When root canal treatment is needed?
The progress of dental caries through the enamel, dentin and dental pulp system. The root canal pulp tissue inflammation is caused by a prolonged bacterial irritation normally caused by extensive and deep tooth decay or a leaking filling.
As a result of intensive and chronic long-term bacterial chemical, mechanical, and thermal trauma, the immune system within the pulp causes irreversible hyper-inflammatory reaction whilst the compromised regenerative capacity of the pulp within this closed chamber creates pressure on the pain receptors along the periphery of the pulp chamber. Triggering of the pain receptors conducts the unpleasant sensitivity, pain or toothache via the nerve fibres passing through the apex of the tooth root.
Root canal treatment is required when the inflammatory damage to the pulp tissue is irreversible. Therefore, the damaged or infected tissues within the tooth chamber should be removed. The chamber’s walls should be cleansed by chemical and mechanical means to disinfect the remnant of bacterial residues.
How root canal treatment can be prevented?
Most of us keep looking for alternative treatments instead of undergoing root canal treatment
What the alternative integrative medicine can offer as an alternative to prevent root canal treatment?
1. Ozone therapy
Prolozone, ozonated gas or even saline injection can successfully be used to reduce the severity of infection around the affected roots.
The antimicrobial effect of ozone is the most studied. Oxygen/ ozone therapy in dentistry offers multiple protocols to deal with dental infection. Localised Ozone gas therapy is a well-known non-invasive treatment that disinfects the infected dentin tissues and eliminates harmful bacteria from the caries lesions while promoting faster healing by stimulating the body’s natural immune defence mechanisms.
Irrigating the tooth cavity with Ozonated water or application of the ozonated gas facilitates penetration of ozone molecules into the dentine tubules of the tooth beyond the mechanically excavated caries layer via lateral tubules to disinfect the dentin beneath the enamel. When a tooth is decayed but still alive, ozone therapy can prevent the progression of caries, reduce the pulp inflammation hence irreversible pulpitis and need for root canal therapy. Ozone also speeds healing and recovery time by oxygenating the area.
2. Low-level-laser-Therapy (LLLT)
LLLT also known as photobiomodulation (PBM) uses a red-light laser wavelength of 660 nm. PBM mode of action elicit photon energy of light to the tissue via the skin barrier and is absorbed by the cells where it initiates physiological reactions within the mitochondria.
The advent of PBM enhances our patient treatment and post-op results.
For decades, PBM or low-level laser therapy (LLLT) therapy has been effectively used in the treatment of gum disease, joint disorders, and post-surgical healing. PBM improves oral health and enhances well-being by stimulating the body’s natural healing mechanisms.
3. Bioactive Bioeramic materials
The infected tooth can also be rinsed with an alkaline substance known as calcium hydroxide, which has the ability to deter bacteria growth in tooth canals. Endodontic Bioactive Bioceramic materials have many benefits in advanced Endodontic dentistry including:
3a. Cavity lining: BioCeramic BioActive material disinfect the cavity basis, isolates the exposed dentin tubules from undue Thermal, Bacterial and Chemical trauma.
3b. Indirect pulp capping: When the soft carious dentin requires disinfection and the pulp requires the regeneration of reactive secondary dentin building. We avoid root canal treatment as much a possible by implementing Successive Excavation; an Scandinavian Holistic dental technique used for the last 4 decades.
3c. Direct pulp capping: When the pulp is exposed as a result of caries or during the accidental damage.
4. Partial pulpotomy:
Partial Pulpotomy is an Scandinavian Holistic technique used for the last 4 decades. When part of the Dentin-Pulp Complex is exposed as a result of caries or during the accidental damage. We avoid Total Pulp Extirpation/ Removal of the Root Pulp Complex by implementing partial pulpotomy
5. Are there natural remedies as an alternative to root canal treatment?
Some natural remedies may provide temporary pain relief. Traumee a natural, anti-inflammatory homeopathic preparation can be used for pain, bruising, and inflammation. Traumee contains a combination of homeopathic ingredients like Arnica, Calendula, Hamamelis, and Belladonna. Traumme reduces swelling, pain, and bruising, supports soft tissue recovery, reduced discomfort from sprains and muscle injuries.
6. Can antibiotics be used as an alternative to root canal treatment?
Antibiotics can temporarily reduce the spread of the tooth infection and alleviate infection, but they do not eliminate the intra-canal infection. Therefore, root canal treatment or extraction is necessary for long-term resolution.
7. Monitoring
In some cases, your dentist may recommend close monitoring of the tooth pulp health status instead of approach an immediate intervention. This is typically considered when the pulp inflammation is limited to then pulp horn (corner), and your dentist can access and assesses the treated lesion. However, in case on advanced or late stage of pulpitis the pulp complex cellular and vascular degenerative process exceeds the natural biological capability of pulp to repair!
Although these procedures may prevent the process of reversible pulp inflammation and abate the pain and discomfort, they do not eliminate the unreachable infected pulp tissues following pulp necrosis.
Therefore, a more specialised dental intervention is required to access root cause of the infection.
What are the Holistic approaches that minimise the biological adverse effects of conventional non-biological root Canal Therapy?
1. Infra-Red light therapy Procedure
To minimise the pathogenic microorganism within the root canals, and achieve endodontics germ reduction, we implement, a minimally invasive biological root canal treatment using the latest dental laser benefiting from Infra-red light (970nm) procedure conveyed via a fibre of ø200um into a root canal. Infra-Red light therapy Technology is used to clean the deepest parts of the root canal system.
2. BioCeramic Bioactive Material (BBM)
BBM is used as an intra-canal treatment and offers a higher standard as Bioactivity in regeneration of pulp-root complex. This material is biocompatible, non-cytotoxic, non-genotoxic, with and initial high pH (alkaline/basic), acting as an antimicrobial material. Bioactive Bioceramic materials in Endodontic promotes the formation of hydroxyapatite on the surface to seal and support healing through the release calcium and hydroxide ions. It has a pH of approximately 12.5, antimicrobial activity, and tissue-dissolving ability, can inhibit tooth resorption and promote repair and complex tissue formation.
BBM is a dimensionally stable material which does not shrink ensuring a gap-free seal, minimizing bacterial leakage or infiltration.
The Resin-free nature of its composition offers maximum cellular bioactivity and regeneration.
BBM does not stain or discolour the teeth crown-root complex.
It has been applied for intra-canal placement for different endodontic conditions, including apexification, abiogenesis after trauma, and routine root canal in infected canals.
What Are the Holistic Alternatives to a Root Canal Therapy?
1. Undue monitoring of the necrotic or infected tooth
What can happen if pain-free but necrotised tooth is left untreated but monitored?
Most of the times an avital necrotised tooth with silent inflammation or low-grade infection can progress to high-grade infection causing delayed abscess, discomfort, pain, and even systemic health deterioration. Therefore, if adequate intervention is made, untreated infected teeth can lead to localized and systemic health complications by spreading causing abscess formation, and eventual pain.
Missing teeth due to oral trauma or congenital causes in growing patients before the placement of an implant can be planned in patients with fully grown jaws.
2. Biological atraumatic tooth extraction
Atraumatic tooth extraction is performed to minimise mechanical, chemical, bacterial, or biological trauma to the socket walls. Surgical trauma caused by tooth extraction can be limited by using a minimally invasive approach, which reduces the risk of micro-fractures in the thin surrounding socket housing and decreases the resorption rate.
Biological tooth extraction also involves the complete removal of a periodontal ligament (PDL), granulation tissues, foreign bodies, damaged or infected tooth from the alveolar socket.
To promote the wound healing, autologous L-PRF can be applied into the alveolar sockets.
3. Zirconia Maryland bridges
As Maryland bridges require less alteration of adjacent teeth, they are more conservative. They are bonded using a framework and can be made from materials like porcelain, metal, or acrylic. Traditional bridges involve dental crowns and provide excellent strength and stability.
What are the Indications for Zirconia Maryland bridge?
- Missing teeth when the patient is not a candidate for the dental implant procedure due to, e.g., medical contraindications, mental incapacity, insufficient bone volume or density, angled adjacent teeth roots, or financial limitations.
- Intact neighbour teeth
- Future complex rehabilitation cases
What are the advantages of a Maryland bridge?
Aesthetics: They can be customized to match your teeth’ natural colour and shape, providing a seamless and natural-looking smile.
Comfort: Typically, Maryland bridges fit comfortably without causing discomfort once bonded in place.
Conservative approach: Unlike traditional bridges, Maryland bridges do not require extensive removal of tooth enamel. They require minimal tooth preparation and are more non-invasive and atraumatic to the neighbouring teeth supporting the bridge. This would reduce the future risk of pulp trauma and necrosis, hence the need for root canal treatment. The tooth abutments are mostly left intact, and in case of an existing filling, they can be prepared as a supporting base for the bridge
This type of minimally invasive tooth preparation may require no anaesthesia.
Its minimalist design causes less gum irritation and violation of the periodontal tissue.
An ideal option for patients who are too ill or need invasive dental procedures or surgeries.
An ideal provisional replacement option in patients who plan to undergo the implant procedure.
Financially, an ideal alternative option for patients who can’t afford an implant.
4. Zirconia conventional bridges
Zirconia bridges are prosthetic devices used to replace missing teeth. In cases where a tooth requires extraction, a bridge may be considered as an alternative. However, this option involves modifying adjacent healthy teeth to support the bridge, which may not be desirable for some individuals.
How long does a dental bridge last as an alternative to a root canal?
The lifespan of a dental bridge depends on various factors, including the structural integrity and health of supporting teeth, oral hygiene and overall maintenance.
On average, bridges may last 10 to 15 years or longer.
5. Dental implants
Dental implants are another alternative to root canal treatment. This involves the surgical placement of an artificial tooth root into the jawbone, onto which a crown is then attached.
The implant may be placed during the same visit, or you may need to return a second time to get the dental implant.
Recommendations
- Every effort should be made to preserve the vitality and integrity of the ailing teeth.
- Care should be taken to adhere to alternatives treatment options root canal treatment, most non-invasive and least detrimental to the remaining teeth.
- Preserving natural teeth through root canal treatment is often the preferred choice, as it allows individuals to maintain oral functionality, aesthetics, and overall well-being.
- When exploring alternatives, it is crucial to discuss the risks and benefits with a dentist to make an informed decision based on individual circumstances and oral health needs.
Dr. Nico Kamosi
Dr. Nico Kamosi
Specialist Periodontist, Implantologist, Prosthodontist, Holistic and Biological Dentist
TDL. DDS. (Swe.), MSc.Perio.(Eng.),
MClinDent.Perio.(Eng.), MSc.Imp.Dent.(Eng.),
Dip.Aesth.Med. (Eng.), MClinDent.Prosth.(Eng.),
Cert., Dip.DHSLM.(RCS.Eng.), Cert.Orth.(Eng.), Cert.Law (Eng.)
Member of: AACD - IAOMT - EFP - ESCI - SMART Certified
