Inside each tooth there is living tissue, composed of a small capillary, vein, nerve and some cellular tissue. If a tooth is traumatized the nerve inside can be adversely affected and may die. When this happens, all the cells die and the blood supply to and from the tooth dies. This dead tissue within the tooth is a wonderful place for bacteria to grow and eventually the tooth will become a source of infection. This process can take a period of several weeks, to several months or more.

Unfortunately, these infected teeth often result in severe pain, swelling and in some cases even death if the infection spreads to the bloodstream or other areas of the body. In order to prevent this from happening the tooth must either be removed or undergo root canal treatment (also known as Endodontic Treatment).

Root canal treatment involves removing the dead and infected tissue, and replacing it with a filling material to prevent bacteria from reentering the tooth.

Extensive trauma to the tissues and nerve inside a tooth will cause the cells to die and will cause a tooth to require a root canal. The trauma could be one incident, such as a severe blow to the tooth, a fracture that exposes or nearly exposes the nerve, a crack that extends deep inside the tooth or the combination of several incidents over many years.

Multiple fillings over a course of many years can also cause enough trauma in the long term, resulting in a tooth "dying." Cavities are probably the most common cause, as decay is full of bacteria and if it is deep the bacteria will invade the living tissue and eventually cause the nerve and cells to die.

There has been some ongoing controversy over the safety of root canaled teeth. When a root canal is properly done, all the living and dead tissue within the canal is removed. The canal is irrigated with antibacterial solutions to eliminate any bacteria present, and then a combination of filling material and sealers/cements are used to fill the canal. The success of the treatment is traditionally based on a lack of symptoms, an x ray showing filling material completely sealing the canal to the tip of the root and no sign of infection on the x ray itself.

However, the roots of our teeth are made up of dentin. This material is porous and contains many microscopic tubules. The controversy is even successful root canals may contain some living or dead bacteria within these tubules, and that these bacteria and /or the toxins they produce may potentially spread to other areas of the body causing health problems, even though the tooth itself will feel fine and appear! This is the basis of the focal infection theory. Prior to 1950 this was widely accepted and hence many teeth that were infected were extracted. Since then root canals became possible and many teeth which would have been extracted are now being saved. However since the 1990's the focal infection theory has seen a resurgence among some health practitioners. Many patients and some practitioners are now beginning to question the success and the possible health concerns of root canaled teeth.

At this point the focal infection theory is still very controversial and the evidence for it is not very definitive. Prior to making any irreversible decisions such as extracting a tooth you should review all of your options, evidence and health concerns with your dentist.

The standard of care from the Canadian and American Dental Associations is root canals are effective and the focal infection theory is invalid or questionable at best. Based on a lack of tooth symptoms and x-rays alone, about 85-90% of all root canals are successful, in that there are no signs of infection or symptoms from the tooth. When they do fail it can be the result of difficulty obtaining a proper seal at the tip of the root and/or the strength of your immune system. This can often be corrected by a retreatment or cleaning the area at the tip of the root (apicoectomy). If you still have concerns regarding an otherwise "healthy" root canal, please read the next section on other options.

Root canals are most often filled with a rubber like material called gutta percha in combination with a paste type sealer (zinc oxide). The sealer works like a mortar, filling any spaces that the gutta percha did not seal.

There is another product called Biocalyx which has been used in Europe for over fifteen years. It has been accepted for use in North America but it is not very well known as it is not taught in the dental schools and is slow to gain wide acceptance by the dental community. The active ingredient in Biocalyx is calcium oxide. It has an affinity for water and will expand and penetrate the tubules and react to form calcium hydroxide. Calcium hydroxide is one of the most biocompatible materials used for root canals. The calcium carbonate reacts further to form calcium carbonate creating a wall of calcified material thereby sealing the tubules further. Studies of extracted teeth have shown a significant reduction in bacteria remaining in the tubules when Biocalyx has been used.

As good as this material sounds, there are always some pros and cons. The technique is different and requires some "relearning" on the 'dentists' behalf, the material is not radio opaque so it is not visible on an x ray and as it sets into hard calcium carbonate, and removal of the material for retreatment or placement of a post can be difficult. One possible compromise you may consider is to have the Biocalyx used as a sealer or initial filler and then place the gutta percha as the bulk of the filling material.

Prior to making any final and irreversible decisions, please consult with your dentist or dental specialist or we would also be happy to answer any other questions you may have.