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Root Canal Safety

December 16, 2019 by Dr. Judy McIntyre

The relationship of our teeth and mouth to overall good health is indisputable. Endodontics plays a critical role in maintaining good oral health by eliminating infection and pain, and preserving our natural dentition.

A key responsibility of any dentist is to reassure patients who are concerned about the safety of endodontic treatment that their overall well-being is a top priority. The American Association of Endodontists website (www.aae.org) is the best place for anxious patients to obtain comprehensive information on the safety and efficacy of endodontics and root canal treatment.

root-canal-safety

While plenty of good information is available online from the AAE and other reliable resources, patients sometimes arrive in the dental office with misinformation. This has occurred with the long-dispelled “focal infection theory” in endodontics, introduced in the early 1900s. In the 1920s, Dr. Weston A. Price presented research suggesting that bacteria trapped in dentinal tubules during root canal treatment could “leak” and cause almost any type of generative systemic disease (e.g., arthritis; diseases of the kidney, heart, nervous, gastroinestinal, endocrine and other systems). This was before medicine understood the causes of such disease.

Dr. Price advocated tooth extraction—the most traumatic dental procedure—over endodontic treatment. This theory resulted in a frightening era of tooth extraction both for treatment of systemic disease and as a prophylactic measure against future illness. Dr. Price’s research techniques were criticized at the time they were published, and by the early 1930s, a number of well-designed studies using more modern research techniques discredited his findings.

Decades of research have contradicted Dr. Price’s findings since then. In 1951, the Journal of the American Dental Association published a special edition reviewing the scientific literature and shifted the standard of practice back to endodontic treatment for teeth with non-vital pulp in instances where the tooth could be saved. The JADA reviewed Dr. Price’s research techniques from the 1920s and noted that they lacked many aspects of modern scientific research, including absence of proper control groups and induction of excessive doses of bacteria.

More recent research continues to support the safety of dental treatment as it relates to overall systemic health. In 2007, the American Heart Association updated its guidelines on the prevention of infective endocarditis, drastically curbing the indications for premedication for dental procedures and excluding endodontic treatment from dental procedures requiring premedication. In April 2012, the AHA found no scientific evidence linking periodontal disease and heart disease, concluding that heart disease and periodontal disease often coincidentally occur in the same person due to common risk factors of smoking, age and diabetes mellitus.

Decades of research contradict the beliefs of “focal infection” proponents; there is no valid, scientific evidence linking endodontically treated teeth and systemic disease. Yet some patients still hear about this long-dispelled theory.

Dentists are asked to use the following guidelines to address patients who inquire about a connection between root canal treatment and illness:

address-patient
  • Acknowledge the patient’s concerns; stress that optimum health is the goal for every dental patient.
  • Provide the patient with written information about endodontic treatment, and discuss it. The AAE has a variety of patient education brochures available for purchase (www.aae.org/onlinestore).
  • Provide the patient with information from the AAE website about common root canal myths: www.aae.org/patients/treatments-and-procedures/root-canals/myths-about-root-canals-and-root-canal-pain.aspx#2.
  • Indicate that the patient is in control of his/her own decision to move forward with any dental procedure, and reiterate a commitment to the highest quality dental care.

Category iconroot canal treatment

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Hopkinton Endodontics

Judy McIntyre, DMD, MS
225 Wood Street #1
Hopkinton, MA 01748
508-686-7668

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drjudyendo

What's this??? 🙋‍♀️ Extra oral #bitewings What's this???
🙋‍♀️
Extra oral #bitewings
🙌
Most people don’t think of ExtraOral #bitewings as something that would be helpful in an #endodontic practice. 
Some patients however, such as gaggers,
young and/or autistic patients and others do not tolerate intraoral radiographs or have limitations or disabilities that make taking intraoral films, especially posterior periapicals, challenging or impossible.
This can lead to a result that is not diagnostic and/or does not capture essential information.
☢️
Extraoral bitewings, aka "E/O BWs", can be a great alternative.
🥳
“Extraoral bitewings” is a bit of a misnomer. 
Unlike a traditional bitewing, these images capture the apices of the teeth as well making them
a great option for patients that can’t tolerate posterior PAs. These E/O BWs were a perfect alternative for this 9 yo pediatric patient.

The film taken by the RD did not capture the apices and captured a lot of black space instead.

I had taken a #cbct prior to treatment and wanted to capture a post-op film of the #vitalpulptherapy treatment that was rendered

These images can be captured without having to put anything in the patient's mouth!

This is a valuable and underestimated tool to capture an image when cooperation would prevent/limit the diagnostic potential - for example in an attempted
#periapical film
Hopeful for the follow up in 6m
🤞🤗
Goal: although this pt was in pain, I was able to control the heme within after pulpal amputation 
In 6m, I hope to see continued root development/closure
This postoperative convo with pt/ family is extensive and includes to come back if symptoms develop before then!!
🙏
#alwayslearning
#thinkoutstidethebox
#pediatricdentistry
#oralradiology
#dentalradiology
#3dimaging
@dexisimaging
@ryanz3d
Decay!  ... and, a lot of it!   And, if you no Decay!  ... and, a lot of it!  
And, if you notice, on the preop there's also decay on the LR6 as well. 

Thankfully, this astute RD excavated all of the decay BEFORE referring.  
🥳
While it's not necessary, often decay removal is very much appreciated 🤗 from us endodontists because [I feel that] the restoring #dentists have a better assessment of what exactly one is comfortable saving, rather than either ping-ponging the pt and/or sending for another consult (perio for CL, for ex), etc.  

The GD and pt decided that LR7 was not restorable.  This pt also is missing the UR7 also so there is no opposing tooth.  And, yes, there is a ridiculous radix and curve on it as well - nice eye @grissomendo !

#cbct confirmed 3 canals and no PA pathology

Dx: SIP/SAP LR6 and completed in 2 visit
🥳 Great weekend again with the #mastertrack #de 🥳
Great weekend again with the #mastertrack #dentistry group
📚
This group welcomed their assignment graciously
Homework 1: to meet with their local #endodontist and discuss how to work better together and how to serve #patients better
🙌
Homework 2: review #dentaltrauma and #dentaler protocols with their #dentalteam to improve flow when emergency situations arise
🙌
Homework 3: present a #cbct case featuring something the practitioner has learned or managed differently 
🙌
Thrilled to share these great slides of wonderful meetings and great learning points 

#protips
#alwayslearning 
#3dimaging
#dentalce
#superdentists 
#saveteeth
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