This is not an easy choice as it involves treatment issues that may also have health consequences.\u00a0 Every day in my practice I see patients having to make this decision, so I have a lot of understanding about what’s involved and what all the considerations may be.<\/p>\n
In the vast majority of cases, root canals are caused by infections, and the bacteria that cause\u00a0root canal infections are difficult to remove completely, once they get into the tooth and the bone around the tooth.<\/p>\n
However, extracting teeth can be very traumatic and expensive.\u00a0 It is a $4,000 to $5,000 proposition to extract an infected root canal and replace it with an implant and porcelain crown.<\/p>\n
In this article, I will break down the advantages and disadvantages of each choice and give you my best advice on how to approach treatment.\u00a0 And there is good news as well, as you will discover.<\/p>\n
To Extract or not to extract – An argument for saving the tooth<\/h2>\n
No one wants to lose a tooth.\u00a0 This is very natural and normal.\u00a0 Thanks to the advent of Photon Induced Photoacoustic streaming (PIPS), a technology licensed to Fotona utilizing the Er To understand the importance of this technology\u00a0watch\u00a0this video animation to see an example of how it works.\u00a0 Click on this link to see the Fotona laser in action.\u00a0\u00a0The reason this video is so important is that it shows what PIPS and SWEEPS can do to eliminate bacteria during root canal therapy.<\/p>\n [\/et_pb_text][et_pb_video src=”https:\/\/franksandoval.s3-us-west-1.amazonaws.com\/SWEEPS+Animation+Best.mp4″ image_src=”https:\/\/myholisticdentist.com\/wp-content\/uploads\/2020\/04\/PIps2.png” thumbnail_overlay_color=”rgba(0,0,0,0.6)” _builder_version=”4.16″ global_colors_info=”{}”][\/et_pb_video][et_pb_text admin_label=”Text” _builder_version=”4.16″ background_size=”initial” background_position=”top_left” background_repeat=”repeat” global_colors_info=”{}”]<\/p>\n I think you can clearly see what makes the PIPS technology so revolutionary.\u00a0 It actually reaches and kills the bacteria hiding in the dentinal tubules.\u00a0 Why is this important?\u00a0 Because the bacteria hiding in the tubules are releasing toxic material into your tooth, your jaw,\u00a0and your body.<\/span><\/p>\n When a tooth becomes infected, it’s full of bacteria, as\u00a0there are no more immune cells in the tooth.\u00a0<\/span>\u00a0Please see my previous post<\/a> discussing how this happens and showing the bacteria in the tubules of the tooth.<\/p>\n When teeth get infected the tubules get filled with bacteria and traditional root canal therapy<\/span>\u00a0doesn’t have an effective way of dealing with the bacteria in the tubules of the root.\u00a0 Below is an electron micrograph showing the tubules of a tooth.<\/p>\n ‘So how do we get the bugs out of the tooth and tubules?’ you might ask.\u00a0\u00a0In\u00a0his pilot study\u00a0\u2018Efficacy of PIPS on root canals<\/a> infected with Enterococcus Here is another quote from a different research study.\u00a0 \u2018All instrumentation techniques left 35% of the walls untouched.\u2019 O. Peters, IEJ (3) 2001.\u00a0 In other words, when you are just using files to do root canals 35% of the tooth surface does not get cleaned because the files are not an efficient way of cleaning the canals out.\u00a0 In my opinion, there are bacteria left behind when using hand files and traditional root canal treatment.<\/span><\/p>\n In a recent advancement, Fotona has added the SWEEPS mode to do the same thing as ‘That sounds pretty good, doc.\u00a0 So why would you ever extract a tooth?’ you might ask.\u00a0 In my opinion, there are two scenarios where you would choose to extract a tooth rather than save it by doing a root canal with PIPS\/SWEEPS. <\/span><\/p>\n After reading the above, I’m sure you can see that with root canals, one approach does not fit every situation or patient.\u00a0 it’s impossible to generalize about what’s best for each individual.\u00a0 Every situation is different, including patients’ overall oral health, wants, needs, history, symptoms and the condition of the tooth itself.\u00a0 Many alternative doctors in the holistic and integrative health field believe that every root canal should be extracted no matter what.\u00a0 This, in my experience, is not accurate or realistic, as it takes a very complex issue like health and generalizes one approach for every patient and situation.\u00a0 Conversely, most dentists and root canal specialists recommend that the tooth try to be saved at all costs.\u00a0 This is also not practical or realistic in some cases, as the tooth is clearly not a good prospect for additional treatment.<\/p>\n I have always found that I need to approach things on a case by case basis.\u00a0 In order to do this, I really need to assess the situation fully and listen to what you want as a patient.\u00a0 How motivated are you to keep your teeth?\u00a0 How infected is the tooth and what are your symptoms?\u00a0 Are you dealing with any systemic conditions?\u00a0 <\/span>In all cases, I try to do my best to listen to every patient’s unique needs.\u00a0 What do you as the patient\u00a0<\/strong>want to do after being given all the information?\u00a0 In my experience, this is the only way to arrive at the right solution.\u00a0 It is very important that each patient make the decision that’s right for them.\u00a0 If I try to tell patients what I think they should do,\u00a0the treatment usually does not go as well.\u00a0 I<\/span>t’s my job to give you your options, including the advantages and disadvantages of each.\u00a0 Then you, as the patient, can make the best decision for yourself and go forward with confidence and a full plan to resolve the infection.<\/p>\n When dealing with systemic issues like diabetes and autoimmune disease, I always recommend blood testing before any involved treatment.\u00a0 The reason for this is that certain inflammatory markers in the blood can signal a possible problem during the healing phase after certain dental procedures like extractions, implants and sometimes even root canals.\u00a0 \u00a0The last thing you or I want is for there to be a failure in treatment requiring you to undo all the hard work you have put into your teeth.<\/p>\n There are specific markers that are designed to look at systemic inflammation including:<\/p>\n With infected teeth and root canals, try root canal therapy first with PIPS or SWEEPS using the Fotona laser.\u00a0 After 34 years in practice, I finally can offer a solution\u00a0that makes sense if it makes sense to the patient.<\/p>\n The exceptions, as discussed above, are when the tooth is broken down or fractured, the infection is just too large, or when you have a chronic condition, illness or immune issue.<\/p>\n [\/et_pb_text][\/et_pb_column][\/et_pb_row][\/et_pb_section]<\/p>\n","protected":false},"excerpt":{"rendered":" No one wants to lose a tooth.\u00a0 This is very natural and normal.\u00a0 Thanks to the advent of Photon Induced Photoacoustic streaming (PIPS), a technology licensed to Fotona utilizing the Er:Yag laser, we can now eliminate bacteria in root canal teeth.\u00a0 This is the good news, and a game changer in root canal therapy.<\/p>\n","protected":false},"author":2,"featured_media":4790,"comment_status":"open","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"_et_pb_use_builder":"on","_et_pb_old_content":"I'm often asked by patients who are choosing between\u00a0doing a root canal or extracting their tooth, 'Alright doc, I get that my tooth is infected, what are my choices?\u00a0 What would you do if it was your tooth?'\u00a0 The rest of this post discusses my best recommendations and how to choose between:\r\nA quick review of dentinal tubules and why they are a problem<\/h2>\n
![\"Dentinal](\"https:\/\/myholisticdentist.com\/wp-content\/uploads\/2018\/06\/Blog-pic1-150x150.jpeg\")
<\/a>To recap, the tubules are microchannels in the root connecting the inside of the tooth to the outside.\u00a0 They help provide the tooth with nutrients and are communication channels that allow the nerve to feel what’s happening on the surface of the tooth.\u00a0 They are extremely small, approximately 2 microns in diameter, but when laid side by side would be 1-2 miles long depending on the tooth.<\/span><\/p>\n![\"Microtubules](\"https:\/\/myholisticdentist.com\/wp-content\/uploads\/2018\/06\/Blog-pic2-150x150.jpg\")
<\/a>The problem with this bacteria is that you can’t see them on imaging or x-rays.\u00a0 Nor can you feel them, as they don’t cause pain.\u00a0 However, they are there just the same, draining endotoxins and exotoxins into your body.\u00a0 Endotoxins and exotoxins are fancy words for bacteria poop.\u00a0 Sorry to be so graphic, but this is why infected teeth are bad for you and need to be treated.\u00a0 It’s really the toxins caused by the bacteria that create an unhealthy situation in the tooth.<\/p>\nWhy PIPS is important when doing root canals<\/h2>\n
![\"Healthy](\"https:\/\/myholisticdentist.com\/wp-content\/uploads\/2018\/06\/Tubule-with-no-bacteria-300x240.jpg\")
<\/a>Here is an image from the study showing the tubules devoid of bacteria after treating the tooth with PIPS technology with the Fotona laser.\u00a0 To me as a dentist, this result is nothing short of amazing.<\/p>\nAn argument for extracting the tooth\u00a0<\/span><\/h2>\n
![\"Infected](\"https:\/\/myholisticdentist.com\/wp-content\/uploads\/2018\/06\/RCT-Infection2.jpg\")
<\/a>Some teeth are just too far gone.\u00a0 Sometimes a tooth has been worked on too many times in the past, and it is just not viable anymore.\u00a0 This includes too many root canals being attempted when it’s clear that there is something structurally wrong with the tooth that a root canal cannot resolve.\u00a0 <\/span>Here is an image of an old root canal tooth that has become reinfected.\u00a0 See that black area at the end of the root.\u00a0 This is bacteria draining from the tooth even after the root canal has been done.\u00a0 ‘Wait a minute doc, I thought root canals were supposed to resolve tooth infections.’\u00a0 Well, usually they do but not always. Additionally, the tooth can become re-infected.<\/span><\/p>\n![\"Infected](\"https:\/\/myholisticdentist.com\/wp-content\/uploads\/2018\/06\/RCT-Infection1-300x242.jpg\")
<\/a>Secondly, some patients are struggling with a chronic condition or disease, and it’s not a good idea to add any further possible source of inflammation.\u00a0 When in doubt I always recommend that my patients get the opinion of their M.D.\u00a0 <\/span>If there are systemic factors that are not getting better, sometimes your physician may advise you to sacrifice a tooth.\u00a0\u00a0Inflammation is the silent killer, so the last thing you want to do is a procedure that will increase chronic inflammation.\u00a0\u00a0<\/span>After hearing all viewpoints and opinions sometimes<\/span>\u00a0patients follow their intuition and decide to get the tooth out.<\/span>\u00a0 Down the road, the tooth can still be replaced with an implant or a bridge.<\/p>\n‘One size does not fit all’<\/h2>\n
What I do when I find an infected tooth or root canal<\/h2>\n
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Why blood testing is important<\/h2>\n
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Dr O’s recommendations<\/h2>\n
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To Extract or not to extract - An argument for saving the tooth<\/h2>\r\nNo one wants to lose a tooth.\u00a0 This is very natural and normal.\u00a0 Thanks to the advent of Photon Induced Photoacoustic streaming (PIPS), a technology licensed to Fotona utilizing the Er:Yag laser, we can now eliminate bacteria in root canal teeth.\u00a0 This is the good news, and a game changer in root canal therapy.\r\n\r\nTo understand the importance of this technology\u00a0watch\u00a0this video animation to see an example of how it works.\u00a0 Click on this link to see the Fotona laser in action.\u00a0\u00a0The reason this video is so important is that it shows what PIPS and SWEEPS can do to eliminate bacteria during root canal therapy.\r\n\r\nhttps:\/\/www.youtube.com\/watch?v=LMinJl9COxo&rel=0\r\n\r\nI think you can clearly see what makes the PIPS technology so revolutionary.\u00a0 It actually reaches and kills the bacteria hiding in the dentinal tubules.\u00a0 Why is this important?\u00a0 Because the bacteria hiding in the tubules are releasing toxic material into your tooth, your jaw,\u00a0and your body.\r\n
A quick review of dentinal tubules and why they are a problem<\/h2>\r\nWhen a tooth becomes infected, it's full of bacteria, as\u00a0there are no more immune cells in the tooth.\u00a0<\/span>\u00a0Please see my previous post<\/a> discussing how this happens and showing the bacteria in the tubules of the tooth.\r\n\r\n
<\/a>To recap, the tubules are microchannels in the root connecting the inside of the tooth to the outside.\u00a0 They help provide the tooth with nutrients and are communication channels that allow the nerve to feel what's happening on the surface of the tooth.\u00a0 They are extremely small, approximately 2 microns in diameter, but when laid side by side would be 1-2 miles long depending on the tooth.<\/span>\r\n\r\nWhen teeth get infected the tubules get filled with bacteria and traditional root canal therapy<\/span>\u00a0doesn't have an effective way of dealing with the bacteria in the tubules of the root.\u00a0 Below is an electron micrograph showing the tubules of a tooth.\r\n\r\n<\/a>The problem with this bacteria is that you can't see them on imaging or x-rays.\u00a0 Nor can you feel them, as they don't cause pain.\u00a0 However, they are there just the same, draining endotoxins and exotoxins into your body.\u00a0 Endotoxins and exotoxins are fancy words for bacteria poop.\u00a0 Sorry to be so graphic, but this is why infected teeth are bad for you and need to be treated.\u00a0 It's really the toxins caused by the bacteria that create an unhealthy situation in the tooth.\r\nWhy PIPS is important when doing root canals<\/h2>\r\n'So how do we get the bugs out of the tooth and tubules?' you might ask.\u00a0\u00a0In\u00a0his pilot study\u00a0\u2018Efficacy of PIPS on root canals<\/a> infected with Enterococcus Faecalis,\u2019 \u00a0Dr. David Jaramillio explores whether the Er:Yag laser in PIPS mode is effective in the elimination of bacteria from infected root canals.\u00a0 This research study shows how efficient and effective PIPS is in removing bacteria from the tooth during root canal therapy.\u00a0\u00a0<\/span>\r\n\r\n
<\/a>Here is an image from the study showing the tubules devoid of bacteria after treating the tooth with PIPS technology with the Fotona laser.\u00a0 To me as a dentist, this result is nothing short of amazing.\r\n\r\nHere is another quote from a different research study.\u00a0 \u2018All instrumentation techniques left 35% of the walls untouched.\u2019 O. Peters, IEJ (3) 2001.\u00a0 In other words, when you are just using files to do root canals 35% of the tooth surface does not get cleaned because the files are not an efficient way of cleaning the canals out.\u00a0 In my opinion, there are bacteria left behind when using hand files and traditional root canal treatment.<\/span>\r\n\r\nIn a recent advancement, Fotona has added the SWEEPS mode to do the same thing as PIPS, but do it even better.\u00a0 Please see the video above once again and you will see the action of PIPS and SWEEPS side by side.\u00a0\u00a0SWEEPS is like PIPS on steroids.\u00a0 'It's like a tsunami of activity,' an endodontist commented\u00a0when it's used in conjunction with root canal therapy.\r\nAn argument for extracting the tooth\u00a0<\/span><\/h2>\r\n'That sounds pretty good, doc.\u00a0 So why would you ever extract a tooth?' you might ask.\u00a0 In my opinion, there are two scenarios where you would choose to extract a tooth rather than save it by doing a root canal with PIPS\/SWEEPS. <\/span>\r\n\r\n
<\/a>Some teeth are just too far gone.\u00a0 Sometimes a tooth has been worked on too many times in the past, and it is just not viable anymore.\u00a0 This includes too many root canals being attempted when it's clear that there is something structurally wrong with the tooth that a root canal cannot resolve.\u00a0 <\/span>Here is an image of an old root canal tooth that has become reinfected.\u00a0 See that black area at the end of the root.\u00a0 This is bacteria draining from the tooth even after the root canal has been done.\u00a0 'Wait a minute doc, I thought root canals were supposed to resolve tooth infections.'\u00a0 Well, usually they do but not always. Additionally, the tooth can become re-infected.<\/span>\r\n\r\n<\/a>Secondly, some patients are struggling with a chronic condition or disease, and it's not a good idea to add any further possible source of inflammation.\u00a0 When in doubt I always recommend that my patients get the opinion of their M.D.\u00a0 <\/span>If there are systemic factors that are not getting better, sometimes your physician may advise you to sacrifice a tooth.\u00a0\u00a0Inflammation is the silent killer, so the last thing you want to do is a procedure that will increase chronic inflammation.\u00a0\u00a0<\/span>After hearing all viewpoints and opinions sometimes<\/span>\u00a0patients follow their intuition and decide to get the tooth out.<\/span>\u00a0 Down the road, the tooth can still be replaced with an implant or a bridge.\r\n'One size does not fit all'<\/h2>\r\nAfter reading the above, I'm sure you can see that with root canals, one approach does not fit every situation or patient.\u00a0 it's impossible to generalize about what's best for each individual.\u00a0 Every situation is different, including patients' overall oral health, wants, needs, history, symptoms and the condition of the tooth itself.\u00a0 Many alternative doctors in the holistic and integrative health field believe that every root canal should be extracted no matter what.\u00a0 This, in my experience, is not accurate or realistic, as it takes a very complex issue like health and generalizes one approach for every patient and situation.\u00a0 Conversely, most dentists and root canal specialists recommend that the tooth try to be saved at all costs.\u00a0 This is also not practical or realistic in some cases, as the tooth is clearly not a good prospect for additional treatment.\r\n\r\nI have always found that I need to approach things on a case by case basis.\u00a0 In order to do this, I really need to assess the situation fully and listen to what you want as a patient.\u00a0 How motivated are you to keep your teeth?\u00a0 How infected is the tooth and what are your symptoms?\u00a0 Are you dealing with any systemic conditions?\u00a0 <\/span>In all cases, I try to do my best to listen to every patient's unique needs.\u00a0 What do you as the patient\u00a0<\/strong>want to do after being given all the information?\u00a0 In my experience, this is the only way to arrive at the right solution.\u00a0 It is very important that each patient make the decision that's right for them.\u00a0 If I try to tell patients what I think they should do,\u00a0the treatment usually does not go as well.\u00a0 I<\/span>t's my job to give you your options, including the advantages and disadvantages of each.\u00a0 Then you, as the patient, can make the best decision for yourself and go forward with confidence and a full plan to resolve the infection.\r\n
What I do when I find an infected tooth or root canal<\/h2>\r\n