Root Canals: Are They Safe?

Root canal treatment is a dental treatment, which is designed to remove bacteria from the infected root canal, prevent reinfection of the tooth and save the natural tooth.

A better name for the procedure is a “root-filled tooth”. The nerve inside a tooth can get inflamed or infected from a very large cavity, or from trauma.

Option #1 – Pull the Tooth.

Option #2–Remove the nerve tissue in the center of the tooth and down the root, and fill the area with a material called gutta-percha (a rubber-like material from Malaysian trees).

The Root Canal

In the 1800s when modern dentistry was in its infancy, dentists and their patients were frustrated because so many teeth had to be pulled. They experimented with removing the infected and dead nerve tissue, rinsing and disinfecting the inside of the tooth, and filling it.

The techniques and materials have evolved, and today more than 22 million root canals are performed every year in the US alone.1 Why?…

… To “save” teeth that have been neglected or damaged. The tooth is no longer alive, but it is retained in the jaw bone to continue functioning.

Root Canal

The problem with root canals

Dentists are usually quite successful in cleaning out the main root canal area and disinfecting it. In fact, in most cases, even the infected bone at the end of the root will heal and new bone grows in its place after the procedure. If so, what is the problem?

Dentin is made up of miles of tubules, all filled with a lymph-like fluid. Each of those tubules opens into the center nerve chamber in the tooth. The bacteria that are involved in tooth decay travel through those dentin tubules to get from the outside to the inside of the tooth in order to infect the nerve. Think of it as the highway system of the tooth.

Dentin Tubules

The medications used to sterilize a tooth are very effective at cleaning the main root canal area, but not the tubules. There are simply too many of them. Once the root is filled, the fluid that fills those tubules and the bacteria they contain back up like a clogged sewer.

The tubules are a nice place for the bacteria to hide, and your immune system or any antibiotic can’t get to them because the flushing system in the tooth has been removed.

Those trapped bacteria have to adapt to living with no oxygen, and these new “anaerobic” (without oxygen) bacteria create waste products called endotoxins. Those toxins are the thing that causes harm as they freely circulate in the bloodstream and around the end of the tooth.

This causes the bone around the tooth to become very unhealthy. The nerve is gone so the tooth often doesn’t hurt, but those endotoxins are affecting your jawbone and your body.

Failed Root Canal

This low-grade infection causes your immune system to stand guard constantly. Eventually, your immune system wears out from working overtime, and when there is an invader somewhere else in the body, it won’t have enough fresh troops to send to fight.

Sickness, fatigue, chronic illness, and autoimmune disease are all conditions that can come because of an overtaxed immune system. And that reinfected root canal tooth can contribute to the overtaxing.

Why Dentists Don’t Know This

I used to be out on a limb when talking about the problems with root canals, but recent research has supported and validated these concerns many times over.

In a comprehensive research article published in the Jan-Mar 2016 European Journal of Dentistry, the problems and potential pitfalls of root canals were explained very clearly. Interestingly, none of these are new to dentists.

Any dental student or dentist can tell you where a root canal can go wrong and is taught how to avoid the problems. However, there are so many potential areas of failure, it is difficult to perform a “perfect” root canal.

As the article explains, the “usual suspects” are:

  • Bacteria remaining in the root
  • Leaking of the root canal filling material
  • The filling material ending up too short or too long for the root
  • Leaking fillings or crowns on top of the root canal tooth
  • Instruments breaking inside the root during the procedure
  • Completely missing one or more of the canals when cleaning out the root

Whew… that’s a lot of things to do perfectly every time, reducing the chance that every root canal will be perfect. The odds are stacked against long term success with root canals, and indeed, studies are showing that failures do occur at some point in the life span of the root-filled teeth.

Research About Root Canals

The first research was done more than 100 years ago by Dr. Westin Price. He was the head of research for the National Dental Association, the precursor to the current American Dental Association.

He tried to sterilize teeth with the chemicals that are used today in root canal treatments. He found that out of 1,000 “sterilized,” extracted teeth, he could culture dangerous bacteria out of 990 of them after only two days.

Don’t just take my word for this. Dr. Josef Issels, MD, a world-famous cancer specialist, was one of the first doctors to require all of his cancer patients to have their root-canaled teeth removed as part of his healing protocol. In his book, Cancer: A Second Opinion, he explains that during 40 years of working with 16,000 thousand cancer patients, over 90% of his patients had between two and ten root-canaled teeth in their mouths.

He believes that root-canaled teeth generate toxins that can lead to cancer. Dr. Jerry Tennant, in his book Healing, is Voltage: Cancer’s On/Off Switches, stated that he finds 90% of cancers are related to a diseased tooth.

In a 2013 study12 published by Dr. Tanja Pessi and others in the American Heart Association’s journal, Circulation, they show that failed root canals play a significant role in heart attacks and strokes. In a study of the clots and blood samples from 101 people that had had a fatal heart attack, it was discovered that 78.2% of the clots had oral bacteria that cause root canal abscesses and 34.7% of the clots contained bacteria found in periodontal disease.

X-rays from 30 of the patients found that 50% had infected teeth. These research findings suggest that up to 50% of heart attacks may be triggered by an infection in the mouth.

This research study was groundbreaking in many ways, and follow-up research has affirmed what the study found. See a list of follow-up studies in the list of sources at the end  of the book.13-17

Can You Have a Successful Root Canal?

This is where it gets sticky. Traditional dentists will usually recommend a root canal for infected or dead teeth, and redo or surgical root canal (called an apicoectomy) if that root canal fails. In fact, I myself have performed hundreds of root canals in my career, but I no longer offer or perform the procedure.

Why the change?

I now use a specialized dental x-ray called a Cone Beam CT scan that shows the teeth and surrounding bone in 3D. I can see teeth and root canals and the bone surrounding the root canals in a way I never could before–and every day I see failed root canals.

In fact, nearly every new patient that I visit has at least one failed root canal. I see so much infection and disease I can no longer offer that procedure myself.

I still tell my patients about the root canal option, as I am required to do by law, but I prefer them to a root canal specialist (endodontist) if they choose to have a root canal.

Does this mean there is no other choice than to remove a tooth that is dead or dying? Some of the most convincing research completed in this area was again by our friend Dr. Weston Price.

In his day, root canal filling and sealing materials were much less successful than they are today, so you might think he would make this “pull every infected tooth” recommendation. He didn’t.

There are people that have had root canal treatments completed years ago, and the tooth has not reinfected, and they have remained in good health. Dr. Price found that this was about 30% of those treated. He said…

 “I am not ready to draw the line so rigidly to state that all root-filled teeth should be extracted for every patient or for all patients at any given time, though I do believe there is a limit of safety for all such teeth for each and every patient.”

Can You Have a Successful Root Canal?

What is the key to a successful root canal? The health of the person getting the root canal! People with strong immune systems and no family tendency to chronic degenerative disease can possibly have and retain successful root canal fillings.

Here’s the catch twenty-two. Dr. Price found that if those healthy people had an accident, caught a flu-bug, had a death in the family, or suffered some other severe stress, their immune system becomes overstressed. When the immune system is overstressed, it must drop the ball on a few things, and those trapped bacteria may multiply and start causing problems.

A healthy person with a root canal may not stay healthy. This means a non-problematic root canal may become a problem–even years in the future.

What to do, what to do?! I was faced with this very personal situation a few years ago with my 11-year-old son. While warming up for an All-Stars baseball game, he got hit in the mouth with a baseball. He came around the corner spitting out teeth, and my heart just sank. I knew what he was in for.

One of his front teeth came out and was not savable, and the other front tooth was fractured 1/2 way down the root but didn’t come out.

My choice was to do a root canal to save the tooth for now or take out both of my son’s permanent front teeth. It makes me sick to my stomach to think about it even years later!

I chose to do a root canal. And in his situation, with a fractured root, I 100% know his root canal will leak and fail. Why did I make this choice? He was very healthy, in the middle of a big growth spurt, and I could keep an eye on his health and the tooth.

His body should be able to handle the root canal for a few years until he has grown enough to permanently replace the tooth.

I view root canals as temporary solutions. They help retain the tooth in the mouth, keep the space and buy time for the patient to stop growing or find a better solution.

Recommendations

There is not a hard-and-fast answer to the root canal controversy. I can’t give you a rule, but from what I’ve observed with hundreds of patients, I’ve come up with some recommendations.

  • If you are in that 30% category of the healthy immune system and no family history of degenerative diseases like diabetes, arthritis, heart disease or cancer, you have a statistically higher chance for a successful root canal right now. You may get 5, 10, even 15 years more with that tooth.
  • If you are in the 70% category with some immune problems, any existing degenerative diseases (arthritis, heart problems, diabetes, etc) or a family history of degenerative diseases, you have a statistically lower chance for a successful root canal. You may wish to extract the tooth rather than pay for a root canal and have it fail and negatively affect your health.
  • If you have an existing root canal and have had a nagging, unexplained medical problems, or progressive degenerative diseases or immune problems, your root canal may be contributing to your health problems.
  • If you have an existing root canal and are in good health, AND if the tooth appears healthy and uninfected on a diagnostic x-ray (CT scan is the only method to view this), you may choose to leave the tooth there for now.

Warning: Any good holistic dentist will let you know that the removal of a root canal tooth may not fully alleviate the illness you feel may be related to that tooth. There are often multiple “foundational problems” that contribute to your illness or disease, the root canal being one.

If enough of these foundational problems are removed, the body is able to heal. Improving nutrition, correcting stomach acid, and rebuilding your energy systems are all important pieces of your holistic dentist should be able to help with as well.

The best root canal is no root canal at all. Except in trauma situations like my son’s, most root canals can be avoided with proper care and nutrition. Please read the chapters on Tooth Care and Diet again. You don’t ever want to have to make the difficult decision to keep or remove a tooth.

If you do have a very deep cavity, make sure to read the section on Biomimetic and Tooth Preserving Dentistry before getting a root canal. There are treatment options, including ozone, that can be used to seal and heal a tooth that may otherwise have required a root canal.

Twenty-First Century Dental Options

There are new advances in all areas of dentistry, including root canals. Some things are in the experimental stages, while others are being used by a few pioneering dentists. Things to watch for:

  • Laser sterilization of root canal areas– There is hope that the use of a laser during the root canal procedure can sterilize the root area and keep bacteria out. To date, this has not prevented the regrowth of these damaging bacteria, but the technology is advancing every day.
  • Ozone sterilization of root canal areas18– Ozone is a very powerful anti-microbial. One molecule of ozone is more powerful than 3000 molecules of bleach (which is the standard of care for disinfecting root canals right now). But ozone is a gas, and it leaves the area quickly. The root canal is completely disinfected at the time it’s filled, but the effect of the ozone does not last and the bacteria regrow. Ozone research is at the leading edge of medical and dental innovation, so I will be anxiously watching for solutions to this problem.
  • Antimicrobial root filling materials– This is up and coming technology. There are also experiments using root canal sealing materials made of ceramics, in hopes the root canal will not leak. This would prevent leakage, but leakage isn’t the only problem. The bacteria congregate at the end of the root canal, outside of the root, as well. Nothing has been shown to inhibit growth there yet.
  • Oral probiotics19– These are specialized beneficial oral bacteria. The thought is, if the destructive bacteria are overpowered by beneficial mouth bacteria, there is less likelihood the tooth will re-infect. Again, the problem is that unless you continually take these probiotics, the effect does not last.
  • Helping a tooth regrow the nerve– This is the one I’m most excited about! Bodies are able to heal in so many other ways, there must be a way to help teeth heal as well. I will be one of the first to adopt this treatment, if and when it becomes clinically viable.

What can you do if you already have a root canal tooth?

Option #1 – Have it removed. No one likes this option. People don’t like going without teeth or paying to have them replaced, and dentists don’t like removing them! Root canal teeth have lost the ligament surrounding them and they are often “cemented” to the bone, making these teeth difficult to remove.

Despite this difficulty, I am recommending and removing teeth on a greater number of patients than ever before. I used to recommend saving a tooth at any cost, and now I save health at any cost, even if it means losing a tooth. Keep that in mind when making your decision.

Option #2 – Keep it healthy. How can your health of the tooth by keeping your body healthy. There are two additional dental procedures you can choose from to prolong the life of the root canal tooth.

  1. Non-metal crown. This one is a little mad-scientist like. If you have a metal filling or crown or porcelain crown with a metal core, you have a small battery in your mouth (You can’t always see the metal core, and can check to see if there is one with a dental Xray).

    All fillings and metal-containing crowns are made out of an alloy, which is a combination of different metals. In saliva, those metals have a small electrical current running between them. You may have felt like “you are chewing on tin foil”. That’s the current I’m talking about. It’s called galvanism.

    Bacteria love this small current and they flourish when it’s there. If you have a metal filling or crown on the tooth with a root canal, you’ve created the perfect storm. The metals are attracting bacteria and the bacteria are re-infecting the root canal. Solution–have the metal replaced with porcelain.

  1. Good bugs. We all have millions of microbes in our mouths. Some are good and some are bad. If you have a root canal that you would like to keep healthy, give your mouth an extra boost by taking a special probiotic formulated for mouths.

    There are many brands available online now, including Florassist by Life Extension, a lozenge shown through research to reduce infection in the mouth.

    Interesting to note – just like you can pass on those flu bugs, you can pass on your cavity bugs too. If you and your mom have bad teeth, it’s probably as much about a mom giving you her bad bugs as it is about genetics. A probiotic can turn this around for you and your family.

IMPORTANT: Root Canal Tooth Removal Protocol

There is a very specific protocol that must be followed when removing the root canal tooth in order the ensure the bone heals properly.

Remember the ligament that surrounds the root of the tooth? It’s called the periodontal ligament. If your tooth is infected, this ligament is infected as well. After the tooth is removed, the ligament and a thin layer of the bone surrounding the tooth must be removed.

If this infected area isn’t removed, the body takes 14 days to realize the tooth is gone. During that time the body has started to heal over the top, “capping” a hole in the bone rather than filling the hole in. This hole could be a source of long-standing bone infection and toxins.

The action of removing this ligament and the surrounding thin layer of bone also turns on the cells that help the bone in the area to regenerate. This is a simple step you can ask a dentist to perform to help any tooth removal area heal.

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