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  • Writer's picturerymerws

The Root of all Evil

Updated: Apr 25, 2020

Historically, some dental treatments were uncomfortable, even painful. Poor, dated technique and a terrible tradition of a poor bed-side manner created an army of people across the world who have a dental anxiety of a full-blown dental phobia. Even in 2009, up to 24% of the population regarded themselves has having a dental fear.

Laurence Olivier in Marathon Man. 1976. Is it Safe?

Hollywood has latched onto this and has frequently abused our vulnerabilities to sell seats in movie theatres. From Laurence Olivier's portrayal in Marathon man (1976), and Steve Martin in the Little Shop of Horrors (1986). We even had a root canal scene thrown in to Finding Nemo (2003), with hoots of laughter in the cinema as the patient writhed in agony on the chair.

Steve Martin in Little Shop of Horrors (1986) Warner Bros

Unfortunately all these scenes do is perpetuate a dishonest representation of modern dentistry. It continues to upset the population and prevents us from being able to move forward as a profession.

Root Canal treatment today is virtually unrecognisable from what was being performed even 15 years ago. Lets bust some common myths about root canal treatment.

1) Root Canal Treatment is painful.

Often getting into a situation where root canal treatment is needed is painful, like a very large cavity or a fractured tooth. However the treatment itself is pain-free. Its performed under profound anaesthesia, which is to say that the dentist will use a combination of analgesics, topical anaesthetic and local anaesthetic to remove any sensation during treatment. As with all treatments in Expressions, it is always possible to stop the dentist at any time if there is any discomfort.

Finding Nemo (2003) Root canal treatment. Pixar, Disney.

2) Root Canal treatment is expensive and takes many appointments.

Sure, root canal treatment is certainly more expensive than a normal filling, and if you attend the dentist with a toothache expecting a normal filling this may come as a bit of a shock. The reality of the situation is that the alternative option is very depressing. Tooth extraction. Now this will appear initially as the simpler, cheaper option. How do you replace that tooth in your smile though? Denture? Bridge? Implant? The denture often takes up to four visits over a period of weeks to manufacture, and the bridge or implant options are often more expensive and time consuming than it would have been just to save the original tooth. We would always value preserving the original tooth where it is viable.

3) It is an uncomfortable awkward experience, all those instruments.

Root canal treatment used to be carried out using small hand instruments, this technology whilst still used occasionally is now outdated, it often saw dentists trying to fit their whole hand into the back of your mouth and it took up to 2 hours to work through all the different tools required. For the last 15 years at least we have been using motorised instruments with efficient files that make the whole process much more stream-lined, less bulky instruments, less time in the mouth. We also utilise rubber dam, which is a protective rubber sheet that clips over the top of your tooth during treatment, this means that none of the instruments or chemicals are anywhere near your mouth or your tongue. Much more comfortable.

Rubber dam placement

4) It kills the tooth

The tooth is not 'dead', the pulp tissue where the blood vessels and the nerve fibres are has become necrotic, but the ligament that supports the tooth and the tissue around it is still very much alive and the tooth can continue to be useful for many years into the future.

5) It doesn't work very often and it'll probably need to come out later anyway.

In the right hands root canal treatment has a reported success rate of 95%, that's not to say it can't go wrong, but with all things being equal its pretty unlikely. It's important to qualify the success, The tooth having a a major procedure, and it will not last forever, but to expect another 10-15 years of life for your investment seems reasonable. Longer if it is well looked after and well protected.

So in summary, a more friendly caring approach where we listen to patients concerns has enabled us to convert people to engage in more advanced treatments rather than extracting. We also now know that with rubber dam placement and more efficient, motorised instruments the time in the chair is much less onerous. Modern root canal treatment is predictable and painless.

Rubber dam placed on molars

This is a series of x-rays from a recent case showing excellent healing.

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