I Thought Root Canals Are Forever?

One of the most common statements I hear from patients experiencing dental pain related to teeth that have already had root canal therapy is “but I thought there’s no nerve and I won’t ever have a problem?“…

courtesy of "http://www.deardoctor.com/"

Unfortunately this is far from reality.  Typically, a root canal is done when the tooth’s nerve is so badly inflamed that it cannot heal itself.  This can happen from a bad cavity, chronic decay underneath an existing filling or crown, or from a tooth fracture. Since the nerve is beyond the point of repair, there is pain or infection, and it must be removed. The space that the nerve used to occupy is filled and sealed with a material called “gutta percha”, aka root canal.

The sealant, however, may not last forever. New decay can form and the bacteria causing the decay can travel the entire length of the root all the way to the tip and into the jawbone.  What happens next is cyst formation in the bone as your immune system attempts to cope with the bacterial infiltration.  When the cyst reaches a certain size, there is pain when you bite down.  Not tooth nerve pain, but jawbone pain!

Sometimes another attempt at root canal can be done to remedy this. It really depends on the circumstances and whether the adjacent teeth are impacted or whether the new decay is beyond repair. Other times the jawbone is so badly infected that the tooth cannot be saved and must be removed.  The general industry consensus is that the average lifespan of a root-canaled tooth is about 7 years before it needs attention.  That’s only an average, however.  I’ve seen root canals fail after 1 week, and I’ve seen decades of success.

Another unfortunate consequence of a root canal is the tooth is generally rendered more brittle and prone to fracture. If there is a post as part of the restoration, that also represents a weakness in the tooth structure.  Natural, intact teeth rarely fracture, but when we do see a fractured tooth it’s almost always one with a history of root canal therapy.

It would be nice if clinicians were a little bit more forthcoming about the longevity and realistic expectations of doing a root canal.  It’s still one of the best way to preserve an infected tooth.  Unfortunately like just about anything else, it’s not without real risks, and there’s a good chance it won’t last forever.

Deceptive Dentists

Raise your hands if you’ve seen any of these descriptions before: implantologist, dental implant specialist or cosmetic dentist…Guess what?  There is no such thing.  No such specialty as dental implants or implantology is recognized by the American Dental Association.  There are residency programs that teach dental implants, some of which take years to complete. Then there are weekend courses that offer a limited educational experience.  The levels of training for dental implants vary significantly from excellent to useless, leaving the consumer further unsure.  As for cosmetic dentists, all dentists are cosmetic – is there a non-cosmetic dentist?  Some may be better than others but sometimes it sounds as if it is a special title with special training involved, which is not accurate.

Another way that dentists confuse consumers is by making claims such as “we offer a full range of x services” when they are not.  These statements may put dentists in danger of offering a standard of care that is not justifiable.  Offering free exams is another gray area, as it unfairly puts pressure on a competing practice.  The FTC is the regulatory body involved but many of the guidelines are vague.

Grade 5 Titanium for Dental Implants???

For years Grade 4 commercially pure titanium has been the material of choice for dental implants.  There is plenty of long term data demonstrating safety and success.

More recently some manufacturers have been switching over to Grade 5 titanium.  Titanium Grade 5 is alloyed with 6% Aluminum and 4% Vanadium and is commonly known as Ti 6Al-4V.  For dentistry, there is another version called “ELI”, extra low interstitials, which further reduces surface impurities.  Grade 5 titanium is said to be stronger than Grade 4.  However there is evidence that Vanadium is released into the host tissues and can be cytotoxic.

A recent literature review concluded that there is not enough evidence indicating superiority of one vs the other, noting specifically that good clinical comparison studies do not exist.

I have made inquiries to implant manufacturers asking for long term safety data in humans, and so far I have received nothing decisive.  Hmmm…