Saving Teeth: The Rush to Preserve Natural Smiles
March 6, 2020Uncategorized
Q: I am a practitioner of 20 years, and I am seeing a trend evident among many practitioners in my area that is disturbing to me. It has always been my belief that, as dentists, one of our most significant professional responsibilities is to assist the public on how to keep their natural dentition for as long as possible—potentially for their entire lives. Yet, some practitioners are eager to accomplish root canals when teeth look even slightly questionable and remove teeth that could be easily restored. Amalgams that could serve for years are being removed only for esthetic reasons, taking away viable tooth structure and further weakening teeth. I am also seeing wanton removal of restorable teeth and unnecessary removal of bone to facilitate the placement of dental implants. Other colleagues have also commented to me on this current state of the profession. You are well known as a reputable dental speaker. What is causing these observable changes in the profession, and what can be done about our apparent shift in emphasis?
A: Unfortunately, your stated observations are correct. I am greatly concerned about the conditions you have described and many others. In my answer to you, I will state my own observations about the current state of the profession and how in our own practices we can help our patients better preserve their natural dentition for life.
There is an obvious movement toward measuring practice success by dollar production. This has happened because of numerous factors to move the profession toward business characteristics and away from professionalism.
Using root canal treatment only when needed.
Properly accomplished root canal treatment is a necessary technique, but I am seeing some practitioners move too rapidly to devitalize teeth and perform root canals. Current pulp capping procedures—indirect (no pulp exposure) and direct (pulp exposure)—should be used more often, reducing the need for root canal treatment. The following characteristics should be present for successful pulp capping (figure 4):
• Healthy patient, preferably with apparent tooth vitality present according to testing
• No pulp exposure or a small (0.5 mm to 0.75 mm) exposure
• If pulp exposure, there is slight red blood exuding—not magenta, not serous, not purulent
• Use of popular, proven pulp capping materials—examples are Vitrebond Plus (3M), Fuji Lining LC (GC America), MTA pastes from Ultradent, Dentsply, Avalon, and others—accompanied by informed consent for the patient about expectations of the indirect or direct pulp cap.
Nonetheless, often enough root canals are mandatory. Therefore, consult with an experienced endodontist and check that their previous patients are satisfied. You can ensure so by searching the doctor and/or practice on Google and trusted platforms like YELP. After which ask your dentist to refer you to that 5-star senior endodontist, like Dr. Shinn of EndodonticsLA. Dr. Shinn has been serving the West Los Angeles community for over 45 years.
#rootcanal #endodontist