AboutGary Backlund, DMD, MSD Expertise I am an Endodontist ( root canal specialist ) and can answer questions about root canals and their treatment. I cannot diagnose or treat online, but can answer general questions. I have been a specialist for 25 years and am Past President of the Washington State Association of Endodontists.
Experience 25 years practicing as a specialist
Organizations American Association of Endodonists, Past President Washington State Association of Endodontists.
My regular dentist is a "biological" dentist who does not believe in root canals. I do believe in root canals, so when I developed a problem with a crowned tooth that I suspected would need a root canal I sought out a different dentist to do the new crown.
It now turns out that the new dentist is actually only willing to do a root canal if absolutely necessary, but wants to avoid it if at all possible. He sent me this Internet link explaining why: http://tuberose.com/Root_Canals.html
I’d read these opinions before, in the material my "biological" dentist gives out, and while I’m quite sure some people are allergic, I don’t personally know anyone who has had their health compromised by a root canal, including me.
The xray of my tooth showed a darkened area just below the base of the tooth, but no abcess in the roots. When he prepped my tooth for the crown, the decay was very close to the pulp. He placed medication under the temporary and told me that I would only need a root canal if I experienced very severe pain during the next week.
My pain during that time was just the same as it had been for months, pressure-sensitive plus low-level aching on and off for hours at a time, not severe.
He placed an indirect pulp cap, which he cemented in permanently with the crown.
That was three days ago, and I’m still experiencing pressure sensitivity and a low level nearly constant ache.
I have the following questions:
1. What do you think of his decision to do an indirect pulp cap rather than a root canal?
2. Do you think my current systems suggest that I will need a root canal?
3. What do you think of the claim that "a growing number of physicians, including dentists, believe that root canals can be the cause of, or at least contribute to, a long list of illnesses and degenerative diseases."?
4. Considering that an indirect pulp cap seals in bacteria permanently, is that any less problematic for illnesses and degenerative diseases than a root canal?
Thank you for any perspective you can share.
ANSWER: Hi Gail,
I'm sorry I haven't answered sooner, but I wanted to check out the link to the website you sent. Let me start by saying that I'm a competent, "old fashioned" endodontist who believes in eliminating sources of infection and return the mouth to a healthy state. The website you sent is FULL of half truths and unsubstantiated claims and assertions....so many I stopped reading. Quite honestly, I don't know where these folks get their science. In my practice we have NEVER had a patient get a systemic disease from a TREATED root canal that we have done. The whole concept is called the "focal infection theory" which was popular in the early 1900's. Basically it says exactly what that website claims....that root canals "seed" your body with infection that causes all kinds of other problems in your body. It has been disproved over and over by GOOD science. I would refer you to www.aae.org which is the website of the American Association of Endodontist. They have quite a different picture of root canals as you can imagine.
Whew...now I'll get off my soapbox and answer your questions:
1. What do you think of his decision to do an indirect pulp cap rather than a root canal?
I think it is a very poor choice with the symptoms you describe. When you talk about a dark spot at the end of the root, that is the first sign of an abscess that has begun to destroy bone. Indirect pulp caps were used to try to preserve a healthy pulp and allow it to heal and lay down tooth structure to repair the decayed area. This is not appropriate treatment if the pulp has died which is what the dark spot tells ms.
2. Do you think my current systems suggest that I will need a root canal?
From what you have said and your continued symptoms, I think there is no doubt you need a root canal. I would suggest that you get a 2nd opinion from an endodontist just to be sure.
3. What do you think of the claim that "a growing number of physicians, including dentists, believe that root canals can be the cause of, or at least contribute to, a long list of illnesses and degenerative diseases."?
I think I answered that above, but basically I don't buy it. Maybe in their group of holistic dentists that's true, but certainly not mainstream dentistry and medicine.
4. Considering that an indirect pulp cap seals in bacteria permanently, is that any less problematic for illnesses and degenerative diseases than a root canal?
I don't think degenerative diseases is an issue at all as I stated above. What is an issue is that breakdown products from inside the tooth can still escape from an indirect pulp cap,because the end of the tooth is not sealed off and no material has been removed from inside the tooth. When a root canal is done, the canal down the center of the tooth is cleaned, shaped and filled. This prevents material from exiting out the end of the tooth that's in the bone. Unless this is done, toxins seep out and continue to make the end of the tooth sore which you are experiencing when you bite down.
I hope this helps. If you nee more info, please write back!
Gary Backlund DMD, MSD
---------- FOLLOW-UP ----------
QUESTION: Hi Dr. Backlund,
Thank you for your soap box. I never know quite what to say to people who believe that kind of stuff. They make it sound logical, but it just doesn't fit with my experience. When dentists subscribe to those beliefs I just wonder if it's because they see a market among the people who believe that kind of thing.
Anyway....
I do want to clarify something about my symptoms. The dark area isn't at the end of the root, it's in the area I circled with blue in my drawing here: http://cyberglitz.com/Tooth.gif
The dentist felt quite certain there was no abscess, nothing going on in the roots.
Given this information, I'm wondering what accounts for the pressure sensitivity. It only happens with a LOT of pressure, like if I'm chewing along kind of mindlessly (and therefore rather hard) and suddenly hit a fairly firm bit of something like tortilla chips with that tooth.
The dentist believed that would stop after the crown was cemented, but it hasn't. However, it has only been 4 days, and there was certainly great trauma to the tooth in being drilled so close to the pulp, so my hope is that it is just still sensitive from that.
At this point, my primary question is how long I should wait, and what symptoms I should watch for, to make a decision to ask for a root canal, or to make an appointment to have an endodontist look at an xray of the tooth.
Obviously I’m hoping I’ll be fine and not need one, and I want to believe that my dentist was not unethical to try this solution, because if he is, then I have a really big problem... By the way, he tells me that if it turns out that if I do end up needing a root canal he will not charge me for the new crown...though I'll still be stuck with his charges for this one, and his separate charges for the buildup and pulp cap came to almost as much as the crown itself... Most dentists in this area include buildup in the cost of the crown, for prices comparable to this dentist’s charge for just the crown.
What are your thoughts given this new information?
Gail
Answer Hi Gail,
The area you draw where the dark area is seems to show bone loss between the roots rather than at the end. If that's the case, it is highly likely that you have a gum problem. If so, a crown won't help that heal.
I would suggest that you get that 2nd opinion from a endodontist as soon as possible. There is really no reason to wait. The first thing I think you need to find out is whether the tooth is alive or dead. This can be done with testing and an examination. The endodontist can also evaluate the dark spot and make suggestions. It may mean an evaluation by a periodontist...gum specialist.
Once you have all the info, then you can make an informed decision about what to do. If the tooth is abscessed, you may need a root canal, but you don't want to spend a lot of time and money if the problem is gum disease. You just need to collect information and then make a decision.
