APART from “cleaning” (prophylaxis), “root canal” (root canal therapy) is the most frequently sought dental procedure. No patient really knew the implications. I would not be surprised to learn that I am the only dentist who would not perform root canal therapy on a patient’s tooth simply because that patient requests it to be done.

Only if it is justified in my professional opinion would that request be granted. And the reason for this posture is simple. Root canal therapy literally involves killing a tooth and I believe it is a universally accepted fact that we only kill when it is necessary. If the tooth is dead then the body will slowly reject it as manifested by root absorption.

Root canal therapy (endodontics) has come a long way since it started in the 17th century. Imagine having the nerve of your tooth removed with a filed down watch spring without any anaesthesia. Back in 1838, this was thought to be innovative, along with the use of arsenic and heated instruments to cauterize the nerves. No wonder why root canals got such a bad reputation. Since then, there have been numerous advances and developments, such as safe and effective local anaesthetics after 1910, and dental x-rays in 1919, the same year my father was born.

Root canal therapy is when the dentist removes the inflamed or infected pulp (nerve), carefully cleans and shapes the nerve canals of the tooth’s root and then seals the prepared space. The aim has always been to relieve pain and preserve teeth. The procedure can be done in one or two sessions lasting no more than 30 minutes each. The procedure is safe, reliable, and no more uncomfortable than placing an ordinary filling.
In addition to relieving oral and facial pain and discomfort, root canal therapy allows you to preserve your natural teeth.

Indications for treatment include prolonged sensitivity to heat or cold, spontaneous toothache, discolouration of the tooth, and swelling or tenderness of the gums adjacent to the tooth in question. Transient sensitivity to cold may just be due to exposed root surfaces or heavy teeth grinding. If the cold sensation lingers and radiates up giving you a headache, chances are there has been irreversible damage to the nerve. Sensitivity to heat is usually a clear indication that there is some nerve damage present. Sometimes root canal treatment is recommended as a result of the bacteria from the decay extending into the nerve (pulp) of the tooth.

Root canal therapy is the alternative to an abscess, loss of bone support around a tooth and severe spreading of the inflammatory process (swollen face/jaw). The choice whether to do or not to do a root canal has to be made promptly since a late decision can change to present no other option but an extraction. Like every dental procedure, there is always the factor of limitation and the diminishing likelihood of success if the procedure is not done at the right time.

The downside to a root canal therapy is that the dentist created a glorified “stump”. Since a tooth without a pulp is practically dead, our biological system is designed to discard it. That is why “stumps” have their roots and crowns absorbed by the body over a long period. That is why the legs of a person who is paralysed from the waist down, become thin and spindly. Their bones and muscles are slowly being absorbed over the years because the body’s physiological programme is interpreting the person’s condition to mean that their legs are no longer needed and therefore must be disposed of.

Some strong advocates of root canal treatment, (especially those who no doubt are thinking about the money involved), would say that a tooth without a pulp can get its nutriments from the tissue surrounding its root. However, this cannot be logical because the apex ( opening at the root’s tip), is the anatomical entrance for the major innervation ( dental nerve), artery, vein and lymphatic vessel. And remember, one of the objectives of root canal therapy is to completely seal the apex. Any nutriments can only be available to the paradontal ligaments which are outside the root.