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Root Canal Treatment Discussion

By 24/06/2019September 18th, 2023Biological Dentistry

The documentary Root Cause, which claims that root canal treated teeth may be one of the underlying causes of chronic diseases, has created a heated debate on root canal treatments. These claims are actually not new, but are based on experiments conducted by Weston Price in the early 1900s. When W. Price extracted root canal treated teeth and placed them under the skin of rabbits, he observed that the rabbits developed the same problems as the person from whom the tooth was extracted. Price’s studies were criticized as not being done in a sterile environment because they were very old, but the controversy did not end.

Why can root canals be problematic?

Firstly, because the canal structure can vary so much, it is very difficult to clean them perfectly. For example, molars are “mostly” considered to have three canals, maybe 4 canals, and treated. However, there may be other canals connecting and branching with each other. In the photo below, these mixed morphologies of the canals are shown in color.

Complex morphologies of dental canals depicted in color

  • The second and main problem is the thousands of microtubules that make up the structure of the tooth. Even if we clean the main and side canals perfectly, the tooth itself consists of thousands of tiny canals. In a living tooth, there is a fluid flow in these canals. In a dead tooth with root canal treatment, this disappears. This area becomes an ideal environment where microorganisms can settle. I have shared a drawing below so that you can visualize the microtubules.

microtubules present in the tooth structure

The photo below shows electron microscope images of the microtubules and the microorganisms inside them. microtubules and microorganisms inside them

  • These microorganisms in both main and side ducts and microtubules can produce gases such as methylmercaptan and thioether. These gases are thought to stimulate the immune system and cause the response to be systemic (1)

Some studies suggest that root canal treated teeth can cause diseases in the body. For example, clots taken from 101 patients who suffered a heart attack were analysed and 78.2% were found to contain bacteria found in root canal treated teeth. (2). In addition, the bacterial DNA in these thrombi was 16 times higher than in the blood of the patients.

Dental canal anatomy illustration showcasing intricate structures and connections

However, before making a direct decision about root canal treatment, it is necessary to consider some other points.

Root Canal Treatment and Failed Root Canal Treatment

In most of the studies on root canal treatment and systemic diseases, root canal treated teeth with chronic inflammatory areas at the end of the roots were used. Not root canal-treated teeth that looked “successful” on X-rays… The study I gave an example of above was one of them.

Even if the fact that microtubules cannot be cleaned and filled is also valid for looked successful root canal treatments, there are not many published studies on these.

Are the Channels Considered Successful Really Successful?

In conventional dentistry, X-rays are used to interpret the condition of the root canal treated tooth. In recent years, it has become clear that X-rays are very inadequate in detecting these pathologies compared to tomography images. Therefore, a “successful” appearance on the X-ray does not necessarily mean that the root canal treatment is problem-free.

Comparison of 2d opg and 3d dvt techniques:The x-ray image on the left may suggest that the tooth is unproblematic. However, in the tomography on the right, we can easily see the inflamed area at the tip of the root.

The following study(3) compared root canal treatment in patients with and without systemic disease. It states: “In the group of 98 people with systemic disease, chronic lesions were also detected in 95% of all root canal treatments counted (tomography was used).

root canal treatment in patients with and without systemic disease.

In the same study, root canal treatments in a control group with no health problems were also less favourable: 444 of the 656 root canal-treated teeth detected on 631 CT scans had chronic inflammation at the root tip. The high rate of “unsuccessful” root canal treatments is probably due to the use of tomography in the diagnosis.

In other words, root canal treatments associated with systemic diseases may be unsuccessful root canal treatments, but their rate may be higher than we think.

Which of them started it?

There are many more studies showing that chronic inflammatory root canal treatment is more common in patients with systemic diseases (4, 5, 6, 7). But based on this relationship, can we say that root canal treatment has caused these problems? Or is there a basis for the failure of root canal treatment in people with these diseases? Whatever the condition that causes systemic diseases, does it also cause root canal treatment to fail?

There are studies suggesting that the formation of such a lesion at the tip of the roots may be related to genetic predisposition(8, 9). In the study in the photo, a genetic change of the type that increases inflammatory responses was observed in people with clinically unsuccessful root canal treatments.

genetic change of the type that increases inflammatory responses

Conclusion

For now, I would like to end by briefly writing my comment in order not to extend the article further. When we look closely at the root canal treated teeth, we can see that they are not the kind of environment that we want to harbour in the body. On the other hand, we cannot say “Root canal treatments cause diseases in everyone” with the data we have. You know how some people smoke, do not sleep properly, eat poorly, and while you approach all of these issues meticulously, you feel unhealthier than that person… There may be a similar situation with root canal treatments. The person may have an advantageous structure that manages to keep the problems that the canal may cause under control. Or everything has not come together yet! The glass has not overflowed… We do not know. Some biological dentists are definitely in favour of extracting all root canal treated teeth. Not only among dentists but also among oncologists, cardiologists and doctors from other specialities. On the other hand, there are also physicians who believe that we have not yet reached the point and that further research is needed. The IAOMT (International Academy of Oral Health and Toxicology), which has a very clear stance on amalgam fillings and fluorine, does not make a clear recommendation on root canal treatments.

Therefore, I think that many factors such as the patient’s general health status, expectations, replacement procedures, not only X-ray but also tomography images of the tooth, etc. should be evaluated in order to decide whether or not to perform root canal treatment, whether or not to extract the canaled teeth. I also believe that the patient should be informed about this issue and his/her consent should be obtained before the procedure is performed.

For this purpose, measures such as raising awareness of the society especially about nutrition, making regular check-ups a habit in the society, educating patients about the symptoms that can provide early diagnosis and giving regenerative treatments more chance can be taken. Root canal treatment can be avoided as much as possible where it is not necessary (For example, a crowded tooth to be crowned for aesthetic purposes can be treated with orthodontics if it is foreseen that it will go to root canal).

I will try to share more detailed information about all these measures in the following days…

References
  1. https://www.ncbi.nlm.nih.gov/pubmed/25864743
  2. https://www.ncbi.nlm.nih.gov/pubmed/23418311
  3. https://www.omicsonline.org/open-access/impact-of-endodontically-treated-teeth-on-systemic-diseases-2161-1122-1000476.pdf
  4. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3448330/
  5. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6164509/
  6. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4856634/
  7. https://www.ncbi.nlm.nih.gov/pubmed/26174809
  8. https://www.ncbi.nlm.nih.gov/pubmed/21419289
  9. https://www.ncbi.nlm.nih.gov/pubmed/29306532 
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