Feature: Tooth Decay and Root Canal Treatment

Dr Johnathan Wee, Clinical Director at Advent Endodontics Inc., talks about the causes of tooth decay and looks at some of the treatment options…

Modern diets have been blamed for causing tooth decay, besides poor dental care. But when tooth decay happens, tooth extraction is not necessarily the only way out. Food, host factors, time and bacteria are the four factors that determine the process of tooth decay. Whilst a softer, sweeter and stickier diet can lead to more caries (decay) or being prone to such an ailment, the ability of the patient to clean (or reduce the bacteria count) in a regular and expedient manner (time) can help negate the ill effects of this so called “modern diet”. Genetics (host factors) and regular effective maintenance by the patients are still important factors in suppressing tooth decay.

Just as you would not expect a surgeon to chop your leg off if it’s broken, but instead fix the fracture to facilitate healing, you should also not be too keen to extract a tooth just because it gives you a toothache. Extraction is the end game. The removal of a tooth (especially in adult teeth) is permanent loss of an important part and functional component of your body. Contrary to popular belief, it is far easier and less costly to keep and maintain your own natural dentition than extracting it (with or without teeth replacements).

Keeping and maintaining your own tissues and structure is always the treatment of choice.

Root canal treatment is one of the more technically challenging aspects of dentistry because it deals with very small spaces in a hostile bacterial environment. The benefits of a successful endodontic treatment, however, are immensely satisfying for the patient. The delivery of root canal treatment is part of the field of dentistry called endodontics which encompasses the science, art and management of the health and disease of the living pulpal tissues inside the tooth and root. Root canal treatment forms but a subset of the entire scope of endodontic therapy.

Whilst the subject of endodontics is taught in all modern dental schools, pre doctoral dental schools focus predominantly on rendering non-complex root canal treatment and pain relief.

Endodontists or dental specialists who have spent additional years in an accredited institution for this speciality, and have the necessary experience and skill sets, can render endodontic treatment in its entire scope. On the average, a typical endodontist manages about 25 teeth for root canal treatment every week, whilst a general dentist sees about two cases a week.

A salvaged tooth whose root canal system has been successfully treated and has a proper crown placed, can give a lifetime of service to the patient. Compared to an implant supported crown, the natural tactile sensation of having your own teeth remains, and you negate the need for surgery and all its associated post-operative discomfort.

The same factors that make patients poor candidates for surgery due to impaired healing or other medical reasons (e.g. uncontrolled diabetes, bleeding factors, long term use of drugs that alter bone healing) also make them poor candidates for implant surgery.

Experienced endodontists can even complete root canal treatment for some teeth in a single visit of about an hour or so (for the noncomplex cases), compared to months (not weeks) that will lapse before an implant supported crown can be completed from start to full function.

Sadly, many patients are erroneously told that dental implants have higher success rates than root canal treated teeth. There is a multitude of evidence based published articles in peer appraised journals (and growing) that state clearly that both success rates of both treatment types are similar. If anything, the patient undergo root canal treatment do not have to bear with surgery related post-operative pain. Our patients’ choice in deciding on root canal treatment or extraction and implants, should be based on other factors besides success rates.

Endodontic treatment is suitable for all stages of decay, and pretty much for almost any patient with any medical history. It is only delivered as definitive treatment (but rather for pain relief), if the tooth can no longer be salvaged structurally due to extensive decay or fractures.

A root canal treated tooth is still your own natural tooth. It is as susceptible to decay as all your other natural teeth. A good coronal reinforced structure (e.g. a crown), adequate hygiene and maintenance will be important in its sustenance and function.

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290 Orchard Road #11-10 Paragon

Tel: 6100 3636