Root Canal

Have you been told you need a Root Canal? Did you know that there are alternatives to having root canal surgery? Root canals can also cause long-term health problems, if not done correctly. Most people are in severe pain before the procedure is complete. And while the pain may subside after the procedure, a traditional root canal may not get rid of all the infection.

Dr. Memoli is committed to helping patients achieve their best possible oral health by taking a holistic approach to dental care and making sure patients have the information they need to make the right decisions for them. Schedule and appointment today.


What is a Root Canal?

What are the pros and cons of Root Canals?

Does tooth pain indicate I need a Root Canal?

How is Root Canal properly diagnosed?

What are my options once a Root Canal is inevitable?


Does severe pain indicate the tooth requires a Root Canal?

What is the success rate of Root Canals and what constitutes failure?

Can a failed Root Canal have a systemic effect on the body?


What is Root Canal?

A root canal-treated (RCT) or root-filled tooth is one in which the dental nerve, commonly called the pulp, is intentionally removed and is filled with an inert material called gutta percha.

Once an RCT is performed, the tooth must be restored with a post and a crown. These will strengthen the tooth and prevent a crack or fracture from developing after treatment. A good analogy is a tree branch. When it’s alive, it flexed or bends when pressure is applied. On the other hand, a dead branch, like an RCT, will break under the same stress.


The pro of a root canal is obvious: the painful or dead tooth is treated and extraction is avoided. But we must ask two key questions before starting a root canal.

-Can the tooth be restored?

-Can a predictable RCT be performed, or are there risks for a poor result?

The cons or risks with an RCT are less obvious. They center on the fact that a tooth is an “open” biological system which interacts with the body. In other words, anything placed into the tooth will eventually finds its way into the body and may interact with a susceptible cell or organ.

An RCT seals the inner main nerve trunks of the dental nerve. However, accessory nerves and dental tubules, which are present in all teeth, can still communicate with the body. The dental tubules alone may present a surface are equal to two miles per tooth. Furthermore, the seal at the root apex or tip does not constitute a true ‘hermetic” seal. As a result, it may, under conditions of low resistance, provide passage into the body for bacteria and bacterial toxins.

Although there are millions of healthy individuals with root canals in their mouths, it’s wise to consider these systemic risks, particularly if a patient has any medical symptoms or diseases already present.


Generally, a dentist first will tap on several teeth and look for signs of abscess or a radiograph. However, a tooth with constant or sever pain doesn’t necessarily indicate need for a root canal. Nor does an x-ray image.

It’s important to realize that other conditions can simulate tooth pain. These include sinus infections, myofascial pain, neurovascular disorders, neuralgias (a common cause), neuritis (a viral infection of the tooth), neuropathy, and neuromas. Even heart attacks can refer pain to the teeth of the lower jaw.


A root canal is a treatment, not a diagnosis. A good dentistry, like good medicine, starts with a proper diagnosis of the tooth.

In order to confirm a proper diagnosis, we need to establish two facts: the cause and the effect.

Some dentists argue that a diagnosis is academic and a waste of a patient’s time. The result is always the same, they say, a root canal. However, establishing a true diagnosis of tooth pain may avert an unnecessary root canal of an otherwise healthy tooth.

Other “causes” of tooth pain, other than those listed above, can include decay, bite trauma, bruxism (grinding or clenching at night), referred pain, nerve disorders and cracked teeth. These causes result in various “effects”, such as tooth nerve infection, inflammation and ischemia (a reduction of blood flow to the tooth). All of these will produce pain, even sever pain. But some of them are reversible, provided a timely diagnosis and proper treatment are given.


It’s important to understand that all the teeth problems are unique. No treatment is universal. Individual circumstances may dictate that a specific treatment is not an option. Or perhaps one option will offer a superior result over another.

Once the dental never has been properly diagnosed as dead, we can assume that the dental nerve space inside the tooth (called the root canal system) and the bone surrounding the tooth are now infected. At this point, either the tooth must be extracted or a root canal performed. If a patient is undecided about which procedure to pursue, a dentist can perform a pulpectomy (removal of the never) to alleviate pain and buy time for the patient to make his decision.

The root canal is a three-step procedure. Failure to follow all three steps may result in tooth (and money) loss. First, the dentist must remove the nerve from the root system and seal the space with an inert material gutta percha. Second, a post-core must be placed to prevent root fracture. Third, a crown should be added to prevent fracture of the tooth. As mentioned earlier, a tooth is like a branch. While alive, they both can be flexed and return to their normal positions. Once dead, they break when flexed. Placement of the post-0cre and crown are designed to minimize that breakage.

On the other hand, if the patient choose extraction, the following surgical and tooth replacement options need to be considered:


Tooth extraction

Bone Grafting to prevent bone loss and improve bone healing.


Bridge Definition: three or more crowns joined together to “bridge” a missing tooth space.


Excellent cosmetics, chewing and maintenance

Good long-term prognosis (bridges and implants are essentially equal in this regard)


Must involve the use of adjacent teeth

A high decay rate may contraindicate bridges

Implants: These involve a zirconium or titanium post which is surgically placed into the jaw bone.


Excellent cosmetics, chewing and maintenance

Good long-term prognosis

Does not involve the use of adjacent teeth


Are invasive by virtue of implantation into the bone. (Autoimmune is currently being studied in Europe)

Root canal teeth with no apparent infections visible on x-rays have resulted in the loss of some implants.

High dental stress patients (those who knowingly or unknowingly clench or grind their teeth) have a higher failure rate.

Smokers, diabetics, and those with autoimmune may have a contra-indications for implants.

Sinuses and nerves close to surgical sites may be more difficult to treat or may contraindicate treatment.

A removable appliance must be used until the implant restoration is completed.

Removable Dentures: This is a false tooth (or a set of teeth) which can be removed.


Can be designed to be temporary or long-term

Can be flexible and constructed from a variety of substances such as acrylic, nylon, and metal.

The cosmetic appearance in certain case may be excellent.

The cost is less expensive that the bridge or implant option.


They are removable

In certain cases, chewing is difficult, and food may collect under them when eating.

Clasps are sometimes visible on the front teeth (although they often can be made to match the teeth or gums).

In some cases, it’s necessary to cover the palate, which can interfere with tasting food.



Several studies were performed to investigate the hypothesis that the more severe the symptoms of tooth pain, the more advance the damage to the tooth never and the greater the need for root canal treatment. (RCT)

The results shocked dentists. There was no statistical correlation between the amount of pain and the amount of nerve damage.

The conclusion: pain is not an indicator of the need for root canal.


Cohen S. and Hargreaves KM, Pathways of the Pulp, 9th ed., p.514-540, Mosby 2006

Mitchell DF, Tarplee RE: “Painful pulpitis; a clinical and microscopic study,” Oral Surgery, Oral Medicine, Oral Pathology, 13:1360, 1960

Selzer S, Bender IB, Ziontz M: “The dynamics of pulp inflammation: correlation between diagnostic data and actual Histological finding in the pulp.” Oral Surgery, Oral Medicine, Oral Pathology, 16:846,1963


With recent improvements in technology, root canal success rate are estimated between 86% and 98% (Friedman, 1989 et al, 2003) That means that as many as one tooth in seven may be classified as a root canal failure, In addition, many of those failures are chronic, that is, producing no radiographic sings or pain symptoms to indicate failure.

The reasons for root canal failure are not entirely clear. Failure may occur predictably on teeth which have a poor clinical result. This might be caused by doctor error, the inability to clean out all the canals. Or the failure to place a post or crown after the root canal. Failure can also occur unpredictably on teeth with excellent results.

Research has found four major causes of root canal failure;

Toot or root fracture

Infections including bacteria (primarily enterococcus fecalis, etc.), viruses, and fungus (candida, etc.).

The body’s reaction to root canal materials, microorganisms, and cements which inadvertently are pushed past the tooth into the bone.



When we consider that ta tooth is an open biological system which communicates with the body, whether alive or dead following a root canal, the question of systemic effects on the body becomes an important issue.

Such concerns were raised when studies were done on patients with acute myocardial infarctions (heart attacks). One study focused on chronic dental infections, that is infections which produced no visible or symptomatic signs (Matilla et al, 1989). A follow-up study was performed to determine the correlation between chronic (silent) dental infections and coronary atherosclerosis (Matilla et al, 1993). Both studies cited endotoxins from dental infections a a potential mechanism for cardiac disease.

Root canal infections also have close access to blood circulation and systemic dissemination (Tronstad, 1992). One study, performed during root canal therapy, isolated bacteria from the blood stream of patients (Debihan,1995). That leaves is with a basic question which has yet to be thoroughly investigated. Can root canal failures, which may be as high as one is even treated teeth, seed infection in the body and contribute to systemic disease?

The question regarding the safety of failed root canals may never be adequately answered. Also, the basic question about whether a root canal faillure can be determined due to pain is still debated. Pain, as we have discussed, shows little correlation to histological findings. Researchers as far back as the 1960’s have demonstrated that infections can be present without radiographic evidence (Bender and Selzer, 1961, Van der Stelt, 1985; Huumanen and Orstarik, 2002). In fact, one study found infections up to 8mm may be present without any trace of radiographic evidence (Ricucci and Bergenholtz, 2003)

Root canal failure, an issue of systemic proportion, remains a little understood and hotly debated subject.