Root canals have been a dreaded topic for a long time, associated with great discomfort and pain and sometimes even sheer horror. No one will ever forget Dustin Hoffman having his teeth drilled to the nerve by Nazi dentist in Marathon Man. A favorite topic among comedians and Hollywood filmmakers is the root canal: poorly understood and unjustly accused. Johnny Carson maligned root canals so much on the Tonight Show that a New York dentist brought a suit against him and we all know Bill Murray was acting when he told Steve Martin he wanted a root canal in Little Shop of Horrors.
We all know what a root canal is, don’t we? We know it’s amusing when it’s happening to someone else. We know it’s pretty crazy when someone begs for a root canal. We know it’s going to hurt a lot, but in fact, few of us really know what a root canal really is and how beneficial it can be to the failing dentition.
The root canal has long been an indicator for civilized culture. Ancient civilizations performing root canals developed this highly refined method of saving teeth that otherwise would have been removed. Available usually to the upper classes, such as the nobility and wealthy, root canals were performed on pharohs, kinds, queens, and dignitaries. Teeth from the peasants were often extracted and sold for transplanation to nobles. Because the toothache has been the scourge of mankind’s history, many unusual remedies have resulted. In time, it was understood that the clean and complete removal of the nerve was the best way of eliminating the toothache caused by extensive decay.
To fully appreciate the root canal (and there are those of us that actually do) you need a better understanding of the structure of the tooth. A tooth is born from an embryonic tissue, or bud (these buds are still forming in the jaws of newborns). This tissue then lays down around itself the calcified tissues of the teeth. Among them are the familiar enamel and others such as dentin and underlying tissues softer than enamel.
Once the tooth is formed, the inside tissue consisting of blood vessels, nerves, and specialized cells to form dentin, lives on. This pulp tissue enters the tooth from the very tip of the root and travels up the root canal into a chamber in the middle of the tooth. If the tooth has three roots, as do upper molars, the three root canals converge at this chamber. As decay nears this chamber, the pulp tissue becomes irritated by the acids released by the bacteria. The pulp tissue becomes inflamed and begins to choke itself off because of the fixed space where it exists. Usually by this time, there is a toothache present.
If unheated, the pulp eventually becomes irreversibly irritated and dies. As a result, toxins are released from the dead tissue out the end of the root and into the surrounding bone. This can infect the bone and lead to the destruction of the support of the tooth and surrounding teeth.
The prompt removal of this pulp tissue at this “point of no return” is then required to save the tooth and the surrounding bone. By removing the source of the toxins, the tooth can maintain itself for the life of the patient. Once the pulp tissue is removed, files are used to clean and shape the inside of the canal, making sure all bacteria and toxins are removed.
Confirmation that the file reached the very tip of the root can only be accomplished via a series of x-rays showing the actual location of the file in respect to the root canal and root tip. When the length has been established, the canal is shaped to facilitate its filling. Once dried, the canal is filled successively with rubber cones and a paste. This allows the canal to become completely sealed to prevent further chance of infection. Later, a crown is placed over the tooth to help maintain its strength over the years because a non living tooth is slightly more brittle.
What is so terrible about all this? Why does the thought of a root canal turn grown adults into whimpering cowards? Why all the fuss over a procedure that enables your dentist to save an infected and aching tooth rather than extracting it and placing a bridge or denture in its place?
Is it the fear of the unknown? Is Hollywood to blame? Or is it the agonizing pain of a tooth with an inflamed pulp tissue? Armed with knowledge of how cavities form and what a root canal is, you may never have to answer these questions for yourself. See your dentist every six months to greatly lessen the chance.
Mark Burhenne DDS
This article originally appeared in Silicon Valley Insider in 1996 and on Dr. Burhenne’s first website, Virtual Dentist.