Talk:Root canal

History

How about a history of root canal therapy ? The article discusses modern therapy, and mentions inprovements (from what) over the last 10-20 years.

My recollection of seeing people who just had a root canal back in the 1980's CE, is that they looked like they just had lost a fight - black eyes and other facial brusing and pain.

It would be great if someone could contribute a knowledgable history of root canal therapy.

Mr. Grace 21:58, 10 April 2007 (UTC)

In my opinion these people had the largest effect on endodontics over time

1683 Antonin van Leeuwenhoek the Father of Microbiology

1894 Miller In 1894, Miller became the first researcher to associate the presence of bacteria with pulpal disease

1965 Kakehashi et al Gnotobiotic (germ‐free) vs normal rats

Exposures created in single molar teeth in each animal

Normal rats had pulpal abscesses

Germ free rats had dentinal bridging

Micro‐organisms are the basis of all endodontic disease

1966 Moller Culturing studies on root canals, transport media and growth media.

Showed that up till now all studies on RC flora had identified the wrong causative species.

Previous studies had cultured aerobic sp. Sampling techniques were not sophisticated enough to extract the real culprits from deep within the RC.

These sp are anaerobic, and easily killed by any exposure to oxygen.

1976 Sundqvist ‐ periapical lesions (Human) 32 Humans with non vital unrestored teeth

All teeth with apical lesions demonstrated infection within the canals

Teeth without areas were sterile

The more sp. isolated from the canal, the larger the lesion

>6 sp. correlated with pain

Bacteroides melaninogenicus assoc with pain, swelling, pus

Necrosis + bacteria = endodontic disease

1981 Fabricius et al ‐ periapical lesions (Primates) Series of experiments on monkeys

Exposures sterile + contaminated

Sterile‐necrotic pulpal tissue did not cause inflammation of surrounding tissues

Contaminated‐ evidence of inflammation clinically +/or radiographically in all teeth

The longer a contaminated tooth was left closed, the more anaerobic the bacterial population became.

Anaerobic sp. inoculated primarily failed to colonize; they require preceding sp. to create right ecology.

Then you could go into the history and modern techniques for chemomechanical canal preparation, obturation the advancement in materials to now where there is the thermofil GP

Once I am done with exams I will flesh it out —Preceding unsigned comment added by Lint.n (talk • contribs) 13:05, 9 November 2010 (UTC)

Root canal definition

"Root canal refers to the hollow area in the center of a tooth" (first sentence)

Isn't that the same as pulp chamber? A-giau 16:34, 23 Oct 2004 (UTC)

My understaning is that the pulp chamber comprises of the chamber proper in the coronal area of the tooth and the root canal system that connects the chamber to the tips of the roots. Some texts will refer to the the root canal and the chamber together as the "pulp chamber", while others will differentiate between the two.

Thanks. From the x-rays I've seen, each canal appears as a fine, elongated tube. So I was surprised to learn here that a root canal refers to a central hollow area (which in my mind is something like a chamber). The details do clarify this impression, though. A-giau 08:05, 24 Oct 2004 (UTC)

Trying to clear this up, I looked around; http://www.aae.org/patients/toothillus.htm and Endodontics both indicate that the root canals are below the pulp chamber, and a canal is long and thin. Editing accordingly, to "Root canals are the long passages full of soft tissue within the dentin at the center of a tooth, below the pulp chamber." -Elvey

To point out an obvious issue, the root canals are only below the pulp chamber if the tooth is in the mandible. If it is in the "upper jaw", then the root canals would be above the pulp chamber. The term in dentistry to describe the position of something closer to the root tips is "apical". Thus, the root canals are apical to the pulp chambers in all teeth. This makes for a good picture. - Dozenist talk 17:07, 22 April 2006 (UTC)

Doh! I replaced it with 'adjoined', a word in more general use than 'apical'. Thanks.

Pain

I just had a root canal today. The dentist used A LOT of anesthetic, however when he was drilling up into the root it was rather painful. Nothing that I couldn't handle, I guess the level of pain for this procedure varies greatly from individual to individual. —Preceding unsigned comment added by 98.233.101.147 (talk) 01:35, 28 April 2009 (UTC)

I just had my treatment started on the NHS at a dental access centre. I had an injection and never felt any pain just some vibration as the drilling was happening. Mine felt the same as any other filling i've had before. —Preceding unsigned comment added by Katerlyn (talk • contribs) 11:40, 14 April 2009 (UTC)

I was somewhat nervous before having this procedure done, and there's nothing to be nervous about. After the anesthetic is applied you won't feel a thing. They gave me a prescription for vicodin and told me to take some advil, and it should be fine in a couple of days. (Each endodontist preforms the surgery differently, ask questions if you have any) —Preceding unsigned comment added by 24.34.125.24 (talk) 19:49, 20 May 2008 (UTC)

Contrary to popular belief, root canal treatment is usually painless due to effective pain control techniques used by the dentist while the treatment is being performed and the (optional) use of pain control medication after treatment.

When I had root canal treatment, my dentist only gave me a little anesthetic and told me to tell him when it hurt - apparently this is how he knew he'd hit the end of the root canal. Apparently this "drill by feel" is or was a common technique, so the above passage doesn't seem very accurate to me. --203.52.130.136 04:21, 6 Apr 2005 (UTC)

This is EXACTLY what happened to me on Monday. "Drill by feel" is exactly what she called it. I think it needs to be re-written. TruthCrusader

When I had a root canal I was surprised it didn't hurt more. It was reasonably painless (no worse then most fillings and better than some). There wasn't that much drilling involved. Once the pulp cavity was exposed it was done with files (of graduated size). RJFJR 20:50, Jun 15, 2005 (UTC)

Guys I don't know about you but in my case it hurt like anything... The anesthesia has been wearing off and even the place where the doctor injected me with has started to hurt. Trust me I am not being a baby, I have gone through military training with flying colors and there were some massive quantities of pain there as well. I guess it serves me right for going to a military hospital for treatment... :) --80.92.52.5 22:56, 8 August 2005 (UTC)

people only talk about the bad painful root canals. The majority are not painful. But some times the nerve is harder to anesthetize due to the severity of the infection or trauma to the nerve. It becomes hyper sensitive. - ?

I had a painless root canal procedure (a 4-root molar, #19/USA numbering). My Endodontist injected me several (3, I think) times beforehand, and gave it around 15 minutes to take effect, and injected me once more when I 'ummed' to let him know I felt something (a very slight discomfort). Because of something I read here, I avoided swallowing during the 15 minutes so my throat wouldn't go numb. My jaw up to my ear canal and half my tongue were numb. So it seems it depends on the effort and skill of the procedure followed. It also depends on the sensitivity of the patient - this varies widely too. I rarely feel pain from the needle when I give blood. However, I must add that I'd cheated - I'd also taken a (generic) Vicodin 40 minutes before the root canal procedure started. (Luckily, I had some from an episode of back pain.) I suspect it's important to scrape one's teeth together shortly after the temporary filling has been put into place (I think this will keep it from protruding such that biting puts pressure on the root. I didn't close my mouth until a few hours later; it was painful; I carefully scraped a bit of the temporary away with a knife where the opposing teeth had indented, and that and a second Vicodin fixed the problem.) (Note, this was my idea and I'm not a dentist; this isn't medical advice! Maybe one can pipe up.) Oh, and I asked for a mirror and watched much of the procedure (while keeping the mirror out of the dentist's way) and it was cool to see (of course, this could freak out the more squeamish!) -Elvey

This is essentially correct--anesthetic is pH sensitive, and if the infection has caused a good deal of inflammation, the pH in the region will be lowered (more acidic). The anesthetic has a harder time penetrating the nerve fiber in this environment, and consequently its pain reducing effect can be greatly decreased/slowed. Also, many patients complain of the time the procedure can take, requiring them to sit with their mouth wide open for a long time, leading to TMJ pain. But in general most root canals should be no more painful than a standard filling. Wikipac 21:42, 8 January 2006 (UTC)

Having just gone through this treatment myself today, I must say that the only pain was in the injection, and that was mostly projected from my discomfort around needles. I took ibuprofen as soon as the numbness started wearing off an I haven't felt anything except a small bit of soreness. -- Masterzora 04:02, 11 April 2006 (UTC)

I had a root canal recently after a tooth with a large cavity broke (on a bit of popcorn in fact, the dentist's bane). I went in for an initial visit with a dentist, who did some drilling and applied a sort of plaster that started to break apart about two hours after the visit. As I understand, this was some sort of preparation for my root canal. The pain from this first visit was intense, such that even the impact of walking was excruciating. Recovery from the root canal itself (some week or two later) was almost painless, though. Does anyone know what might have occurred during the initial procedure that caused so much pain and inflammation? Only the root canal itself, the later visit, was performed by an actual endodontist, so I don't think the first procedure was anything described here. The pain was unrelated to the breaking of the tooth itself, as best I can infer, since the only pain involved there occurred during the fracture itself. If this is a tangent or a probable exception to the rule, my apologies, but I am curious about just what might have happened. -(Second question:) Now that I've had my root canal, the endodontist wants me to come back so that it can be "closed up" (his words), but there is some kind of rubbery material over it presently, which I expect is the Gutta-percha mentioned in the article. I am supposed to go in for a crown at the dentist's, however. Do I need the appointment with the endodontist to "close up" if a crown would do the same job? Or is he planning to close the canals themselves, and not just the chamber? Thanks in advance. Fearwig 16:24, 1 June 2006 (UTC)

Call the endodontist's office and ask; don't guess.

When I went in and the dentist determined I needed a root canal he couldn't get me a long enough appointment that day to do the whole job so he did some that he had time for and we made an appointment when there was an opening in his schedule. He also put me on antibiotics. (I wasn't prescribed pain meds at that time but if I'd called back they almost certainly would have.) RJFJR 16:36, 1 June 2006 (UTC)

That may be it. I probably just filled up a talk page with personal chat, but these questions came to my mind as I was reading about the typical procedures. Perhaps some incorporation into that section of RJFJR's experience of multiple visits would be apt (though I don't know enough about what is and isn't typical to venture a guess myself). As for the antibiotics, RJFJR, I expect I wasn't placed on them because I don't think there was an active infection--most people get root canals because their tooth is infected, whereas I just had a deep cavity that went to the pulp (I think). They probably thought it better to remove the pulp from a broken molar before crowning it, just in case it became infected later (I wouldn't want to have to remove someone's crown for drilling if I were a dentist). Speculation, though. It may just be that they don't put everyone with a root canal on antibiotics, since the infected material is, after all, extracted. Fearwig 16:53, 1 June 2006 (UTC) Also, since the topic is pain, I will note that I was given tylenol 3 (300mg acetaminophen, 30mg codeine) in anticipation of post-procedural pain. This indicates to me that pain is commonly significant, but not extreme (as there is a 60mg codeine variety as well, not to mention other pain medications--the 30mg variety is pretty light-weight for an opiate/NSAID combination). Fearwig 16:56, 1 June 2006 (UTC)

From my perspective, having a root canal is not that bad--it was tedious (the procedure is intricate), but not painful thanks to judicious administration of medication by my dentist.

Needing a root canal, however, is amazingly painful, even though I had the help of Vicodin. Tellumo 09:33, 4 May 2007 (UTC)

I just got one and it was the least painful dental procedure I've ever had (painless procedure, imo). Drilling and filling is many times more painful, but it's possible that the excedrin I took several hours earlier helped cancel out some of the pain.

I've had two root canals in the past four days, the first one I already had a severe toothache in, and I can say without a doubt it was the most physically painful thing I've ever experienced. They gave me 2 shots prior (and my gums were numbed with orajel or something prior to that), the shots didn't really hurt, but was alittle uncomfortable (but really, aren't all shots?) . They also ended up spraying more directly into the tooth when it became evident just how badly it was hurting me. The actual drilling didn't hurt and neither was removing the pulp, the real pain came when she started killing the nerves. I had to litaraly wrap my legs around the base of the chair to prevent myself from raising up out of the chair. Then the second big pain (and third) was after all that was finished, and they jammed the filling in. This was about as painful as moderate tooth ache. After all that, all I could really do was crawl into bed and sleep, waking up now and then to re-dose on painkillers/antibiotics for the rest of that day(was finished by about noon) and all of the next day. My second one, thankfully, hadn't developed into a tooth ache (just a slight increase in it's sensitivity to cold). This time they gave my 3 injections (2 on the outer sides of my gums and one at the interior), in addition to spraying alittle more once they got the pulp out of the way. Now, I wouldn't say it was painless, but nothing like the first. The drilling/pulp removing were no problem. But again, there was a little (stress on the little) pain when they killed the nerve. But again, it hurt when they put in the fillings (the rubber they have to heat up first). This was about as bad as a moderate tooth ache again. The pain from the actual filling is what will stick with you for awhile(and what the dentist will most likely prescribe a painkiller for). My advise, if your dentist tells you that you need this, get it done asap, even better if you haven't developed a tooth ache yet. From my experience, the more pain your in prior to the operation, the more pain your going to be in during and after the operation. If your at all worried about pain during the operation, take a painkiller(preferably prescription-strength) about an hour before the operation. Your most likely still going to feel pain, at least from the filling process, but you can at least minimize it.172.193.63.91 06:49, 6 November 2007 (UTC)

Picture

The picture labels the tooth as 46. Human adults only have 32. 68.23.224.34 20:58, 26 July 2005 (UTC)

Tooth nubering systems vary depending on the country. One system in common use numbers teeth by the quadrant from 11 to 18, 21 to 28, 31 to 38 and 41 to 48 (for adults). Another system (used in the USA) goes from 1 to 32 for the same teeth.

I edited the picture description by identifying the tooth by its actual name to clear up any confusion. But about that picture, it isn't really a good example of normal root canal therapy, seeing as the tooth has also had a partial root amputation in addition to root canal therapy. I'll try to find a pic that just shows a plain old vanilla root canal.LitMatch 18:45, 17 August 2005 (UTC)

I had root canal done a couple of weeks back, and after reading the talk on this page scanned and uploaded a copy of my x-ray. Added it to the page as a 'normal' example. Renski 15:30, 26 September 2006 (UTC)

Can someone (e.g. LitMatch) put up X-ray pictures that show teeth that do and do not need root canals? That would be a valuable addition. -Elvey

There can be some examples placed, but (for the record) you cannot definitively diagnose a tooth needing a root canal from a radiograph alone. - Dozenist talk 17:00, 22 April 2006 (UTC)

I have x-rays I could scan, but as my tooth was also broken it would probably serve as a bad example. And Dozenist's point is probably quite valid. It's an interesting idea to post comparison photos, though. That be informative for almost any medical article. Of course, I suppose it's more likely for editors to have personal dental X-rays than, say, photos of their own scarred liver tissue (I am sure most existing photos of such on the internet are copyrighted). Fearwig 17:00, 1 June 2006 (UTC)

I just had a root canal earlier today. Before I tell you how it went keep in mind that I am a 13 year old girlie-girl who cries at the sight of flu shots and is a huge whimp. The freezing was nothing. I could barely feel anything more than the slightest pinch. The rest of the time i couldn't feel anything. My only problem was that it was boring. After the freezing wore off i didnt have the slightest amount of pain. I hope that this reassured anyone who is having worries about getting a root canal:) —Preceding unsigned comment added by 24.141.189.160 (talk) 17:49, 6 June 2008 (UTC)

Files Can Be Lost in Canals

A root canal performed on a patient by a dentist (not an endodonist, resulted in a file being broken off and lodging inside the canal. When this happens, it is usually given the status of "if it's not broken, don't fix it." Problems can occur including pain and infection of the tooth anywhere from five to fifteen years while the broken file remains intact. If a root canal patient experiences swelling and extreme pain in any tooth where a dentist or endodonist has told the patient a file was lost in the canal, seek immediate attention. The patient will suffer swelling, infection, and extreme pain. Usually, but not always an endodontist can extract the file(see solutions) once the infection has ceased, however, if the file is in an canal not wide enough to extract, the tooth may have to be pulled. —Preceding unsigned comment added by Jean Scheid (talk • contribs) 19:58, 1 September 2009 (UTC)

Endodontist Solutions for Broken Files

According to QNA Dental, the following procedure(s) may be used to correct a file broken off during a root canal:

Your question about 'will the broken file cause a problem' does not have a straightforward answer however. Depending on the type of instrument and the location within the canal it broke at, some are actually able to be removed. There is no doubt that the best solution is to remove the broken file. The second best solution is to bypass it, clean around it, and ultimately incorporate it into the filling by entombing it in the root canal filling material. When these two things cannot be achieved, the third solution is to complete the case as well as possible and observe for future healing and resolution. Endodontic specialists are becoming more highly skilled in removing objects that should not be there (including broken files) from root canals. A variety of techniques to remove objects (such as broken files, posts and old filling material) are available. Many of the techniques require special training and instruments your general dentist may not be aware of or does not have. —Preceding unsigned comment added by Jean Scheid (talk • contribs) 20:16, 1 September 2009 (UTC)

getting a root canal

do you get to sleep through a root canal if you are under 18?does it hurt to get a root canal done ?(what about under 18?)

See the 'pain section' above and in the article. It answers both of these questions. (Well, it could be explicit: a shot (of novacaine (sp?)) does not put you to sleep, but sometimes nitrous is used. Without pain medication, it would be extremely painful.)

I am told that general anesthetic is rarely used for root canals. It's understandable--as long as you are responsive to local anesthetic general would be an unnecessary risk. Being especially sensitive, I was found minimally responsive to novocaine, but they stuck to it. Six shots, I think, were needed, and they still didn't resort to nitrous. Fearwig 17:03, 1 June 2006 (UTC)

Why drill?

Could someone explain why root canal treatment requires the drilling? Why not inject an antibiotic with a needle trough the gum and be done with it? (thus sprake some unknown person.)

I think the point is, it is absolutely necessary to get out ALL the organic soft material down inside there, so it does not rot over the coming years. This requires mechanical procedures. 69.87.201.21 21:51, 17 May 2006 (UTC)

Actually, Root canal treatment requires two types of drilling. The first is to get access to the pulp chamber and the pulp canals. This is usually performed with high speed drills. Traditionally these are the "noisy" drills. Once accessed, the canals themselves can be "cleaned" either by hand, with hand files, or with electric rotary drills. This part of the procedure is usually "quiet". The question you ask is a good one. "why can't we just use antibiotics".The problem is, once the pulp (nerve and blood vessels) has degenerated, the bodys normal defenses against the bacteria are disabled. Root canal therapy removes the contents of the canal system through mechanical and chemical means. Then, a material is placed in the canal system that ideally fills the space three dimensionally so bacteria can not get in. Although this sounds simple, it is by no means easy. In most instances it is impossible to completely "sterilize" the root canal systems. Research is presently being done to find the right combination of irrigations to effectively remove all of the infected and healthy tissue within the root canal system without causing significant damage to the surrounding healthy tissue. September -06

The root canal process can be "finished off" per se using a bleach to clean out the rest of the small canals the doctor could not reach with the file. However, the compound will damage gums if it is allowed to come into contact with them. The canal must be accessed with a drill for a safer procedure. January -09 —Preceding unsigned comment added by 63.3.2.2 (talk) 15:54, 6 January 2009 (UTC)

illustration

I feel having a crown as part of the initial picture implies that its a nessacery part of the process. I'm also pretty sure (and the article text seems to agree) that in many cases it is not. Anyone have any comments on this? Plugwash 21:10, 26 May 2006 (UTC)

If you have a root canal, you will eventually need a crown to protect the significantly weakened tooth. It is not absolutely necessary to have it the minute you finish the root canal procedure, but a crown will be needed to extend the lifetime of the tooth. - Dozenist talk 21:56, 26 May 2006 (UTC)

I wonder if the country makes a difference to whats accepted practice. Afaict here in the UK the NHS won't pay for a crown until the tooth actually breaks. Plugwash 22:29, 26 May 2006 (UTC)

Well, finance may affect what commonly occurs in terms of treatment, but a tooth that has a root canal is sufficiently weakened to the point that a crown is needed if the goal is to extend the life of the tooth as long as possible. If the tooth cracks, then it can break sufficiently enough for a crown to be too late and the only possible treatment is extraction of the cracked tooth. So well, a crown may not absolutely be "necessary" after a root canal, but it would be the ideal treatment if the purpose is to save the tooth (which I guess would be the purpose if you went through the trouble of having a root canal in the first place. - Dozenist talk 05:44, 27 May 2006 (UTC)

One of the links lead to what is siad to be animated images of root canal treatment, but there is no animations. Animations would be moving pictures.

Crowning without root canal work?

I had a large filling in my RU5 premolar which just fell out, leaving a largely hollow tooth. However there is no infection at all. My dentist filled it temporarily. My question is... is root canal work really required in this situation? I would like the tooth to be crowned without killing the nerve. If future infection does occur for whatever reason, then I will simply have the whole tooth removed. Is there a reason to have root canal work on this heathly tooth? Darrall 00:53, 7 March 2007 (UTC)Darrall

I don't know whether I should touch this one, but here goes. Occasionally, if there is not enough tooth structure left to support a standard filling, another option is elective endodontics (root canal) in order to use the root canal space to hold a post and core, which would support a crown. This is a difficult concept to get across in just words, but the post in the centre of the root retains a core material, which is meant to replace lost tooth structure. The new core supports a crown which covers the core and part of the tooth in order to obtain a ferrule effect (ferrule being the band of a barrel which holds it together), thereby preventing bite force causing the post to fracture the root. All complicated, but short answer is sometimes root canal is necessary if you want to save a tooth.

This procedure is particularly prevalent in premolars because once the decay has compromised the centre of the tooth (usually from mesial to distal - the front to back, not side to side) the filling placed can act as a wedge and split the two cusps resulting in a near catastrophic loss of tooth structure. This means the only way to save the tooth is by bonding a filling - which has an unpredictable prognosis in many cases, or by using the internal root canal space to retain a restoration. Sorry if this is overly complicated, but it is a concept which takes some dental students a year or two to get their heads around. A diagram would help, but I don't have one.Dr-G - Illigetimi non carborundum est. 19:06, 7 March 2007 (UTC)

A crown is usually only immediately necessary if the tooth the root canal operation was performed on is one of the back molars. Crowns can cost a good bit of money, if you don't necessarily need one, it's okay to live without it. However, always consult your dentist. January -09 —Preceding unsigned comment added by 63.3.2.2 (talk) 15:57, 6 January 2009 (UTC)

Separate article?

I just realized after looking closer at this article that there are two topics being discussed. It begins with a discussion of the anatomy of a tooth's root canals and then goes further to discuss root canal therapy as in endodontics. Should there not be two separate articles: one focused on the anatomical part of the tooth and another on the treatment when the tooth is infected? - Dozenist talk 18:45, 3 June 2006 (UTC)

I agree. But who are you going to get to write about such an interesting subject? Dr-G - Illigetimi nil carborundum est. 18:08, 31 October 2006 (UTC)

I feel the sarcasm, man. :-P Don't worry, I am sure I can find someone... - Dozenist talk 21:20, 31 October 2006 (UTC)

Lidocaine and NSAID

The common local anesthesia dentists use today is Septocaine (4% Septocaine 1:100,000 epinephrine). This medication replaces the traditonal lidocaine because it has less toxicity, more perfusion, and more profound analgesia.

Ibuprofen is not the medication commonly prescrided for relieving moderate-to-severe dental pain. Typically the dentists would prescribe a "combined" medication. The combined drug includes a nonsteroidal anti-inflamatory agent (NSAID) such as ibuprofen or acetaminophen and a narcotic agent such as codeine or hydrocodone. Tylenol #4 and Vicodin ES are examples of these combined drugs.Drnguyen 04:00, 30 October 2006 (UTC)

I'm sorry Dr. Nguyen, but I wouldn't agree. Most dentists in the UK and Ireland still use lidocaine hcl 2% w/1:80000 epi. As far as therapeutics are concerned, mine and many dentists (and I believe correct) approach is to prescribe the minimum strength drug that will achieve the desired analgesia. Usually I prescribe ibuprofen with codeine for mild to moderate dental pain. Codeine and other low strength opioids have debatable application in dentistry, as they have many side effects, and mediocre painkilling abilities. My therapeutics lecturer in college famously once said that codeine is only good for making people constipated. If I'm managing pain, I think the more robust, cox-2 selective NSAIDS such as diclofenac and nimesulide are great. However, I am aware of the published evidence regarding combined NSAID and opioid use for dental pain, which says that this is an extremely effective modality. This issue is clearly difficult to make NPOV. Dr-G - Illigetimi nil carborundum est. 18:07, 31 October 2006 (UTC)

This may be an issue where POV is important. The POV of the patient. I have been prescribed Hydrocodone and the tylenol/codein combinations, but for me they are never as effective as plain Ibuprofen. People experience pain and pain killers differently. It is important to know what works for you. -- Samuel Wantman 22:59, 28 April 2007 (UTC)

Septocaine is actual the septodont trade name of Articaine hydrochloride 4% with epinephrine 1:100,000 or 1:200,000. I disagree that articaine HCl 4% is the most common anaesthetic. One should note that a higher rate of mandibular nerve damage in inferior aleveolar nerve blocks (mandibular blocks) has been documented. Articaine is useful and common, but I strongly suspect lidocaine HCl 2% is still the most commonly used dental local anaesthetic due to its documented safety (re max dose in mg/kg) and excellent overall practicality for duration of anaesthesia. stdavidsboy (talk) 02:31, 4 April 2009 (UTC)

Proposed name change to 'Root canal therapy'

As hinted to in the first section of this talk page... root canal definition, Root canal should actually refer to the pulp chamber of the tooth. Root canal therapy is what this page is about, not about the canals in the roots of teeth. (Bouncingmolar 09:23, 22 February 2007 (UTC))

I think people are more likely to search for "root canal" than "root canal therapy". If it is moved, which I'm not advocating, please leave a redirect at "root canal" so people can find the article. RJFJR 14:22, 8 March 2007 (UTC)

That is exactly what would happen. a redirect or link would definately be present. But a root canal is just the name for the canal inside the root. root canal therapy/ root canal fillings, are the treatment of the canal in the root by filling it. Therefore it should be retitled, as root canal is the lay term for root canal therapy Bouncingmolar 22:06, 8 March 2007 (UTC)

I know that, I just don't want it moved then a proposal to delete the redirect to be made. I also wanted it on record that (I believe) this is the common term, and is what people would search on. RJFJR 19:58, 9 March 2007 (UTC)

Whether it is the common term or not, it is not the correct term. I am in favour of the name change. Root canal should, in fact, be a separate article. Dr-G - Illigetimi non carborundum est. 23:00, 9 March 2007 (UTC)

It's irrelevant what people search for -- that's the beauty of Wikipedia. We can redirect them. I have already begun an article on endodontic therapy, will redirect 'root canal therapy' to that, and place a disambiguation notation at the top of the 'root canal' article. DRosenbach ^{(Talk | Contribs)} 12:13, 19 June 2007 (UTC)

How to tag

There was a {{howto}} tag on the article, but I disagree (so I move it here). There is no how to section - it doesn't tell someone how to do it (that's a job for a trained dentist). What there is, is a description of what happens, which is not only encyclopedic by necesdsary (kind of hard to discuss something that you don't know what involves, AND the thing I relaly wanted to know was what is the dentist doing to me while I'm sitting here and is this going to hurt).

Therefore I removed the tag and created this discussion. We can add it back or take care of it if there is consensus here. RJFJR 14:26, 8 March 2007 (UTC)

Removed External Link

Replaced link to www.aae.org/patients/faqs/rootcanals.htm with one to WebMD article since the aae.org article no longer exists. GuyInCT 09:28, 6 September 2007 (UTC)

Pro-industry POV

It is interesting to me that the criticisms of endodontics pioneers Weston Price and George Meinig are not addressed in this article. IMHO, this reflects pro-industry POV. --207.244.187.107 (talk) 05:05, 10 December 2008 (UTC)

I'm not sure I would describe Weston Price as an "endodontic pioneer". AFAIK his criticisms of root canal therapy were soundly discredited, and my limited probing of him yields some pretty crackpot stuff. Asserting that his omission qualifies as "pro-industry POV" would seem akin to criticising the objectivity of virtually any medical article that failed to mention the alternative healing powers of (insert your crackpot pseudo-science here)... Recommend that the criticism above (from 207.244.187.107) not be considered grounds for NPOV claim. —Preceding unsigned comment added by 129.55.200.20 (talk) 20:19, 1 May 2009 (UTC)

High cost due to cartelization

There should be some discussion of the tremendously increased cost of root canal therapy over the past 30 years due to the dental cartels strict control over the number of practicing dentists. The research of economist Morris Kleiner should be mentioned, as well as new evidence that dental therapists can do much of the same work as dentist so, but at lower cost. (See New York Times: http://www.nytimes.com/2008/04/28/business/28teeth.html?_r=3&scp=1&sq=Alaska+dentistry&st=nyt&oref=slogin&oref=slogin) Nicmart (talk) 17:41, 28 April 2009 (UTC)

• That may be a valid criticism of dental practice in general, but it does not go on this page. The NY Times article you link to specifically states that dental therapists cannot do root canals or other complex procedures.--Scarren (talk) 15:35, 25 December 2009 (UTC)

Controversies from Meinig's "Root Canal Cover-Up" and a historical review

Copied this to Talk:Endodontic_therapy#Controversies_from_Meinig.27s_.22Root_Canal_Cover-Up.22_and_a_historical_review. I noticed George Meinig's Root Canal Cover Up (see summary) on Amazon. Haven't read the book, but did some research and found a 2000 California Dental Association article which has a good review of the "focal infection theory" (root canals leak bacteria into the blood, causing chronic illness). So if this controversy ever gets big, the 2000 CDA is an excellent resource - although it doesn't reference the book specifically, it is about the same "focal infection theory". Shankland seems to be a modern advocate of the theory who has published in peer-reviewed journals (see his summary).

The CDA article actually disputes the validity of the "Focal Infection Theory". That is to say, teeth treated with root canals do not cause disease. The article does admit that there is a connection between the following: untreated infections may cause or increase the risk of certain systemic diseases. Specifically, the bacterial that cause periodontal (gum) disease have been found in the plaque coasted arteries in coronary disease.

This is the Abstract:

"This paper discusses the past, present, and future of the focal infection theory of disease. A focal infection is a localized or general infection caused by the dissemination of microorganisms or toxic products from a focus of infection. The resurgence of the focal infection theory of disease has been greeted with great enthusiasm in some quarters; however, the present evidence for the relationship of oral microorganisms and systemic disease is very limited due not only to a dearth of prospective studies and a complete lack of interventional studies but also to very significant methodological difficulties associated with the clinical studies that have been performed."

Some more searching turned up Microbiology of endodontics and asepsis in endodontic practice, an excellent article which references Meinig specifically. I will look into incorporating into the article. II | (t - c) 05:57, 27 November 2009 (UTC)

Choice of illustration

If this article is about the root canal and not the root canal procedure, then the main illustration probably shouldn't be of the root canal procedure. It is misleading. It makes you think you are in the right place when you are not. Xuehxolotl (talk) 01:18, 7 February 2010 (UTC)

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Move discussion in progress

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