Root canal treatment is a treatment in which the infected and dead tissues inside the teeth are cleaned and then the cavity is filled with root canal filling materials in cases where the teeth are severely decayed and infected. In fact, we can say that it is a kind of tooth embalming method. In this way, it aims to keep the tooth that is no longer alive in the mouth.
Root canal treated teeth do not contain blood circulation and defense mechanisms. In addition, the dentin fluid flow from the center of the tooth to the outside of the tooth, which is found in living teeth, is unfortunately no longer present. Therefore, they cannot be equated with living teeth. There is no defense and feedback mechanism against infections that may develop inside. In addition to the root canal system, the hard part of the tooth consists of thousands of tiny tubes (tubules). Unfortunately, it is not possible to clean and fill these parts 100% with root canal treatment. Therefore, in biological dentistry, it is considered that leaving root canal treated teeth in the body may have negative systemic effects (the recommendation of biological dentistry is not to leave the tooth without root canal treatment, but to extract the tooth). In classical dentistry, this idea is not accepted and root canal treatment is considered as saving the tooth. Because when a good root canal treatment is performed, the inflamed areas at the tip of the roots can shrink and patients can use this tooth for years without symptoms. Treatments such as tooth extraction and implants are avoided. As an additional information, I should also mention that even without symptoms, there may still be bacteria in these teeth. Special laboratories that have examined the bacteria in extracted root canal treated teeth have found pathogenic bacteria even in well-executed root canal treated teeth that do not show inflammation even on tomography. Unfortunately, there are not many studies on whether these bacteria harm the body.
Since I have already discussed the debate on this subject in other articles, I do not want to extend it further here. If you want to read more in detail, you can take a look at my articles “The Root Canal Treatment Discussion” and “Tooth Root Inflammation and Heart Diseases”. Because of these doubts I mentioned about canals, I believe that we should do everything we can to prevent a tooth that is alive and has the potential to heal from going to the canal. It should not be so easy to force a tooth to undergo root canal treatment. Therefore, in this article, I will try to answer the question of whether we can avoid root canal treatment.
First of all, if a tooth is really infected or dead enough to require root canal treatment, unfortunately, we cannot keep the tooth in the mouth without root canal treatment. If a root canal is not desired, we have to extract the tooth, otherwise this tooth will quickly cause inflammation in the bone at the end of the root due to the infected and dead tissues inside. With root canal treatment, the areas where bacteria can grow are reduced. In summary, we can say that in cases where the decay is very advanced and the tooth is irreversibly inflamed, root canal treatment must be performed if we do not want to extract the tooth.
However, unfortunately, sometimes root canal treatment can also be performed on teeth that are not dead or severely infected. There are some things we can do to prevent a live and healthy tooth from going to the canal in this way. We can pay attention to these points so that our teeth do not die in vain.
1 – Is Root Canal Treatment Necessary in Tooth Sensitivity?
Except for very severe tooth sensitivity that does not go away when it starts, tooth sensitivity does not require a root canal. Most of the time, there are other underlying causes of sensitivity that can be addressed without root canal treatment. In fact, tooth sensitivity can even be a positive signal that the tooth is alive!
- The cause of tooth sensitivity may be a problem with the restorations in the tooth. For example, if composite fillings are placed in very large pieces when they are made, in other words, if they are made very quickly, they undergo severe shrinkage and break away from the walls of the tooth and cause micro gaps to form between the filling and the tooth. This could be the source of the sensitivity (that’s why it takes us so long to do fillings:))
- In another scenario, sensitivity can be caused by tooth decay. If the sensitivity occurs with a stimulus and goes away within a few seconds, the decay has not yet progressed to the canal of the tooth. In this case, it will be useful to see your dentist as soon as possible in order to treat the tooth only with a filling without a root canal, preserving the vitality of the tooth.
- There may be a crack in the tooth. In this case, different restorations can be made depending on where the crack is and how far it extends, but again, root canal treatment is not required.
- There may be a gum disease. As a result of inflammation or recession of the gums, the root surface may be exposed and sensitivity may develop. Gum treatment is performed, not root canal treatment.
- Tooth surfaces may be worn. Bruxism, bite disorders, hard brushing, bulimia, etc. There may be abrasions on the tooth surfaces for many reasons, and if these have developed rapidly, sensitivity may also be seen.
- There may be mineral loss in the teeth. The minerals normally found in saliva constantly repair the teeth from the outside. Teeth are also nourished from the inside, and the flow of dentin fluid inside them protects the tooth against external factors. These mechanisms can be disrupted and teeth weakened by poor diet or gut health, mouth breathing, medication, systemic diseases. In this case, various applications can be made on the tooth surfaces to relieve sensitivity, but of course, it is also important to question the causes and try to correct them in order to prevent further loss in the long term.
When the cause of tooth sensitivity cannot be found or no relief can be achieved, canal treatment is sometimes recommended to end the complaints of patients. I do not find this approach correct because in this case, root canal treatment means actually killing a living tooth with our own hands! Here, of course, it is useful for our patients to be conscious and cooperate with their doctors (such as not pressuring their doctors to resolve a complaint that requires a healing process as soon as possible:)).
2 – Not every deep filling requires a root canal!
Unfortunately, another situation I encounter very often is that dentists tell patients that the tooth will go to the canal based on the depth of the filling without evaluating the symptoms. In fact, such information may be given here in order to prepare patients for the worst possible situation. Nevertheless, in deep fillings, if the work is not precise and unnecessary material is lost from the tooth, unfortunately, the tooth may actually go to root canal treatment. There are some methods we apply to prevent this situation (you can use this term when looking for your dentist, as these are the field of interest of biomimetic dentistry).
- Biomimetic approach – In this approach, the biomechanical properties of the natural tooth are mimicked as much as possible and unnecessary tooth cutting is avoided by opting for restorations that bond to the teeth by adhesion rather than mechanically. In addition, how much decay is removed is based on certain rules determined by scientific studies, so that a living tooth, no matter how deep the decay, does not go into the canal. Another aim of biomimetic dentistry is to prevent irreversible damage to the tooth in the future (for example, fractures due to excessive loss of material or weak tissues and extraction of the tooth).
- The use of a caries detector – Actually, this is another substance that is routinely used in biomimetic dentistry. It allows us to see the different layers of decay and prevents us from unnecessarily removing parts that normally appear dark but are actually healthy. Thus, we are less likely to take the tooth to the canal because we are cleaning the decay.
- Pulp Capping Treatment – Sometimes, when the decay is very deep, the canal may be exposed. Even in this case, if clinical findings allow, it may be possible to preserve the vitality of the tooth without root canal treatment with the treatment we call pulp capping. In this treatment, after stopping the bleeding from where the canal is opened, the cavity is closed with biocompatible agents that will stimulate dentin regeneration and then the tooth is restored. In this treatment, sodium hypochlorite is generally used to stop bleeding and clean the area. We use ozone at this stage. Whichever is used, we do not take the tooth to the canal immediately. And most of the time it is successful.
- Using a loupe – Working with a dental loupe gives us a much larger and more detailed view of the area we are working on. In this way, we can work much more carefully and gently in places where we are very close to the canal and we do not injure the teeth unnecessarily. I think I can best explain this with the photo below:
3 – Dental veneers made for aesthetic concerns or to eliminate misalignment
Another sad situation that we often encounter that leads to the need for a root canal is the cutting and veneering of teeth, which are often very healthy and beautiful, for aesthetic reasons or to correct crowding. Unfortunately, you can see that teeth made with this approach are called “Turkey teeth” on social media. It is quite sad to be labeled with this label even though we have very good dentists in general and we are a country with very high quality dentistry services, but unfortunately, it cannot be denied that there are clinics working in this way in our country. In this approach, teeth are cut and veneers are placed on them in order to provide a beautiful smile(!). I don’t think patients are informed that the enamel will never come back, that the more sensitive layer called dentin will be exposed as a result of cutting the teeth, that some teeth may require root canal treatment and that teeth with root canal treatment are teeth that have lost their vitality. Moreover, if these restorations are not made with great care, after a while the remaining tooth tissues will decay and gum problems will develop. Restorations will need to be renewed. Perhaps some teeth will be lost in the process.
To return to our topic, if the aesthetics of your teeth make you unhappy, you can avoid root canal treatments by first considering more minimally invasive solutions. For example, orthodontic treatment can be considered for crowding. If the size or shape of your teeth bothers you, porcelain or composite laminates can be considered. If you want your teeth to be lighter in color, you can consider teeth whitening. Of course, all these treatments can have side effects, but they are still much safer than cutting and capping teeth.
4 – Protective Dentistry Medicine
Last but not least, I would like to add the most obvious point: Let’s not cause tooth decay so that we don’t need a root canal! For this, you may first think of brushing, flossing, mouthwash, etc., but it is not. In fact, the most important measure we can take is to pay attention to our diet. This will protect our teeth from both inside and outside and prevent the formation and rapid progression of caries.
In addition, routine dental check-ups allow you to take the necessary precautions by detecting problems at the initial stage. In other words, you should not wait until your tooth hurts to go to the dentist, because when it reaches this stage, unfortunately, the tooth is in such a bad condition that it can no longer repair itself and root canal treatment (or tooth extraction for those who do not want root canal) is often inevitable.
