Does Root Canal Treatment Work?

I often hear patients say, “My neighbor says to not get a root canal, because he’s had three of them and each of those teeth have been pulled. Do root canals work?” Although root canal failure is a reality, it happens more often than it should. When a root canal failure is present, root canal retreatment can often solve the problem. This article discusses five reasons why root canals fail, and how seeking initial root canal treatment from an endodontist can reduce the risk of root canal failure.

The ultimate reason why root canals fail is bacteria. If our mouths were sterile there would be no decay or infection, and damaged teeth could, in ways, repair themselves. So although we can attribute nearly all root canal failure to the presence of bacteria, I will discuss five common reasons why root canals fail, and why at least four of them are mostly preventable.

Although initial root canal treatment should have a success rate between 85% and 97%, depending on the circumstance, about 30% of my work as an endodontist consists of re-doing a failing root canal that was done by someone else. They often fail for the following five reasons:

1. Missed canals.

2. Incompletely treated canals – short treatment due to ledges, complex anatomy, lack of experience, or lack of attention to quality.

3. Remaining tissue.

4. Fracture.

5. Bacterial post-treatment leakage.

1. Missed Canals

The most common reason I see for failure is untreated anatomy in the form of missed canals. Our general understanding of tooth anatomy should lead the practitioner to be able to find all the canals. For example, some teeth will have two canals 95% of the time, which means that if only one canal is found, then the practitioner better search diligently to find the second canal; not treating a canal in a case where it is present 95% of the time is purely unacceptable.

In other cases, the additional canal may only be present 75% of the time. The most common tooth that I find to have a failure is the upper first molar, specifically the mesio-buccal root, which has two canals more than half the time. I generally find two canals in three out of four cases, yet nearly every time a patient presents with a failure in this tooth, it is because the original doctor missed the MB2 canal. Doing a root canal without a microscope greatly reduces the chances of treating the often difficult to find MB2 canal. Also, not having the right equipment makes finding this canal difficult. Not treating this canal often leads to persistent symptoms and latent (long-term) failure. Using cone beam (CBCT) 3-dimensional radiographic imaging, like we have in our office, greatly assists in identifying the presence of this canal. In addition, when a patient presents for evaluation of a failing root canal, the CBCT is invaluable in helping us to definitively diagnose a missed canal.

The bottom line is that canals should not be missed because technology exists that allows us to identify and locate their presence. If a practitioner is performing endodontic (root canal) treatment, he or she needs to have the proper equipment to treat the full anatomy present in a tooth. Although getting a root canal from an endodontist may be slightly more expensive than getting one from a general dentist, there is a greater chance of savings in the long-term value of treating it right the first time.

2. Incompletely Treated Canal

The second most common reason that I see failure is incompletely treated canals. This usually comes in the form of “being short”, meaning that if a canal is 23 millimeters long, the practitioner only treated 20 millimeters of it. Being short increases the chance of failure because it means that untreated or unfilled space is present, ready for bacteria to colonize and cause infection.

Three reasons why a root canal treatment was shorter than it should be can be natural anatomy that does not allow it (sharp curves or calcifications), ledges (obstacles created by an inexperienced practitioner, a practitioner not using the proper equipment, or even an experienced practitioner in a complex situation), or pure laziness – not taking the time to get to the end of the canal.

Two factors that contribute to successfully treating a canal to length are proper equipment and experience. One example of proper equipment is an extra fine root canal file.Having the smallest most flexible file (instrument used for cleaning) allows the practitioner to achieve the full length of the canal before damaging it in ways that are not repairable. If the doctor is using a file that is too large (and therefore too stiff) then he may create a ledge that is impossible to negotiate and will therefore result in not treating the full canal and could possibly lead to failure. Endodontists generally stock these smaller files, and general dentists often do not. Ledges can occur even with the most experienced doctor, but experience and the proper equipment will greatly reduce their occurrence.

The second factor that contributes to successfully treating a canal to length is experience. There is no substitute to having treated that particular situation many times before. Because endodontists do so many root canals, they develop a sensitive tactile ability to feel their way to the end of a canal. They also know how to skillfully open a canal in a way that will allow for the greatest success. Treatment from an experienced endodontists greatly increases the chances that the full length of the canal will be treated and that failure will be reduced.

3. Tissue

The third reason I see for failure is tissue that remained in the tooth at the time of the first root canal. This tissue acts as a nutrient source to bacteria that can re-infect the root canal system. Root canals naturally have irregular shapes that our uniformly round instruments do not easily clean. Two common reasons why tissue is left is lack of proper lighting and magnification, which is achievable with a dental operating microscope, and that it was done too quickly.

Immediately before filling a root canal space that I have cleaned, I stop to inspect the canals more closely by drying them and zooming in with the microscope to inspect the walls under high magnification and lighting. Even when I think I have done a thorough job, I will often find tissue that has been left along the walls. This tissue can be easily removed with experienced manipulation of the file under high magnification.

The second reason why tissue may remain in a root canal treated tooth is that it was done too quickly. I am completely aware that the patient (and the doctor) want this to go as quickly as possible, but one of the functions of the irrigant used to clean during treatment is to digest tissue – the longer it sits there, the cleaner the tooth gets. This is good because areas that are not physically touched with a root canal instrument can still be cleaned by the cleaning solution. If a root canal is done too rapidly, the irrigant does not have time to work and the tooth does not become as clean as it possibly could be. Practitioners continually make judgment on when enough cleaning has occurred. Whereas we would love to have the patient’s tooth soak for hours, doing so just is not practical. Therefore we determine when the maximum benefit has been achieved within a reasonable time period. If it is done too rapidly and has not been thoroughly flushed then tissue may still remain and latent failure of the treatment may occur.

4. Fracture

Another common reason for failure is root fracture.Although this may affect the root canal treated tooth, it may not be directly related to the treatment itself. Cracks in the root allow bacteria to enter places they should not be. Fractures can occur in teeth that have never had a filling, indicating that many of them simply are not preventable.

Fractures may also occur due to treatment that was overly aggressive at removing tooth structure. This is more common with root canals performed without magnification (such as the dental operating microscope) because the practitioner needs to remove more tooth structure to allow more light to be present.

Sometimes a fracture was present at the initial root canal treatment. When a fracture is identified, many factors go into determining if treatment should be attempted. The prognosis in the presence of a fracture will always be decreased, but what we can never know is by how much. Sometimes the treatment lasts a long time, and sometimes it may only last six months. Our hope is that if treatment was chosen to treat the tooth, then it will last a long time.

Fractures generally cannot be seen on an x-ray (radiograph). However, fractures cause a certain pattern of infection that can be seen on the radiograph which allows us to identify their presence. The cone beam (CBCT) 3-dimentional imaging system in our office can show us greater radiographic detail that helps us determine if a crack is present better than traditional dental radiographs. I have had many cases where I decided that root canal treatment or re-treatment would not solve the problem because the likelihood of a fracture was too high to justify treatment to save the tooth.

5. Leakage

The goals of root canal treatment is to remove tissue, kill bacteria, and seal the system to prevent re-entrance of bacteria. All dental materials allow leakage of bacteria; our goal is to limit the extent of leakage. At some unknown point the balance tips and infection can occur. The more measures we take to prevent leakage, the more likely success will occur. Four measures that can help reduce failure due to leakage are rubber dam isolation, immediate permanent fillings, orifice barriers, and good communication with your general dentist.

Rubber Dam

A root canal should never be done without using the latex (or non-latex) barrier called a rubber dam. I was taught in school that root canal treatment without a rubber dam constitutes malpractice, and most practitioners would agree on that point. The rubber dam protects the patient in two ways. The first way that the rubber dam protects the patient is that it prevents small instruments from falling to the back of the mouth and being aspirated.The second way the rubber dam protects the patient is that it prevents bacteria rich saliva from entering the tooth and allowing for infection. A root canal done without a rubber dam is doomed to failure from bacteria. Although not required, use of the rubber dam at the time the access is restored can also hedge against failure from bacterial leakage. The first step to a successful root canal is to prevent the entrance of bacteria by using a rubber dam.

Permanent Filling (Build-Up)

When a root canal is finished by a specialist, it is a highly common practice for the endodontist to place a cotton pellet and a temporary material, which will then be replaced by the patient’s general (restorative) dentist. This temporary material can begin leaking right away, but is generally sufficient for a period of 7-21 days while the patient makes an appointment with their general dentist.

The best way to reduce the chance of bacterial leakage is to have a permanent filling placed at the time treatment is finished. This will assure that the tooth is sealed as much as possible against bacterial leakage. This filling is called an access restoration or a build-up. Although many endodontists place restorations to seal the access, many still place a temporary. Whether the patient receives a permanent filling or a temporary filling is largely dependent on a combination of factors including the practice philosophy of the endodontist, the preferences of the referring dentist, the complexity of the treatment plan, and the time allotted for treatment.

Orifice Barriers

When a permanent filling cannot be placed at the time treatment is completed, an orifice barrier is the next best alternative. The opening to the canals is called an orifice, and the barrier can be a variety of materials. The material used in our office is a purple flowable composite that is bonded to the floor of the tooth and hardened with a high intensity light. Research will never prove whether this technique is effective or not in improving the long-term prognosis, but the general feeling in the endodontic community is that a bonded orifice barrier is better than nothing.

Good Communication and Timely Follow-up with the Restorative Dentist

Finally, leakage can be reduced when the patient sees their restorative dentist as soon as possible after root canal treatment has been completed. This can be accomplished when there is efficient communication between the endodontist and the restorative dentist. In our office we also send a monthly summary of patients to each doctor that they can use as one more layer to confirm that treatment on their patient has been completed and that the patient needs to be seen as soon as possible for restorative treatment. Much of the responsibility for timely restorative care is in the hands of the patient. Patients who delay restorative treatment after root canal therapy are risking failure of their treatment, which may necessitate re-treatment at their expense. Patients should not delay in getting their root canal treated tooth permanently restored with a filling and in many cases with a crown.

The best way a patient can prevent failure of a root canal is to seek care from a practitioner like an endodontist that has experience, that has the proper equipment (including a microscope and possibly a cone beam CBCT 3D imaging), and to receive timely restorative treatment either at the time root canal treatment is completed or shortly thereafter.

By Dr. Peter Q. Shelley DDS, MS

This article along with photos can be viewed at http://www.elmendo.com

Getting The Appropriate Window Treatment For Your Bathroom

There are actually a lot of bathroom window treatments available. But finding one that would contribute to the appearance of the room requires the ability to choose the right components that would significantly contribute to the entity decorating process.

Curtains

Curtains are never out of fashion when talking of window treatments. They are classy, ​​versatile and when used properly, they could really enhance the windows of the bathroom. While there may be a lot of choices of curtains for all types of needs, there are only a few that would really fit the demands of a bathroom window.

Take note that the bathroom is reliably humid. This could alter your choice of curtains clearly since some fabrics are already to mold and mildew growth. Thus, it is necessary that a bathroom curtain is highly resistant to moisture and water. Usually the materials used for bathroom curtains are water-proofed cotton fabric, polyester and synthetic materials as these limit water absorption.

Drapes

Drapes are used for ornamentation; however they also provide practical use. Since they are usually made of strong, heavy and thick fabric, they could give sufficient privacy that is needed for nearly all bathrooms. Drapes are typically used for larger bathrooms with relatively larger windows.

Shades

If you want a bathroom window solution that could be easily operated, one of your best choices is the shades. These could be easily lowered or raised using a cording system. Moreover, a variety of choices like Roman shades, balloon shades, and pleated shades makes it possible to create a different atmosphere in the bathroom.

Roman shades have the appeal to classic, clean-cut design. Balloon shades, on the other hand, are pretty much like the Roman shades, the inverted pleats gather at the bottom of the shade which creates romantic effects.

Blinds

For a simpler but often elegant solution, blinds are called for the job. They provide sufficient privacy while giving a versatile design that could easily be matched by the basic components found in the bathroom.

Valance

If privacy is not really an issue, a valance could be used for visual interest. Usually this is used to hide the hardware of the curtain, drapes or blinds as a finishing touch.

Bishop's sleeves

Normally paired with a formal valance, a bishop's sleeves are achieved by hanging long panels of fabric on the sides of the window which are belted around the middle to create the puffed effect.

Natural Herbal Treatment for Low Sperm Count or Oligospermia

Oligospermia or low sperm count is the reason behind the inability of some men to conceive babies. Unfortunately, the causes of this condition are still to be understood. There are some hypotheses regarding the factors that lead to low sperm count. It might not be clear what's causing it, but it seems to be common knowledge what's aggravating it. Smoking and using drugs or alcohol are the number one enemies of fertility. So is overweight or underweight. Neither is good for the sperm count because it is believed that men who do not have a normal weight also have hormonal problems. Testosterone imbalances are to blame for many cases of oligospermia. Besides these, there is also the overheating of testicles that "kills" sperm. This can happen due to wearing tight underwear or due to taking frequent hot baths. Prolonged exposure to chemical substances like pesticides is also connected with fertility in men.

Natural treatment for oligospermia or low sperm count should definitely start with identifying the factors that trigger this condition in your particular case. There are synthetic pills on the market claiming to cure oligospermia. They are mainly hormone based and they can have unpleasant side effects. It is best to go for a natural treatment based on herbs, especially ayurvedic ones. These have similar properties with hormonal pills and have the same effects, only without the side effects.

Once you know the factors that might cause oligospermia in you, you might find it easier to increase your sperm count. If you smoke or constantly drink alcohol, give up these habits. Avoid overheating of the testicles and also keep a normal weight. This is not only done by dieting, you also need to exercise on a regular basis. Herbal remedies are indeed helpful in oligospermia, but a few changes in your life style will not hurt either.

Many men do not realize that stress can prevent them from conceiving a baby. It is very important to stay calm and relaxed during the natural treatment for oligospermia or low sperm count. Otherwise, stress might reduce your sperm count even more.

Oligospermia is indeed a condition that has no other symptoms and no other disadvantages besides the fact that you can not make babies. Even if you do not consider enlarging your family right now and you do not plan to do this in the foreseeable future either, it's still good to treat it because you never know when you change your mind in what concerns your descendants.

How Does Frontline Spot On Flea Treatment Work?

If your pet is infested with a bad case of fleas one of the best ways to treat it is to apply Frontline spot on flea treatment. This flea control product will effectively control fleas which are breeding and feeding in your pet’s fur. Once you apply the treatment to their fur it will kill all of the fleas, larvae and eggs within 24 hours. It also keeps working for a month after the application to prevent fleas from coming back.

Before using Frontline spot on flea treatment it is a good idea to understand how it works and how it kills the fleas on your cat or dog.

What are Fleas?

Fleas are tiny wingless insects which live in the fur of mammals and feed on the blood of their hosts. They have mouthparts which are designed for piercing the skin and sucking blood. They can live in almost any animal including cats, dogs, rats and humans. These tiny agile creatures can jump seven inches into the air, which is around 1200 times their own body length.

These annoying little bugs cause itchy bites and rashes for their hosts. Sometimes the host animal can even suffer an allergic reaction from the saliva of the flea and it can cause serious problems. The frequent scratching as a result can cause hair loss. Fleas are also known to transmit a variety of viral and bacterial diseases.

How Does it Work?

Frontline spot on kills the fleas on your cat or dog because it contains a powerful insecticide known as Fipronil. When you apply it to the back of your pet’s neck, the natural oils in their skin work to spread it all around their body.

Fipronil is bad news for fleas and it kills them very quickly. It targets the nervous system of these little bloodsucking pests and causes them to become paralysed and die. Once the Frontline spot in is first applied, this chemical stays in the hair follicles of your dog or cat and is released to continue killing fleas. Even if the fleas do not bite the animal, they will still die.

If you choose Frontline Spot On Plus, it contains an extra ingredient known as methoprene, which inhibits the growth of insects. This means that it prevents the fleas from growing and reproducing with each other.

It is important that you use the Frontline Spot On treatment properly and that you apply it according to the instructions. You will also need to continue the treatments every few months so that the fleas do not come back. This is one of the most effective ways to prevent these horrible pests from causing your beloved pets discomfort and seriously health problems.

Arthritis Treatment Will Depend On The Severity Of The Condition

There are a lot of different arthritis treatments available to assist patients in managing their pain and other symptoms. What works for one person, however, might not work for another. It's important for patients and doctors both to view each case on an individual basis to see what works and what does not. There's no point in diving right into the most stringent of treatments, when a simpler one could do the trick.

When it comes to finding an effective arthritis treatment several factors must be considered by both the doctor and the patient. These factors include the type of arthritis in question, its potential long-term effects, the severity of the case, the age of the patient and the quality of life desired. For example, a patient in a certain amount of pain, may require a more drastic remedy while one that has mild to moderate pain and no risk of deformity or permanent joint damage might want to consider a route that involves minimal therapy with drugs and other interventions .

The standard arthritis treatment options include such things as changing lifestyle habits, taking medicine, alternative therapy and even surgery. Let's look at each of these options and how they might be beneficial.

Lifestyle changes can be very beneficial when it comes to a function and minimally invasive arthritis treatment. By doing such things as increasing exercise and movement, losing weight and even considering a better diet, a patient can find that stress on the affected joints is reduced and so is the pain. In some cases, lifestyle changes along with a mild anti-inflammatory agent when flare-ups are present will work wonders. In other cases, these changes must be considered with other measures to really have an impact.

Medicine is also almost included as a form of arthritis treatment. Whether it's an over the counter medicine or a prescribed one, the primary form is the anti-inflammatory. The reason behind this is to take swing out of the joints while decreasing the chances for permanent joint damage. In the process, this form of treatment can reduce pain. Since many of these drugs, even over the counter ones, can be harsh on the digestive system, this form of treatment is not always recommended over the long haul for daily management. In some cases, too, painkillers will be in order to reduce the pain and make a person suffering from a severe flare-up at the very least comfortable.

Alternative measures work well as arthritis therapy in some cases. These measures can include everything from meditation to water therapy and beyond. If the therapy works to reduce pain without presenting side effects that are negative, it's worth a shot. Many patients report that these measures are very effective.

Surgery is an arthritis treatment that tends to be only used in sever cases. Rather than fix the arthritis, this form of therapy actually tries to correct some of the damage the disease may have created.

There are a number of different arthritis treatment options available. The one that works best for a patient while having the lowest potential for side effects and impact on quality of life is often the one that's chosen. When picking out an arthritis treatment, it's important for both the doctor and the patient to consider the long-term effects.

What About Addiction Treatment

One main function of Treatment is providing "Tools", or skills to help resist the "craving" for the drug-of-choice. In the end, though, helping the addict return to normal functioning in society can be the most important and difficult part of the recovery process. Being an addict ruins a person's life, and it takes a lot of patience to regain the ability to work as a responsible employee, function as a family member, and just generally being a productive member of society! If, as is often true, an addict took drugs because of life failures, we can not put them back into that failure situation unprepared, and expect them not to use drugs again!

There is a widespread mistrust among the public and many politicians regarding the effectiveness of
a society is defined by how it deals with difficult problems!

Are we going to continue with the kind of thinking that spawned "Leper" colonies to isolate the victims of that disease? We need to bring the same standards to treatment of addiction that we apply to other "chronic, but treatable disorders". It often takes months to bring diabetes or high blood pressure into a manageable state. Cancer and many other diseases can take years and unbelievable amounts of effort and money to control, but we do it anyway. It's difficult to achieve complete abstinence, because the brain has been so changed by the drugs, but the pressures that bring on many addictions are still out there and addicts fear them.

So many different things are responsible for different people resorting to drugs to cope; that it only follows that various diversified treatments can be more or less effective for different individuals. Matching treatments to individuals is imperative to be able to expect good results. We bought to bring the same standards to treating drug abuse that we apply to any other disorder. There is no cookie cutter treatment for any chronic disorder. One may try several medications, each over a nominal period of time, before bringing blood pressure under control. It can take weeks, or even months, but we do not give up until we find the right one. How many times have we heard a doctor a doctor, in regard to antibiotics, say "take all of the pills, even if you get to feeling better before they're all gone"? That's what we have to do with the treatment for drug addiction. Treatment is like taking a certain amount of pills. The behaviors that are changed in treatment change the brain (remember, we can significantly modify the brain and pills can do the same thing, for example, taking anti-depressants). So we have to treat people long enough for the treatment to be effective, with long-lasting results.

Treatment.

This is large based on lack of understanding, because relapse rates are so high. Acceptance of a more realistic set of expectations is what's needed to advance the approval and backing of the whole treatment concept. In other chronic disorders (diabetes, high blood pressure, etc) we do not give up on people because they have a relapse, we give them more or even increased treatment. Thinking that most people should achieve total absence in one treatment episode is not realistic. Once we realize and accept that addiction is a relapsing disorder we can reduce the drug use and lengthen the time between relapses. Then, by getting people to quickly return to some form of treatment, we can absolutely achieve the goal of total abstinence. When viewed and applied in this manner treatment can be, and is, very effective. It's just simply, often, a long, difficult process, but the goal is achievable. This is a proven fact. Patience and understanding are difficult because the symptoms and effects of addiction are so harmful to people who have any direct involvement with an addict! As with cancer, depression, and other major disorders, it's very difficult to achieve complete success on the first try. The bottom line is that there are a tremendous number of people suffering from addiction, in our society. Do we just throw them away?

How are we going to approach this problem? It is complex!

Addiction has spread so broadly and so rapidly that many people hate addicts and are blinded by this. This is because addiction has such far-reaching effects on the non-addicts which society they share. Treating addicts as criminals has failed to achieve any acceptable positive result, because it's the wrong approach. Criminality is most often a result of addiction, not the cause. Until we see addiction as a health problem, families will continue to suffer, and our society will not heal. Most of the prisons could and should be replaced by treatment programs and outpatient counseling clinics.

It only follows, that a complex problem may require complex solutions to succeed in solving that problem! Right? Science knows more about addiction than we would ever have thought possible in the past. We know that addiction is a complex phenomenon, involving physiology (bodily health), psychology (the brain and nervous system), and sociology (public and professional attitudes and beliefs) in many combinations. Treatment professionals know this and have a wide range of approaches available and in use currently. John Q. Public, including policy makers and politicians, need to know what science and treatment professionals know, at some level. You need to understand this, especially if you have an addict in your life. Addiction is a complex disease that will not be conquered by intuition or ideology. Once we understand this; science will then be able to achieve results like they have with schizophrenia, depression, diabetes, heart disease and others.