There is concern that active bacteria is often found on asymptomatic root canal treated teeth with periapical lesion (1), allowing bacteria to travel into the blood stream, as well as having a chronic immune response and inflammation. All dental procedures have risks and side effects, some more than others. Furthermore, when root canal procedures are truly needed, alternatives are often limited. The extractions option has many undesirable side effects. The extraction of a severely infected tooth may also leave remnants of the infected tissue on the bone, even when proper debridement is done. In addition, replacing extracted teeth have multiple complications. For example, traditional fixed bridges require heavy tooth reduction and can lead to the need for more root canals. Bonded bridges can be an option, but are less durable in the long run. The implant option, also has its complications. Literature shows that up to 50% of implants show occurrence of peri-implantitis or chronic inflammation. Removable teeth, such as dentures are also an option, which is usually unaesthetic, uncomfortable, and also has side effects. Thus, all options have risks and side effects. When needed, a well performed root canal procedure may be the best option, remembering that worldwide research had deemed them safe for most patients. Ultimately, the patient must make the final informed decision.
MOST IMPORTANTLY avoiding the need for root canals is key. Proper dental care and maintenance is a primary step in preventing the need for a root canal in the future. AVOIDING UNNECESSARY root canals by choosing a minimally invasive Supra-gingival dentist, is also an important step. A high percentage of unnecessary root canal treatments, could easily be avoided by discontinuing the use of procedures which have a history of damaging the pulp, like full crown preparations, or aggressive decay removal on filling procedures. Also, unnecessary root canal therapy is often used in traditional dentistry for prosthodontic reasons. When not enough tooth is available for mechanical retention, ferrule, root canals and posts are used to add retention. Using supra-gingival minimally invasive adhesive dentistry to virtually nullify the need for unnecessary root canals (2). Another wise choice is also seeking a second opinion.
- Pinheiro ET, Gomes BP, et al. Microorganisms from canals of root-filled teeth with periapical lesions. Int Endod J. 2003 Jan;36(1):1-11.
- Ruiz JL. Health & Biocompatibility Using Supra-gingival Dentistry. Dentistry Today Nov 2018