When Root Canals Fail

Nagging toothache? Has the dentist discovered a tooth that is deteriorating from the inside out on your latest dental x-ray? Sounds like you might be considering a root canal. Is the threat of more pain and agony delaying your decision?

A root canal is performed when the nerve tissue and pulp material of a tooth becomes infected with bacteria. Because of the enclosed nature of a tooth, the body has little chance to fight and conquer this infection. In some cases, the result will be an extraordinary tooth ache. In others, the nerves and live material of the inner tooth will simply die off. The infection may go undetected for years, but the bacteria are still doing damage to the tooth, gum and bone beneath it. In both cases, a root canal is the standard method of treatment.

The root canal involves drilling in through the center of the tooth and removing the soft material of the pulp. To eliminate all bacteria, the tooth must be drilled all the way down into the gums making sure both the root and the tooth are entirely free and clean. The tooth is then capped with a restorative crown

Are there any other alternatives?

There was a time when a root canal would have been presented as your only alternative. Today, however, complete extraction of the infected tooth followed by a dental implant might be the preferred way to go.

Why chose an implant over a root canal?

Good question. In an ideal world, all the bacteria would be removed from your tooth in the root canal process and the tooth would be refilled and capped. Many times, a rod will be inserted to reinforce the tooth and provide a secure point to adhere the cap to the tooth.

But let’s think about what happens when a small amount of bacteria is left behind. Basically, it is packed in with the filling and given an environment to continue to grow and flourish in. Down the road? Another toothache. Assuming there is enough tooth left to drill, do you really want to sit through yet another root canal?

As well, root canals don’t always go as planned. Sometimes the tooth itself is broken in the process of being drilled. And caps or crowns, which top your tooth once the root canal has been completed, don’t necessarily last a lifetime. It is not unusual for a crown to need to be replaced after 7-10 years.

Now imagine that you’d opted to simply have the bad tooth extracted in the first place and replaced with a dental implant. At success rates of 90-97% in the average dentist’s office, a dental implant, which is designed to last a lifetime, sounds like a good alternative.

What exactly is a dental implant?

Rather than use what’s left of a previously infected tooth, a dental implant replaces the tooth entirely. Unlike a bridge, which might be the next step when a root canal and crown fail, a dental implant feels and works just like your natural tooth.

The implant process is started by inserting a screw, generally titanium, into the jawbone. Once healing has taken place and integration of the screw is complete (generally a few months) a prosthetic tooth is placed on the screw. It will look and feel like the real thing. You care for an implant in the same manner you care for the rest of your teeth – standard brushing, flossing, and rinsing.

According to Dr. Maria Lopez Howell of the American Dental Association’s “ADA Dental Minute” (www.ada.org), “Most patients find that an implant is secure and stable, a good replacement for their own tooth.”

Can my dentist do this or do I have to go to a specialist?

Many dentists now place dental implants as a routine part of the services they offer. Your dentist can talk to you about any special circumstances regarding your oral health and will be able to guide you through your options as far as treatment preference, long-term outlook, and working with your insurance company to provide optimal coverage for your specific case.

If your dentist doesn’t mention the implant procedure as an alternative to the standard root canal, seek advice elsewhere. Dental implants are a safe, long-term solution.