Why tooth extraction should be a last resort

Root canal treatment (endodontics) is a dental procedure to remove inflamed or infected pulp on the inside of the tooth, which is then carefully cleaned and disinfected then filled and sealed.

According to Dr Benjamin Simiyu, an endodontist, the treatment is done to eliminate bacteria from the infected root canal, prevent reinfection of the tooth and save the natural tooth.

He says initially, if someone had a cavity, they would feel sensitivity and that means he or she has dental carries disease and this means the bacteria has now reached the nerve and the treatment is filling.

"However, if a patient has persistent pain, says can't eat hot, cold or sugary things because it makes it worse and can't sleep at night, it's called pulpitis and this is due to inflammation of the pulp. That is the patient will be advised to undergo a root canal treatment," said Dr Simiyu, who owns Ideal Dental Care in Kilimani, Nairobi.

Also, after an x-ray and it's found out that a tooth is chipped or cracked, there's a pimple on the gum and something black on the tooth then one requires root canal treatment.

He says more than 15 million teeth are treated and saved each year with the root canal or endodontic treatment, relieving pain and making teeth healthy again.

He says many people in Kenya fear the root canal due to poorly done treatments by general dentists instead of an endodontist.

Dr Simiyu is among the only three endodontists in the country and based in Nairobi including Dr Tom Dienya and Dr Fredrick Weboko.

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• Pulpitis: When the living part of your tooth becomes inflamed

So what happens during root canal treatment?

Inside your tooth, beneath the white enamel is a hard layer called dentin, which is a soft tissue called pulp. This tissue contains blood vessels, nerves and connective tissue, which help grow the root of your tooth during its development.

"A fully developed tooth can survive without the pulp because the tooth continues to be nourished by the tissues surrounding it," said Dr Simiyu, an honorary lecturer at the University of Nairobi's School of Dental Sciences.

He graduated with a Bachelor of Dental Surgery before proceeding to the Philippines for his Masters and has been practising for four years now.

Dr Simiyu, who is the founder of Dental Aptitude College, co-founder of Royal Smiles Dental Clinics and a lecturer at the University of Nairobi has over 15 publications in peer-reviewed journals nationally and internationally.

"A modern root canal treatment is nothing like those old sayings! It's very similar to a routine filling and can usually be completed in one, two or three appointments, depending on the condition of your tooth and your circumstances. The process is relatively painless and extremely effective. You'll be back to smiling, biting and chewing with ease in no time," he explained.

He says it's better to have a root canal treatment than extraction because it retains one natural tooth because there is nothing that can function better than a natural tooth and is also less expensive than extraction.

"You may do extraction but when you want to do a replacement later, it will be more expensive," he says.

Root canal treatment, he says has many advantages including efficient chewing, normal biting force and sensation, natural appearance and finally protecting other teeth from excessive wear or strain.

He says the process of a root canal takes two to three days of doctor's appointment with the first one involving removing all the decaying parts of the tooth and the inflamed nerves and blood vessels inside the tooth and the dentist will put a temporary filling for you with some medicine and you will be free from pain.

"The second appointment will be through cleaning of the root canal system that was affected and introducing an antibiotic to kill any bacteria that may have escaped the cleaning. The last appointment will be to fill the space at the centre, that is the root canal space it is an inert material that will last forever as long as you live," he explains.

Recovery can take two to four hours and you will experience only the numbing effect that may take 24 hours and should not be painful.

One can eat after two hours before going to see the dentist for the root canal so long as he or brushes them.

"The doctor can prescribe for you a painkiller and an antibiotic because the root canal is a bacteria infection mostly," he says.

Root canal treatment can be done on all teeth except the wisdom teeth because we do not need them and they give problems in future and are too far away and mouth opening thus becomes a problem. He says its failure is unlikely if it's cleaned well and antibiotics described.

The cost of root canal treatment varies depending on the type of tooth.

"Molars are more difficult to treat and the fee is usually higher. Most dental insurance policies provide some coverage for endodontic treatment," he says.

An extracted tooth must be replaced with an implant or bridge to restore chewing function and prevent adjacent teeth from shifting. These procedures tend to cost more than endodontic treatment and appropriate restoration.

Life-threatening

Failure to undergo root canal treatment, he says may lead to infection proceeding from the tooth to the jawbone, then it can be carried elsewhere in the body.

"It can be life-threatening especially if the lower molars are involved, blocking the airway. Root canal reduces the risk of other diseases including cancer. Research done in 2013 says those who do root canal have a 45 per cent less risk of getting cancer," he says.

After treatment, one can brush the teeth after two hours and you can drink anything else apart from smoking, which reduces the healing because of nicotine.

A root canal, he says, does not kill the tooth, and after treatment, the tooth will be able to function normally. However, root canals do remove the nerves inside the tooth, but these nerves serve very little function in a fully formed tooth.

He said a root canal can be done under local anaesthesia on the dental chair and one does not need to go to theatre after the doctor administers an injection around the tooth.

"In special cases like for patients with disabilities like epilepsy or cerebral palsy and have altered opening of the mouth then it can be done under general anaesthesia in theatre," he says.

According to Dr Simiyu, tooth extraction should be the last resort and when the tooth is shaking, does not mean the solution is removal as most do.

"The shaking means the pressure due to the pus and the root canal will remove that pus and after the root canal, it remains stable," he said.