What is at the apex of an infected tooth? Part 2.
What happens to the remaining bacteria in the root canal?
During root treatment, the aim is to remove as much of the bacteria load within the canals to the best ability of the dentist. However, ask any dentist and they will tell you that they will not be able to remove all 100% of the bacteria within the canal. Even with meticulous technique, there are inaccessible or sheltered areas in which bacteria can grow and live. The hope of sealing off the root canal is to ?entomb? the bacteria in a space without any nutrients to survive.
But recent research has shown not only that there are bacteria surviving within these spaces, but also that they can survive a very long time in a depleted environment (where they all walled off by the body cells). And to give you a rough idea of what we mean by ?a very long time?, dentist usually take follow-up radiographs every year or two (depending on the situation) to look for signs that the infection is regressing.
So yes, even with the resolution of symptoms like pain and tenderness, bacteria may linger for months to years.
So is this a problem at all, or are we just finding for a problem?
The answer to us is, it depends. If the patient?s immune system is up and running well, this may not be a problem at all. But what if your immune system is a little down? The close proximity of these bacteria to blood vessels/maxillary sinus/bones means that there is a potential route for an infection to spread. The presence of an irritant (mass of bacteria) might trigger the inflammatory reaction to go into a hyperdrive – possibly affecting other systems too.
And with the immune system down, would the bacteria still be walled off securely? Can the body cope with the mass of bacteria? What tips the balance of the immune system in the first place?
These are questions that we do not know the answer to yet. But logically-speaking, would you leave an infection within the bone of arm or leg? The answer is probably not, so why should you treat a dead, infected tooth any differently?
Our experience with extracting root-treated teeth always revealed granulomatous tissue (a mass of chronically-inflamed tissue) attached to the root of the tooth itself, or attached to soft, necrotic bone at the bottom of the socket.
Some patients have reported improvements after extracting root-treated teeth – for example, the clearing of sinuses and their vision being less obstructed.
Anecdotal as it is, maybe the conventional wisdom of root canal treatment is not as successful as previously thought i.e. when you take the patient?s whole holistic health into consideration.