Root Canals and Biological Dentistry

The “Root” Problem: Inflammation

When someone presents with symptoms related to pulpitis, inflammation of the pulp, our first goal is to reverse that inflammation. As its name implies, reversible pulpitis can be reversed, provided that you can identify the causes of the inflammation and support the individual’s healing responses. Irreversible pulpitis cannot.

Causes of inflammation are never singular. You don’t just develop a large cavity overnight. Obviously, diet is a very important factor. However, you have to acknowledge that the same diet that causes tooth decay has all sorts of effects on the body whole. A hole in a tooth is a sign that there are immune compromises that are accompanied by infections in other body systems. The cavity is just the obvious manifestation. In many cases, the body is screaming that it is being damaged. That alert may involve pain, cold sensitivity, touch sensitivity, malaise, bleeding, swelling and a host of other signs we may or not recognize.

While talk of lifestyle changes may be helpful in the long term, when someone is in a lot of pain, that pain commands most of their attention. So we do our best to “reverse” what has caused the pain. If there’s a large hole in the tooth, we’ll try to clean it out, disinfect it and fill it with a biocompatible material that will be conducive to rebuilding tooth structure. The material we use is called Biodentine. Left in place for weeks or months, it allows the body to rebuild itself.

We also have to support the individual’s return to normalcy – to slow down and stop the inflammatory process. We may use lasers, ozone, homeopathic remedies, dietary supplements and stress reduction in addition to the immediate “dental” intervention. All of these measures are important. If we don’t stop the inflammation, the damage will continue and the pulpitis will soon be no longer “reversible.”

Sometimes, it’s obvious that the pulpitis is irreversible and calls for more aggressive treatment.  But when all is said and done, if the inflammation has not gone on for too long and there hasn’t been too much damage, we will restore the tooth or teeth in a biocompatible manner.

When a Tooth Is Deeply Damaged

Sometimes, the inflammation does go on too long, damaging a tooth’s nervous and vascular (blood delivery) systems too much for adequate function. A person might be able to get by with 45% less vessels and nerves within a tooth, for instance, but have problems when the loss is 50%. This number isn’t exact and will vary from person to person.

The bottom line is that at some point, the vital functions within the tooth stop happening. For some people, it will be cataclysmic, almost as if a volcano had erupted in their mouths. For others, there will be a very slow, almost imperceptible decline which will be marked by the onset of swelling or drainage of pus. Sometimes, neither of these events takes place because the inflammatory processes have been internalized to the bone and its supporting structures, resulting in an abscess.

These are the clinical situations that vex the soul of the biological dentist. We know how very harmful it is to have “non-vital” (vital = living) structures within our body. At the same time, all forms of restorative dentistry involve the placement of “non-vital” materials to replace broken or missing tooth structure.

Some dentists advocate the simple surgical removal of these body parts: If a tooth is badly infected, they say, it must be removed. We beg to differ. Removal of body parts is not without consequence or compromise. Not only is there the concern over the surgical procedure and the trauma/damage that may ensue; there is also the concern over the loss of function.

Teeth, if nothing else, provide an important element of the body structure. We have all seen the signs of shrinkage with old age that accompanies osteoporosis. We also know that because the spine is now collapsing, there are all kinds of associated problems with nerve compression and bursal compression. A similar phenomenon happens at a much earlier stage with the first tooth extraction. The support that the teeth provide to maintain the height of the spine is vital and is slowly eroded with each tooth extraction. Certainly, we all adjust, but it is a compromise, and at some point, it is an intolerable compromise when too much “vertical dimension” is lost.

In order to help the body maintain homeostasis (balance), we make every effort to maintain the dentition.

We acknowledge that a conventionally “root canalled” tooth is very likely to harbor a variety of pathogenic organisms within. These teeth must be monitored, tested and, if they are toxic, treated with a variety of therapies other than extraction. Recognizing the dangerous nature of the organisms that can infect a tooth, we make every effort to neutralize these organisms and flush out their toxins. If, after all this, the toxins persist, the tooth must be removed.

Biologically Sound Root Canal Therapy

Our root canal technique begins by creating access to the canals within the tooth being treated, which have many, many branches going into the dentin and cementum. We use magnification and fiber optic illumination to help us identify the canals accurately. We then open the canals, but only as much as needed for the procedure so as to reduce trauma to the internal dental structure.

Next, we use extremely flexible  “hand” files to navigate the sometimes very curved canals and take x-rays to confirm that we have, in fact, reached the end of the tooth. These files are lubricated with ozonated olive oil – the ozone to disinfect and the oil to allow smooth motion of the instrument.

We then clean the canals with rotary files and ozonated olive oil. Once these large structures are clean, we use sonic devices with ozonated water to whip around within them to flush out all the contents of the canals and as many of their lateral branches as we can hope to access. This is followed by a generous application of ozone gas with
very fine needle tips to help disinfect the dentinal tubules that are perpendicular to the main canal.

Once we’ve finished disinfecting the tooth, we pump in a calcium oxide paste known as Endocal. This material is biocompatible and also kills bacteria. Since it takes several days to fully harden, we place a durable temporary filling in the tooth before proceeding to the next step of restoration.