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July 18, 2003 - Nashville, Tenn. -- Painless root canal may sound like an oxymoron, but new techniques are making it a reality for many dental patients. One such technique involves avoiding the root canal altogether by sealing the exposed nerve with newly developed adhesives.
The procedure takes just one visit to the dentist and is much less expensive than a traditional root canal, but it is also controversial and not used as much as it should be, says New York dentist Michael Teitelbaum.
Teitelbaum tells WebMD that he believes 80% of people who need root canals are candidates for the alternative procedure but almost none are getting it, partly because few dentists know about it and partly because the failure rate with an earlier generation sealant was very high.
Teitelbaum spoke Friday at the annual meeting of the Academy of General Dentistry held here.
Root canals are performed when bacteria, introduced through a cavity or crack, compromise the nerves located inside the tooth. The bacteria cause an infection, which eventually kills the nerves. But root canals can be avoided, Teitelbaum says, in cases where the nerves are not yet infected.
Instead of hollowing out the tooth and removing the pulp containing the nerves as is done in a root canal, the exposed nerve area is cleaned thoroughly and sealed.
"We now have bonding technology that allows us to seal over the nerve using the same liquid plastic that contact lenses are made of," he tells WebMD. "It hardens to form a hermetic seal that coats the nerve as well as the tooth."
Although the procedure, known as direct pulp capping, has been around for many decades, the use of traditional adhesives resulted in long-term failure rates as high as 80%. Teitelbaum says he has done around 200 direct pulp caps using the newer sealant, with a success rate of 92%.
"When this fails patients usually end up having a root canal, which they would have had anyway," Teitelbaum says. "Most of my patients don't see that as a very big downside."
Oral pain specialist Keith Yount, DDS, says the procedure is just one of many new strategies now being tried to simplify the treatment of diseased teeth.
"Right now root canal is going through a major evolution and we really don't have a handle on what will end up being the best treatment," the Raleigh, N.C. dentist tells WebMD. "It is premature to buy into one concept right now."
Kenneth Burrell, DDS, says direct pulp capping with the new materials could represent a significant advance, but that has not yet been proven.
"This is certainly the direction we would like to go in, but I would like to see controlled trials so that we know that it works," he tells WebMD.
SOURCES: Academy of General Dentistry annual meeting, Nashville, Tenn. Michael Teitelbaum, DMD, FAGD, private practice, Briarcliff Manor, N.Y. Keith Yount, DDS, FAGD, Raleigh Facial Pain Services, Raleigh, N.C. Kenneth Burrell, DDS, senior director, American Dental Association Council on Scientific Affairs.