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Dentistry/alternatives to bleach in root canal therapy

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Question
Hi Dr Liewehr
In one of your previous posts I read that you don't use bleach to irrigate and cleanse the roots. What do you use? I am allergic to bleach and can't use this because it irritates my sinuses terribly.

Thank you

Jean

Answer
It is a question of risk:benefit ratio, Jean. Older studies show that simply increasing the volume and frequency of irrigation, even if it is plain water, decreases the number of bacteria greatly. Historically we in the US rely upon mechanically cleansing and shaping the root canal system to remove that bacteria rather then chemical alteration of some sort. There have been many studies on sodium hypochlorite eliminating bacteria, but often there is a "rebound effect" which suggests methodological problems in the studies that suggest bacteria do remain but are not picked up in the experimental technique. Other studies have shown that because it has a high surface tension sodium hypochlorite cannot penetrate into the very small fins and isthmuses of the root canal system where the bacteria are hiding. The elephant in the room, of course, is what happens when the sodium hypochlorite escapes from the root and gets into your bone, which produces disastrous effects that will likely put you into the hospital. Finally, the studies all are "bench top" ones, done in the laboratory. No study has ever demonstrated any clinical difference in outcomes that are produced by different irrigants. So, bottom line is that it is not worth the risk of producing a "sodium hyopchlorite accident" (which you can search on the Internet) for some unproven benefit. That said, the most common alternative nowadays is chlorhexidine, which is more efficacious (again, in the lab) at a high dose than at a lower dose, but still kills germs in the form of Peridex (or a generic) mouthwash. So, you might suggest that your endodontist use that.  

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Frederick R. Liewehr DDS, MS, FICD

Expertise

I can answer your questions about root canal therapy in general. PLEASE DO NOT ask me to diagnose your particular problems or recommend treatment as I cannot do this without examining you and seeing your x-rays.

Experience

I am a Board-certified endodontist, former university department Chairman, teach dental residents, and have a private practice.

Organizations
ADA, AAE, ICD, AAOM, FDI, AMSUS, AAOB

Publications
J of Endodontics, Endodontics and Dental Traumatology, O,O,O, Military Medicine, Medical Bulletin, J of Dental Education

Education/Credentials
DDS, MS (Oral Biology), certificate in Endodontics

Awards and Honors
Surgeon General's "A" Designator, Fellowship ICD, Order of Military Medical Merit

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