most typically with a biocompatible thermoplastic material called gutta-percha. When performed by a skilled practitioner, root canals have a success rate of 95%, are generally painless, and when feasible much preferable to extraction.聽
The Price is Not Right聽
Recently, when not discussing the pandemic, some patients have asked me about the safety of root canal treatment. Typically they may have read something on the internet or heard through a friend that root canals are dangerous. Where does this misinformation originate? Back in the 1920s, dentist Dr. Weston Price conducted some poorly designed studies based in large part on the previously developed 鈥渇ocal infection theory鈥� asserting that asymptomatic root canal treated teeth leak bacteria and their toxins into the body, causing a variety of chronic systemic diseases such as cancer, heart disease, and arthritis. Despite well-designed studies conducted in the 1930s discrediting his findings, Price鈥檚 theory gained popularity over the following decades resulting in the needless extractions of countless healthy teeth in order to treat or prevent various systemic illnesses. Only in the early 1950, 鈥檚 did the paradigm shift back to the endodontic treatment of restorable teeth with non-vital pulps. Upon reviewing Price鈥檚 work from the 1920s, a 1951 article in the Journal of the American Dental Association contradicted his research noting it 鈥渓acked many aspects of modern scientific research, including the absence of proper control groups and induction of excessive doses of bacteria.鈥� To date,
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Further contributing to the dissemination of misinformation concerning root canal therapy was a 2019 documentary 鈥淩oot Cause鈥� carried by Netflix. In it, the Australian filmmaker, seeking to find the cause of his own chronic health problems, alleged that serious illnesses are caused by asymptomatic infections inside root canals whose bacteria can travel throughout the body via 鈥渕eridian lines.鈥澛犅燬hortly following its release, upon concerns raised by various dental associations that its content could 鈥渉arm the viewing public by spreading misinformation about safe medical treatments like root canals鈥�, Netflix removed the content from its platform.聽
My Tooth Sense聽
Each year worldwide millions of root canals are performed, saving people the unnecessary trauma of losing their teeth. I find it truly perplexing and disturbing that some members of my profession continue clinging to the long-ago debunked theory advocating extraction of restorable teeth rather than saving them with endodontic therapy. Root canals are safe and effective, and by eliminating bacteria from the infected roots of teeth,聽辫谤别惫别苍迟听infection from spreading into the jaw and beyond. Furthermore, I find advising patients to extract asymptomatic endodontically treated teeth only to replace them with costly implant-supported crowns, unconscionable. My advice to anyone told to do so is to consider finding another dentist. And that鈥檚 the tooth and nothing but the tooth!
Dr. Mark Grossman is a practicing dentist and likes to take a bite out of nonsense when it comes to dental issues.
