Root Canal Therapy

“News flash! All root canal-treated teeth are infected!” If you are a licensed dentist or endodontist, that statement is likely to strike a nerve. Without question, our scientific understanding of bacterial infectious diseases in the oral microbiome has progressed more than ever in recent years. Testing services such as OralDNA® Labs, aid us by analyzing the pathogens living in the oral environment: I would call it a modern wonder. With so much progress in oral health care, it would stand to reason that as we understand more about the nature of the biofilm diseases we treat, our approach to care would change.

In this article, I aim to present the concept that root canal therapy is a flawed procedure. Yes, we have been doing them for years and most people do not appear to have any symptoms afterward. And yes, I do believe that there are certain instances in which root canal therapy can be used as a therapeutic modality. But that does not make it a healthy choice given what we are beginning to understand about the long-term infectious nature of root canal-treated teeth.

Looking at these extracted, endodontically treated teeth, would you consider these to be a dental treatment that yielded a health-promoting result? A patient is associated with the roots of this molar which you see in this image. I will share their story. At age 17, the patient was told “You need a root canal.” She was told post-operatively that her tooth was fine and that her continued pain must be from a sinus infection. The patient experienced pain in her right maxillary sinus and chronic drainage from her right nostril (a “post-nasal” drip feeling). She was told it must be her sinuses. “It couldn’t be related to your tooth” she was told. Finally, at age 22, the infected tooth was removed.

This is standard protocol. We (dentists) were taught that root canal therapy is a “normal” treatment to provide by the standards of the 20th century. But things have changed. New science continues to emerge which demonstrates that not only are all root canal-treated teeth full of pathogenic microbes, but that these pathogens being trapped in the dentin, periodontal ligament space and lacunae of the bone, lead to increased risk for systemic disease.

If you are an OralDNA® provider, applying a higher standard of care to your periodontal patients by testing, consider reading “Hidden Epidemic” by Dr. Thomas Levy. From these scientific writings you will come to understand that the roots of root canal-treated teeth become completely infected within approximately 30 days. “Hidden Epidemic” reviews the scientific work of Dr. Boyd Haley, former Chair of Chemistry at the University of Kentucky. The science is excellent! It is high time that we as oral health physicians look deeper into the therapies we provide. It is no longer adequate to judge our successes only by whether a patient is asymptomatic following therapy.

As the specialists in the field of oral medicine, we must recognize that everything in the body is connected. Our blood vessels, nerves, lymph vessels, fascia, extra-cellular matrix, and the energy which flows through it all is one complete and synergistic system! We must treat every part of the body in such a way that we respect these truths. The next time you find yourself about to say the phrase, “You need a root canal,” think twice. Consider offering multiple solutions such as caries excavation, ozone treatment to the dentin and a sedative glass-ionomer filling. Or if the tooth nerve is necrotic, explain the benefits of extraction. Explain that if the patient’s goal is to keep the tooth, then root canal therapy could be appropriate. But be sure to explain that if that dead tooth is in their mouth, their body will be exposed to small amounts of chronic infection. Our patients deserve to know the truth about all treatment options and have the right to make informed choices.

**To learn more about becoming an OralDNA Provider: Text “OralDNA” to 31996**

Kelly Blodgett DMD

Kelly Blodgett DMD

Dr. Blodgett is a native Oregonian who attended grade school through high school in Southwest Portland. He earned his bachelor’s degree in Psychology from the University of Oregon and completed his pre-doctoral sciences at Portland State University. Dr. Blodgett attended the OHSU School of Dentistry and graduated in June of 1999 where he earned the “Going the Extra Mile” award from his own classmates.

In 2001, he embarked on a journey to offer the best holistic oral health care practice in Portland. His mission holds true today “to reverse the negative stereotype of dentistry.”

Throughout his career, he’s become a recognized leader in minimally invasive dentistry, dental lasers, computerized dental technology, and holistic care.

He has been featured in numerous dental journals, on television, and in magazines for the innovative care he provides. He is truly a modern pioneer in progressive dental care.

Dr. Blodgett and his wife, Julie, have been married since 1994 and have two beautiful daughters: Sara, born in 2002, and Megan, born in 2005. They reside in Southwest Portland, just up the hill from his high school alma mater, Wilson High School.
Kelly Blodgett DMD

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7 thoughts on “Root Canal Therapy

  1. Terry klampe says:

    You need a reference to your statement regarding trapped pathogens leading to “increased risk of systemic disease”. Please provide this
    Sincerely, terry klampe dds ms

    1. Kelly Blodgett says:

      Thank you for this question. For years, authors of books such as “Root Canal Cover-Up” (Dr. George Meinig) and “The Roots of Disease” (Drs. Robert Kulacz and Thomas E. Levy) have shared numerous scientific resources which illustrate the connections between chronic oral and maxillofacial infections and systemic disease. Most recently the book written by Dr. Brad Bale and Amy Doneen entitled “Beating the Heart Attack Gene” has presented more evidence. In this book, they beautifully illustrate the physiologic and biochemical pathways in which oral infection causes cardiovascular complications such as heart attacks and strokes. Their paper which showed this causative pathway was published in the British Medical. I would recommend after reading “Beat the Heart Attack Gene, reading the book “Hidden Epidemic” by Dr. Thomas E. Levy. The information and long list of resources in this book will provide additional insight. On a side note, for more than 100 years dentists have not only observed the “oral-systemic connection” but some have been brave enough to speak up and share their research.

  2. Jake says:

    So if your patient has a tooth ache, you don’t try to save the tooth?

    1. Kelly Blodgett says:

      Thank you for this question. I do try to save teeth. My goal when a patient has pulpal inflammation is to understand what is causing it. Modern technological advances such as air abrasion, Erbium laser treatments and ozone gas therapy have allowed for the most optimal bonding techniques in our profession’s history; however, if we do not understand what led to the pulpitis, the restorative measures may be limited in their affect. The goal within our practice is to help people to obtain and maintain optimal health both orally and systemically. We know that the “symptomatic” health model does not work. If you focus on the “drill and fill” model of dentistry, you may never achieve stable health. It is no different than putting a new roof on a burning house. If you understand the cause of the fire and know how to put it out, then your restorative measures will work effectively and have longevity. Keep in mind, it requires the full commitment of the patient to participate in their own health improvement. I hope this provides clarity to my treatment philosophy.

  3. I totally agree with you and thanks for sharing.

  4. Thank you, Dr. Blodgett for your brave post! We are learning so much everyday and new knowledge must impact how we care for our patients. In my experience, root-canaled teeth are “teeth on probation” and must be closely monitored. Many function well but many do not. Periodic CBCTs and Oral DNA evaluations must be part of the therapy. It was a 20-year old, asymptomatic root canal in my own mouth that convinced me. Treponema denticola showed up on my initial Oral DNA test; I had the tooth removed and it was 100% gone. As a transmissible bacteria, my husband had no root canals but a bit of Td on his test. It also disappeared after my tooth was extracted. This was ten years ago and seemed drastic. As I further research these bacteria and observe patient outcomes, I’m convinced that it was an absolutely wise decision. Thank you again for your post!

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