People prefer cockroaches, colonoscopies—and even Congress—to root canals. Yet as dreaded as they are, 26% of us have had one or more, and 25 million of us get root canals every year.
I recently had one, when my #20 premolar recently died. In layperson parlance, it’s the tooth between the lower canine and the first molars. Before deciding how to handle the corpse, I thoroughly researched my options—which will be no surprise to those of you who know the obsessive me.
But before I get into that, let me extol the virtues of ibuprofen. I’ve never before taken it, and I’ll be happy never to take it again (just read the side effects). Yet what a wonder drug it is when you need something to kick pain’s butt—such as when you have a rotting tooth carcass embedded in your jaw.
And I’d like to give credit to progressive dentistry. I sat through an hour-and-a-half procedure so comfortably that I could have read a book. Well, that may be a slight exaggeration, but I easily spent the time daydreaming.
Okay, now onto the juicy stuff. My first recommendation is to avoid a root canal at all cost. It’s invasive and carries a number of risks (which you can explore elsewhere, as they go beyond the scope of this piece). Do everything you can to keep that tooth alive and the surrounding tissue healthy.
Yet once a tooth is dead, it’s dead. In nearly every case, it will rot out, and it might just take a chunk of your jaw along with it, not to mention poisoning your system. Here are what I found to be the most feasible options, along with their pros and cons:
- Pull the tooth. Works well in the short term, except for compromised chewing. Over time, adjacent teeth start to move and the opposite tooth can loosen.
- Removable partial. Can work well, depending on location in mouth, personal tolerance, and level of hygiene.
- Fixed bridge. Requires grinding the two adjacent teeth down to stubs in order to anchor the bridge that supports the floating replacement tooth. A high level of hygiene is essential.
- Implant. Done properly, this works well for many people. Yet it’s the most invasive option.
- Root canal. The least invasive if well executed; potentially dire consequences if not. The saving grace: if it fails, nos. 1- 4 are still options.The dangers of old-time root canals are well-known and documented. They are one of the primary reasons we have such fear and loathing of the procedure. Because of that, I was all the more amazed at how much my research had shown the root canal procedure to have evolved in recent years.
The first thing we need to know is that molars, with their multiple and sometimes forked roots, are the most difficult to operate on, which means they carry the greatest risk of failure. Second, we need a progressive practitioner, whether dentist or endodontist, who has depth of experience, good bedside manner, and the ability to articulate.
Here are the questions to ask him or her:
- Do you use a slow-speed rather than a high-speed drill (to reduce
cracking)?
Do you use pro taper rotary files (which grind away less dentine)? - Can you execute the procedure through a small entry hole, rather
than grinding off the top of the tooth (which requires a crown)? - Do you use a soft amalgam? (Hard amalgams cause cracking because they
do not flex with the tooth.) - Will you check thoroughly for existing cracks in the enamel
(bacterial entry routes)? - Do you meticulously clean all soft tissue from the canal (to prevent reinfection)?
- Do you use a topical antibiotic throughout the procedure, and after
the canal is cleaned out?
If you don’t settle for anything less than having these seven points met—and you have a skilled practitioner—you stand a very good chance of a root canal procedure that will allow you to keep your tooth for the rest of your life. That is, if you don’t forget your fluoride treatments. Just kidding!