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November 20th, 2014

From the desk of Dr. Fass

Half the readers of this column probably stopped at the topic and continued on to read the library notes or the dockets columns. That’s how powerful the image of root canal treatment has become over the years. By today’s standards, it’s surprising that a common, relatively easy and predictable procedure would have such a bad rep. But you need to understand some of the history to appreciate that reputation.
Root canal (technically endodontic or “inside the tooth”) treatment is nothing more than a sophisticated miniature “roto-rooter” of the infected nerve chamber followed by a filling to seal the system from future bacterial invasion. But early attempts at the procedure were anything but predictable.
The files and reamers for cleaning out the canals were not the finely machined stainless steel or titanium of today but rather steel wire that was shaped and twisted to allow it to cut. The edges weren’t sharp so the cutting was slow. Furthermore, before the 20th century, sterilization was not the norm. Instruments were re-used from patient to patient and the various cleaning liquids were relied on to clean the tooth. Infections and broken files were far more common than today.
Then there’s the problem of numbing the tooth. Earlier anesthetics were either not available at all before the late 1800’s or not very effective or predictable. The hypodermic needle first appeared in 1853 but Novocaine wasn’t developed until 1904 and modern Lidocaine not until 1943.
We’ve certainly come a long way.   Until very recently, most root canal was completed completely by hand instruments. A dentist in post World War II Europe developed a technique for filing the canals with a reciprocating hand piece, a drill oscillating back and forth 1/4 turn, moving the files. His name was Dr. Sargenti and his technique was widely banned since he advocated a brief cleaning and filling the canal with a paste containing formaldehyde. The failures could be catastrophic. It wasn’t until the 1970’s that some looked at using a machine technique with more traditional cleaning and filling materials, but it took many more years for automated endodontics to be accepted. Today, it is taught in most dental schools.
With the modern techniques, root canal is a relatively quick, painless, and predictable procedure which allows natural teeth to be saved from trauma or infection and function for a lifetime.

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