Root Canal or Extraction? There May Be Another Option! May 13, 2014
NOBODY LIKES TO HEAR “YOU NEED A ROOT CANAL!”or “THAT TOOTH NEEDS TO BE EXTRACTED!” when visiting a dentist. Yes, these certainly are the needed treatments in many cases where decay and/or infection have progressed too far and they are the only treatments left. As dentists we all have our share of patients coming in on an emergency basis who are experiencing pain, and it used to be expected that an extraction or root canal therapy were the last two choices. Not surprisingly, with the development of modern materials and treatments, a third choice has become available.
Using a procedure called “Pulp Capping”, dental materials called liners can be used where the removal of decay and/or old restoration comes close to or slightly exposes the main nerve chamber of the tooth, the Pulp, but where infection is minimal. In the past these liners were frequently used beneath dental restorations to reduce post-treatment pain and sensitivity. Now they have taken on a much greater role when placed to protect the main nerve chamber of the tooth.
The “New Kid” on the block in terms of pulp capping materials is a combination of Calcium Hydroxide mixed in with a resin silicate. Calcium hydroxide has long been known to have the capacity to mobilize growth factors in your tooth’s dentin, causing the formation of new “reparative dentin.” The greatest chance for success is if placed “close” to the pulp (Indirectly), however, success can still occur when placed “directly” on the pulp “IF” the exposure is small. It has been shown that if a 0.5 mm thickness of tooth structure (dentin) remains, it reduces the effects of toxins on the pulp by 75%, and with a 1.0mm thickness it reduces to 90%. At 2.0 mm dentin thickness or more, there is little to no pulp reaction.
In some cases dentists have new patients who come into our office that are often experiencing “no pain at all”, yet, during the examination deep decay is detected that they are unaware of. If their decay is very extensive, with the new materials at our disposal, we can sometimes apply a pulp cap, and if successful, avoid the need for a root canal. The capping material is applied over the nerve and then covered by a buildup and protective restoration, which is normally a crown. One caveat… sometimes a tooth that has been pulp capped eventually needs root canal therapy in the future… but the cost for capping is so small that, if successful, you’ve saved several hundreds to over a thousand dollars or more in the meantime!
The Way of the Future?
Over the past couple of years our office has experienced an almost 70% decrease in root canal therapies and extractions by using Pulp Capping procedures. The calcium silicates are antibacterial, biocompatible, and have a high pH that has an “alkalinizing effect” stimulating wound healing and aids in the release of bioactive dentin proteins for repairing your tooth. These Pulp Capping materials are now easily placed and light cured allowing the subsequent restorative procedure to be completed at the same appointment!.
Are you a candidate for Pulp Capping? That’s a decision only your Dentist can make. There are some dentists that won’t even consider Pulp Capping because some patients can experience some discomfort for a period of time afterwards, while the tooth is repairing itself. There is also the possibility of failure when the treatment is unsuccessful and the patient still experiences pain. In these cases your doctor will proceed with root canal treatment or extraction to immediately relieve your symptoms. On the other hand, as dentists we all know that a non-root canaled tooth can be healthier than one that has had its canals done. By using the Pulp Capping procedure when there is a definite possibility of success, we’re erring on the side of best health for our patients.
Root Canal Therapy or Extractions used to be the only alternative patients had for deep decay. Now, with the newer materials and techniques available, Pulp Capping can be a viable alternative in some cases. As practitioners we advise our patients that not all pulp caps work, and for failed treatments, root canal therapy is a quick solution, with extraction usually being the worst case scenario. Our patients treated with Pulp Capping have been very happy with the successful results, because it leaves them wealthier (in the pocketbook) and healthier overall. In any event, it’s nice to have this third option for preserving their oral health!