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INVISALIGN: Utilizing technology for customized treatment, D2 CUTTING EDGE TECHNOLOGY: Dental implants, D2 HAMPTON BEACH: the summer isn’t over yet, D5
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SUNDAY, AUGUST 25
For years hearing the words,
“You need a root canal” would make even the bravest of souls quiver.
By Keith O’Connor
technology and treatment such as microscopic visualiza“Patients ask us, ‘Is it going tion, microsurgical instruto hurt?’ We always tell them mentation, advanced matethat we are going to get them rials and medicaments, and very numb and expect them three-dimensional imaging to feel nothing but vibration help to provide better, longand pressure during their term outcomes and result in root canal. We actually have some patient equating a root patients falling asleep in the canal as no worse than having chair every day, which says a a tooth filled. lot as to how comfortable and Yet some surveys report at ease they become,” said Dr. Americans, many who have Elizabeth Shin Perry of Perry never had a root canal or Endodontics, who established underwent the procedure her practice in 1995 in Westmany years ago, still say that field. fear of pain most concerns “They often ask us afterthem about having root canal wards, ‘Is it done? That was treatment. it?’ Patients often come in So, why do root canals still with notions in their head get a “bad rap” from those based on what they have facing them? heard about root canals and “We deal with patients who what is going to happen. Many are often in a lot of pain, who are in tears beforehand and maybe have been up for two very anxious. Afterwards it is nights in a row in pain, who nice to see them smiling and telling us, ‘That isn’t what I expected at all,’” she added. In simple terms, root canal therapy is all about the “pulp.” It is performed to repair and ultimately save a badly damaged or infected tooth. A root canal eliminates bacteria from the infected root canal, preventing infection and saving the natural tooth. During the procedure, which lasts for about an hour, the inflamed or infected pulp is removed and the inside of the tooth is carefully cleaned and disinfected, then filled and sealed with a rubber-like material called gutta-percha. Afterwards, patients are referred back to their dentist to place a permanent filling or crown on their tooth for protection. The placement of a crown protects the biting surfaces of the tooth from fracture and the permanent filling or crown protects the inside of the tooth from bacteria and re-infection. Undergoing the procedure haven’t slept, and who can’t today is “not your father’s touch their teeth together root canal” to quote a popular because they are in so much idiom. According to the Amer- pain. So, it is often hard for ican Association of Endodon- them to differentiate the pain tists (AAE), a survey of people they came in with from the who have recently undergone procedure, which is relatively root canal treatment describe painless today,” said Dr. Ivy the process as “painless” six Pruitt Ahluwalia of Perry times more often than those Endodontic. who have never experienced “At one time, anesthetic it. They also report a 95 pertechniques were not as adcent success rate for the more vanced as they are now. So, if than 25 million root canals a patient wasn’t fully anesperformed each year. thetized, then they remember the experience as painful and Modern advancements in Special to The Republican
difficult. Also, if a root canal wasn’t done properly the first time around, it can leave the patient with ongoing issues and a bad perception of the procedure,” said Dr. Perry. Yet, there is still another reason why people fear root canals – misinformation they may have found on the Internet or elsewhere. “This misinformation is based on an old theory from the early 1900s called the ‘focal infection theory,’ which spread the belief that infections in the oral cavity would spread throughout the entire body and cause other health issues,” said Dr. Perry about those who felt it was best to extract the tooth. “Through research today we know that the focal infection theory is not valid. When someone has a dental
view of the delicate root canal anatomy. The additional magnification and illumination also allows for the identification of small details such as calcified canals and fractures within the roots. Use of the surgical microscope allows for more accurate diagnosis and treatment and improves the potential outcome of the treatment from good to excellent. “In our practice, we use the surgical microscope on every procedure from start to finish,” Dr. Perry said. The use of the surgical microscope along with all of the other advances in endodontics allows them to complete root canal therapy in a shorter amount of time, and many treatments are completed in one visit. Together with digital radiography,
present inside the tooth. Effective eradication of these bacterial species, after one endodontic visit, is well-documented in the research.” added Dr. Pruitt Ahluwalia. The introduction of cone beam computed tomography (CBCT) over the past 15 years has further added to an endodontist’s ability to diagnose, evaluate, treat and care for patients undergoing root canal therapy or other endodontic procedures. During a CBCT scan, the machine rotates around the patient, capturing images using a cone-shaped X-ray beam. The images are then used to construct a 3-D representation of the patient’s teeth, mouth and jaw. “This innovative imaging technique allows us to see cracks or fractures in a tooth, evaluate the teeth after a
are able to practice. We are able to predict and treat more complex situations. Even if we are in the middle of treatment and we come upon something unusual, we are able to see three-dimensionally what is happening with that tooth. So, CBCT has been really important for us to increase our success rates by helping us to predict the prognosis and to determine teeth that are treatable and which we will need to recommend other treatments,” Dr. Perry added. While it may be tempting for someone in pain to tell their dentist to “pull the tooth and get it over with,” she stressed the importance of saving your teeth. “There is nothing as good as our own parts. Research has shown that our dental health – the number of decayed, missing, or filled teeth we have – is intimately connected to our overall medical health. So, by saving Dr. Elizabeth Shin Perry and the tooth, we are saving its Dr. Ivy Pruitt Ahluwalia with the surgical aesthetics and function, but operating microscope and 3D Imaging also saving a person from a on the computer screen. prolonged journey of ex(HOANG ‘LEON’ NGUYEN / THE REPUBLICAN) traction and replacement of the tooth. Although replacing a tooth with a dental implant is a very valuable procedure when needed, it is not a substitute for saving one’s own natural tooth. A recent study published in the Journal of Endodontics has shown that an extraction followed by an implant takes more than twice as much time waiting for the implant to become functional (13.5 months) versus root canal therapy followed by a filling or crown (4.8 months),” Dr. Perry said. Just as a primary care doctor may refer a patient to a specialist, such as a gastroenterologist or a dermatologist, a dentist may refer a patient infection, the body localizes three-dimensional imaging, traumatic injury, as well as needing a root canal to an it and keeps the infection well electronic apex locators, adanomalies such as a person endodontist. contained so as to not cause vanced instrumentation and having five canals instead of Endodontists are dental disease in other parts of the medicaments, they are using the normal three or four, and body,” she added. make it possible to complete to determine early on, before specialists in treating tooth pain and performing root One of the big differences in treatment in a shorter amount we even open up the tooth, root canals from then to now of time. as to whether we can save the canal treatment. Beyond is that many endodontists “The research behind the tooth or it needs to be extract- dental school, they have perform everything under the protocols in the treatment ed,” Dr. Pruitt Ahluwalia said, completed two to three years of advanced training focusing surgical microscope. we are providing allows us to further noting a CBCT is not on diagnosing tooth pain and The use of surgical microeradicate the bacteria in the taken on every patient and performing root canals and scopes in endodontics greatly tooth safely and effectively,” only when extra information enhances the precision and Dr. Perry said. is necessary for accurate diag- other procedures relating to efficiency of each endodon“Advances in laboratory nosis or successful treatment. the interior of the tooth as the word “endo” describes. tic procedure by enabling a research have expanded the “CBCT has really changed magnified and illuminated ways we can detect bacteria the way we as endodontists SEE ROOT CANAL, PAGE D4