By Valerie Kanter, DMD, MS, BCN, Chair of the IAOMT Endodontics CommitteeDue in large part to the release of a Netflix documentary entitled Root Cause, the debate over root canal treatment has reached a critical juncture. Concerns about this dental procedure and its potential impact on the rest of the body are being raised by patients, providers and dental schools and organizations.Many patients worry when they hear their dentist mention a root canal treatment..reading-box-container-3 .element-bottomshadow:before,.reading-box-container-3 .element-bottomshadow:after{opacity:0.70;}With over 15 million root canal treatments performed each year, we have a responsibility to look at all of the scientific evidence available to us when forming and sharing opinions on such an important issue.Root Canal Treatment and Whole-Body HealthThere is growing evidence that dental conditions and the health of the rest of the body are inter-connected. This shines light on the need for an integrated medical-dental health care system.For example, two new studies published in February 2019 in the peer-reviewed Journal of Endodontics explore this oral-systemic connection. The authors of one of the studies report associations between infections around the end of the root of the tooth and cardiovascular diseases. Similarly, the authors of the second study link root canal infections with increased inflammation and a moderate to high cardiovascular risk.What is a Root Canal Treatment?This graphic shows that the goal of root canal treatment is to remove infected tissue and clean canals.It is important to understand that endodontics is the branch of dentistry that focuses on the treatment of the dental pulp, or the soft tissues inside the tooth (nerves and blood vessels). The goal of endodontic therapy, or root canal treatment, is to prevent and/or treat infections of these structures.Many factors have been associated with the effectiveness of root canal treatment, such as the use of dental dams, surgical operating microscopes, periodontal condition, activation of irrigants and the quality of the final restoration. Factors for failure include residual necrotic pulp tissue, presence of peri-radicular infection, periodontal disease, root fractures, broken instruments, mechanical perforations, root canal overfillings, root canal underfillings, missed canals or unfilled canals.New Technology and Research about Root Canal TreatmentFortunately, there is technology on the rise that may eliminate these shortcomings in traditional endodontic diagnosis and root canal treatment protocols. The use of cone beam computed tomography (CBCT) machines in diagnosing endodontic pathology is emerging as an important tool in improving the quality of care. The development of technology that enhances 3D-disinfection through laser activated irrigation and multisonic irrigation has also gained momentum. The use of medical grade ozone as a complimentary therapy shows great promise.It is also essential to recognize the critical role of immune response in root canal treatment, as well as the confounding relationship among oral infections, metainflammation (low-grade systemic inflammation), and genetics. In particular, specific genetic polymorphisms can influence host response and enhance inflammatory reactions, increasing the susceptibility to persistent apical periodontitis, which has also been associated with systemic diseases.A New Standard for Root Canal TreatmentA new paradigm in endodontics is overdue. An understanding of the newer research and more advanced techniques for root canal treatment is imperative: The use of a microscope, CBCT, advanced irrigation and disinfection techniques and biological monitoring should be the new standard of care. Meanwhile, the following statement written in a status report by IAOMT in 2001 still rings true:.reading-box-container-4 .element-bottomshadow:before,.reading-box-container-4 .element-bottomshadow:after{opacity:0.70;}The IAOMT cannot take the position that all non-vital teeth must be extracted. On the other hand, it is clear that non-vital teeth — with or without endodontic therapy — can present a systemic health risk to some patients. Each patient must be evaluated on an individual basis, considering the medical status and other factors. The IAOMT encourages the dental, medical, and scientific communities to address this area with vigor. Efforts must be made to provide valid methods of determining the systemic health risk from non-vital teeth and provide techniques of endodontic therapy that eliminate, or at least reduce, the risk.CLICK HERE FOR A MORE DETAILED VERSION OF THIS DOCUMENT WITH SCIENTIFIC REFERENCES
