The Alternatives to Root Canals

The Alternatives to Root Canals

Root Canal TherapyWe talk a lot about the alternatives to root canals typically the only alternative mentioned is extraction of the tooth. But is that really the only alternative? Surely there must be other options, right? This was the question posed by Sean after listening to recent podcasts (Root Canals, Infections, Formaldehyde, Oh My!).

The truth is, there are other alternatives depending on the situation. We’ll try to explain it all in detail, here.

First off, if you really need a root canal, then that means the damage has gone too far and you are having serious symptoms (toothache or swelling). At that point, the healthiest option is to extract the tooth and replace it.

Root canals, however, are often recommended for the wrong reasons (such as when a dentist has exhausted or ruled out other sources or causes for tooth pain). A common incident is when the bite is off and the problem tooth is sore and causing pain. Another common example is when the gums have receded and the tooth is painful because of exposed dentin. Of course, taking out the nerve will cut sensation or feeling to the tooth, but it by no means is the source of the problem is cured.

The reason root canals are so often recommended is because many dentists don’t spend enough time diagnosing the root cause of the problem. Diagnosis is time-consuming and inefficient. For every minute a dentist spends diagnosing the source of your dental pain, he or she loses money (because that time could have been spent seeing more patients). While many dentists will dedicate the time to properly diagnose problems, far too many take the easy route and make assumptions in order to quickly provide a solution. Root canals will most often remove the cause of the pain (again, because you’ve removed the nerve), therefore, root canal therapy is often recommended.

Now, if the dentist has properly diagnosed the cause of your problems and if you really have a true need for a root canal (infection or deep cavity), then the damage is too great to reverse. The healthiest alternative to a root canal is simply to take out the infection by removing the tooth.

Does this sound barbaric when you can “save” the tooth with root canal therapy? Probably at first. But what dentists are unaware of are the links between leaving an infected tooth in the body and other systemic illnesses (such as breast cancer). It’s called the focal infection theory. A better question would be, “Would you jeopardize your health to ‘save’ a tooth?”

If you have an infection or severe decay that has caused a deep cavity and a root canal is recommended, your only two options are extraction or root canal therapy. That’s why knowledge and prevention is of utmost importance: learn how to prevent decay and the spread of tooth decay and you’ll never have to deal with a root canal.

If a root canal is recommended to you, you should definitely get a second or third opinion to confirm the true need for the procedure. Unfortunately, too many dentists do root canals for the wrong reasons and you may have other, less “barbaric” solutions if you were misdiagnosed and don’t need to undergo the procedure.

If you already have a root canal and are wondering if there’s a link with that tooth and the rest of the body, view a tooth meridian chart (we have an interactive meridian chart here: Tooth Meridian Chart) or visit a natural or holistic dentist. A lot of times, extracting the problem tooth can help alleviate or eliminate problems (not always, so again, get a second or third opinion before taking action).

The short answer to the alternatives to a root canal question is… If you really, truly need a root canal, you have only two options: root canal therapy or extraction. However, there is always the chance that you have been misdiagnosed and have many, safer, more appealing options available to you.

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  1. Good Day.
    I am 20 years of age and had my first root canal done about 3 months ago.
    I never went back for the permanent filling as I did not have enough funds, so my tooth has become very weak and last week it chipped, I cant afford the crown so is there any alternative?
    My dentist also recommended I will need another 4 root canal treatments. Isn’t there perhaps another alternative? I am not keen on the extraction route as when I smile you tend to see all my teeth I have a wide smile so you can see every tooth. Secondly I don’t like the thought of a dead tooth in my mouth. Plus I am very scared of abscesses and other types of infections. I am so scared for my dental health.
    Isn’t it possible for my dentist to clean out the decayed tooth and place a filling in it. I know there might be pain but isn’t a filling a much better option.
    In addition I get a sudden terrible pain that runs straight through my jaw – could it be my teeth? Is my jawbone eating away?
    Please help me!
    Thank you in advanced.

    • Why do you need so many root canals? Is the decay really that bad? Did you get a second opinion? That’s a lot of root canals to be recommended unless you haven’t brushed your teeth in a few years. I would seek a second opinion and see what’s going on.

  2. I forgot if i would go for a partial denture, what type of material are the teeth made off, ?Or better, what is the best healthy option.

  3. 25 years ago i had a bridge put in , top left, last 4 teeth.
    now 25 years later, the bridge broke,well not the bridge but one of its tooth. The dentist and i decided to have a new bridge put in, . what happened after we took t the bridge out, two tooth need root canal treatments, severe decay!. I am not for it. So my options are very limited really, if i take the two teeth out, then it will be very difficult to have a bridge put in , Or do you think it can be done?. The other option is partial denture made from, plastic or ceramic. Or implants, but the dentist stated that it is close to the sinus flab ? What is the best option in a worse case scenario.

  4. Ms. Warren Says: September 4, 2012 at 9:23 am

    Dear Dr. Marvin,

    I actually just left a dentist on my second opinion for tooth #19…They both stated that I needed a root canal. However, After reading your website blogs, I am really leaning more towards getting an extraction. Can you tell me what risks I can face by removing this tooth or having a root canal? Thank you so much!

  5. Dear Dr Marvin,
    I’ve had 3 root canals at the age of 27 and multiple fillings including metal ones. Breast cancer also runs in my family. I would like to extract the root canal teeth but don’t know if it is safe. I also suffer from bruxism and one of the root canal teeth is painful at the moment. I live in Sydney and was wondering if you have any dentists that you would recommend or any other plan of action. Thank you!

  6. Hello Dr Marvin,

    I wish I found out about you a few years back. I had root canal treatment, now I would like it removed, and I have read it could be a bit of a health problem if removed. It can cause further health issues?

    Hope to year from you soon
    Sally.

  7. Hi Dr. Marvin.
    I’m looking for some advice and I understand that without seeing me, it’s limited, but I’m so uncertain as to what to do. I’m 26 years old and had a piece of my tooth break off. I had a sinus infection and the pain in my tooth was intense for a day or two but has totally subsided for two weeks now. I saw a dentist who said I need a root canal and a crown, but I just don’t know and of course the controversy and information overload is overwhelming. Thank you very much for any advice/information. I have been healthy and haven’t had dental work done since I was a kid, but always had my teeth cleaned yearly. In the last two years I was told I needed dental work, but finances of course play a role and also my husband and son had other more pressing dental work to be done and of course now, what I guess was a small cavity is now to the point that some of my tooth broke! I keep reading all these tests, and about prevention, but it’s not clear/understandable to me aside from getting this work done, what testing/prevention I should/shouldn’t be doing…Thank you very much…

    • I’m not sure I fully understand the question, but it may not matter. If a doctor recommended a root canal and you are uncomfortable with the diagnosis and treatment, I would recommend you see another doctor (or two) for a consultation.

      Sorry I can’t be of more help, but I really suggest you get the opinion of a qualified holistic or biological dentist.

  8. I would love some insight here regarding what to do with my 9 teeth which have had a root canal. Yes,I have had 9 root canals and currently have 13 crowns.

    Reading all of these articles lately has me a bit freaked out and lying awake in bed at night wondering if and when one of them is going to kill me.

    Is my only option to get them all taken out and how feasible is that since I can’t imagine that much of the tooth is left underneath those crowns……do I have any options?

    • Wow, I’m so sorry to hear that… unfortunately you don’t have a lot of options. You can have root canals retreated, but you’ll have the same problems later that you may or may not have now. You can extract the teeth. Or you can do nothing. We would have to have you in for an exam to give you the best possible advice, but I would recommend you seek out a good biological dentist and schedule an appointment to see what he or she recommends.

      Good luck!

  9. I am also curious about pulp capping as an option. What is your opinion?

  10. Hello Doc. PLEASE I NEED YOUR help. About 2 years ago I had a root canal and the dentist used a mercury filling. At the time I did not know that it was in fact mercury. He put a crown on it and I have not have any issues. However after finding out that there is in fact mercury in it is there any way that he can remove the crown an put a composite filling in it instead??? Is there anyway he can get all of the mercury out of the root canal???

    -TINA B

    • I would have that root canal looked at before I worried about the mercury in there. If there’s an infection, you may be better of just extracting the tooth (which would get rid of the mercury as well).

  11. Dr. Marvin why is any dentist allowed to put the second most substance known to man in peoples mouths? Also how would it take to put these criminals in jail?

    thanks,
    –Briccio

    • Back when amalgams were first used it wasn’t widely known that they were toxic (it still isn’t as widely known as it should be). The ADA actually held patents on amalgam fillings, and they also accredit the dental schools. Add it all up and you should have your answer. Unfortunately, politics typically rule over health.

  12. Please help! I have a bottom wisdom tooth that is lying sideways pushing into the root of the bottom molar next to it. The wisdom tooth has not erupted & is lying beneath my gums. An old childhood filling fell out of the bottom molar & now my dentist says a deep cavity exists but he may be able to save the tooth with a root canal & crown but the wisdom tooth need to be extracted. My oral surgeon advised against removing the wisdom tooth since it’s not causing me pain, but recommended pulling the bottom molar instead. I’m 37 and have pretty good teeth, I don’t want to lose any of my regular teeth. Please help Dr. Marvin; thanks!

  13. Hello Dr. Marvin, is there a source where I can search for natural, like-minded dentists in the U.S.?

    • Dan,

      There are but not all of us are like-minded and have similar positions on all of these subjects. If health is your main concern, go look on websites and read what they stand for. So far, there isn’t an organization out there that has set any standards for alternative dentists… at least not yet.

      If you like what I have to say, then you can surely make it a vacation to San Diego and get your dentistry done here.

      Dr. Marvin

  14. […] http://naturaldentistry.us/1557/the-alternatives-to-root-canals/ 1.358046 103.768916 from → Bio Dentistry ← Round 1 of 5- Cancer is Knocked Out– NED! (No evidence of disease) LikeBe the first to like this post. No comments yet […]

  15. Hi Dr. Marvin, it is a tough decision to make….my front tooth (No. 9) has been dead for quite a while. After researching root canals, I would prefer to just extract it, but being a front tooth makes it especially hard. I’ve decided against the Titanium implant, and may go with a resin bonded bridge. Most people I know think I’m crazy but I’d rather extract a tooth that risk my health.

    What is your position on socket grafting when extracting the tooth?

    • My question would be, why do you need to graft? If you have healthy bone and no auto-immune problems or other issues I’m not aware of, you shouldn’t need to do any grafting. Properly extracting the tooth will allow your bone to heal itself without the use of any artificial grafting material.

  16. I am curious why you do not mention pulp capping as an alternative to root canal? I have brought up many results in my googling about it and it seems to be a relatively harmless alternative. Do you have an opinion on it? Thank you so much for all this great info on your web site. 🙂

  17. Hi Dr Marvin,

    Found your website (what a great site btw) on a Google Search after reading about root canal dangers on Dr Mercola’s website and looking for answers, thought I might ask you.

    I have an old root canaled tooth that is obviously infected (bleeding at gumline, sometimes oozing foul smelling pus like substance, and gumline above it a lil swollen) causing me issues and seems to be affecting my system, i am getting sick often (colds) and for a healthy guy this is odd. The tooth/gum is infected, I’m pretty darn sure I need an extraction, but being a front upper tooth, i right now am not sure I afford the extraction and a good replacement tooth/bridge/crown, so vanity and budget are limiting me, so need to do as much as possible to control infection, keep mouth clean and bolsten immune system, anything else u might suggest?

    And re extraction, what do u suggest and what kind of replacement is best solution?

    Thanks

    Jared

    • Thanks for the compliments. The BEST solution is a bridge or ceramic implant, but you already know that. There are some good removable options now that may be appealing to you, including “Snap-It” which is a partial denture that snaps over the teeth… looks good and is more comfortable than a traditional denture. That might be a good place to start looking… but in my experience, patients always ultimately want a permanent solution after the realize the limiting factors of a removable appliance.

      Hope that helps. Good luck!

  18. Hi Dr.-

    I have an interesting conundrum with a tooth that is adjacent to a crown I received three years ago.

    One week ago, I flossed as usual. The next morning, my gum was sensitive. Over the next few days, I developed quite a bit of pain radiating over the side of my head the tooth is located on. The gum was extremely sensitive between the tooth and the crown, it was swollen and had a bad taste that occasionally came from between.

    Four days after this happened, I finally was able to get into the dentist. He shot cold and hot into my teeth, tapped on them (which was minimally painful in the not-crowned tooth and absent in the crowned tooth) and finally said that while he saw “a small infection” that his diagnosis was that since I did not have decay in the non-crowned tooth, that the circulation in my root was bad and the nerve was dying. He recommended a root canal and prescribed me Amoxicilin.

    I am at a loss and will likely seek a second opinion however, the last two days or so, the pain has subsided greatly and I’m just wondering if what simply happened was that I injured my gum and them got an infection it it?

    Any insight?

    Thank you,
    C

    • Without seeing you, it’s very difficult to say. How did the dentist determine you had an infection? Visually? Advanced Imaging? Something else? Did he check your bite? Where was the infection? It’s possible to cut your gums flossing, it got a little infected, and healed up just fine. Not typical, but possible. It’s also possible your bite was out of alignment, you were sensitive to something in your dental work, etc. Just so difficult to say without seeing it. If you’re still having problems, I would seek someone who uses Cone Beam scans to helps determine what’s going on beneath the gumline. I always recommend second opinions… knowledge is your best advocate when it comes to your health!

      Dr. Marvin

  19. Hi Dr. Marv,
    I also wanted to know if you’ve heard of oil pulling and if so what is your thoughts on it? It’s supposed to help gums and teeth by drawing out toxins.I was thinking of trying it to see if it would soothe the gums around that new crown. I’ve tried hydrogen peroxide already which helped a little. Warm salt water isn’t doing much.
    Thanks

    • Hi Steve, sorry for the delayed response. How’s your recovery coming along?

      Yes, I have heard of oil pulling. I’ve heard mixed results. I had one patient who swears by it, but it’s not something we typically “recommend” to our patients (that’s not to say it doesn’t work, just that we don’t get asked very often, to be honest). If you are still having problems around that crown, you have bigger issues that your dentist needs to address… it shouldn’t still be hurting unless there’s something wrong or something that I’m unaware of since I haven’t done an exam.

      Best of luck! Keep me posted.
      Dr. Marvin

  20. Well, I got the crown put in and feeling some discomfort so i have to go back to see if the bite needs to be adjusted. The first Lava Crown mishap and then this replacement so soon afterwards has made the area very sensitive.
    I have a strange taste in my mouth also, i hope it isn’t from the metal base but I am not a happy camper right now.

  21. Hi Dr. Marvin –

    I have a periapical abscess on tooth # 8 which had a root canal 38 years ago. The pain is slight and is mostly by the gumline and there is no swelling, pus, or bleeding. Naturally, the endodontist recommended a re-treat of the root canal. He said the only other option besides extraction, would be an apico, but that due to the spaces in the original root canal that are filled with bacteria, the abscess could return. I’m wondering why I didn’t have this problem for several decades and if perhaps an apico would fix it for another few decades.

    I have a long, sad dental history of teeth 6 – 9. I broke my two front teeth 38 years ago at the age of 8 when I fell on some metal-tipped stairs. Twenty years ago, one of those teeth(#9) required an apico, which was unsuccessful and I ended up with an extraction and a four tooth bridge because I was told that a three tooth bridge would not have a good aesthetic result. So I consented to have perfectly healthy tooth #7 (as well as tooth #10 which was necessary for the bridge) incorporated into a four tooth bridge. A year and a half ago, I was told that tooth #7 had corroded and I ended up with a titanium implant. I now have a temporary bridge over teeth 7 – 10. I do not yet have an abutment.

    After reading about the problem with root canals and metals in the mouth, I am wondering if it is possible to, and if I should, replace the titanium implant (tooth 9) with a ceramic one. Further, what alternatives do I have to a re-treat for tooth 8?

    • Hi Cindy,

      You’ve definitely gone through some work on those front teeth. Without seeing exactly what’s going on, I can’t really tell you in particular what your options are, but in general terms, your options are exactly what you stated. If #8 is infected, extraction is typically the best long term option. As for the titanium implant, removing and replacing an implant is a large stress on your body. If you don’t have systemic health problems that are aggravated by titanium and don’t have any allergies, etc., I probably would just leave it alone. There is no perfect material for replacing a tooth, and every option has it’s drawbacks.

      Good luck to you… If you ever want us to take a look at it, just give us a call.
      Dr. Marvin

  22. >If your bite is in alignment, you shouldn’t have any issues with any materials for your crown. That being said, if you’re concerned, you could try a product called Bruxir, which is zirconium oxide and is very, very strong. The largest problem with gold is that it can create a battery effect in your mouth, but if you are most compatible with gold, you should make the decision that’s best for you and your body. Just because a product is metal-free doesn’t mean it’s the best product for YOU.

    Good luck!
    Dr. Marvin.<

    Thank you for your reply. I decided to go with what the Doc recommended. I am going with an Elite II PFM Crown, which is Gold and a little Platinum. It is compatible with me according to the Clifford Reactivity test and since there is so little tooth left the doc said it's the best choice. I had never heard of Bruxzir before so i didn't mention it to him. I will keep it in mind for replacing my other crowns, all of which are on my large Molars. Lava is out since Bruxzir appears to be superior (thanks for the recommendation). If I like the Elite II, though, I may just stick with that. As for the battery effect i am concerned about that because I have a little es but according to my research it is mainly a problem with conflicting metals, such as putting a Gold Crown on top of a mercury filling, etc. I will definitely keep an eye out for symptoms. Hopefully it won't be an issue since I think this is the last crown this poor tooth can handle (had to remove a botched Lava Crown only 2 months prior).

  23. hurt my tooth duck hunting in oregon. quack…quack..quack… I was told I need a rootcanal on my front tooth. I won’t put metal because I’m afraid of allergic reaction. Now I’m in pain. Guess I need to take out my front tooth. I’m going to look like those ducks I was hunting. quack..quack..quack…
    frown…..

    • Sorry to hear about your tooth. If you’re trying to avoid metals, one option may be a ceramic implant. Made of zirconium oxide, they avoid the potential metal allergies as well as the unsightly graying around the gums often associated with titanium implants.

  24. Hi Dr. Marv,

    I see you recommend ceramic bridges and crowns. I have to get a crown replaced on my large lower molar. I was thinking of a Lava Crown but even 3m says they don’t really recommend ceramic for a large molar because it’s not as strong as metal. I know of a Porcelain fused to Gold crown that is 88% Gold, 9% Platinum, and a little silver. No Palladium or Nickel, etc at all. It is called Elite II. My Clifford Reactivity Test says it is good for my chemistry. Gold is supposed to be biocompatible so what would you recommend for a large molar? Thanks.

    • If your bite is in alignment, you shouldn’t have any issues with any materials for your crown. That being said, if you’re concerned, you could try a product called Bruxir, which is zirconium oxide and is very, very strong. The largest problem with gold is that it can create a battery effect in your mouth, but if you are most compatible with gold, you should make the decision that’s best for you and your body. Just because a product is metal-free doesn’t mean it’s the best product for YOU.

      Good luck!
      Dr. Marvin.

  25. Hi Dr. Marvin –

    Excellent site – so awesome to see the work you’re doing!

    I know you’re very busy, but I have a question for you. Everywhere I look, I see holistic practitioners recommending the extraction of the tooth that has had a root canal procedure. In my particular case, I broke my right front tooth in half when falling off a bike at age 7. I didn’t have much say in the matter of what was going to happen, so I got a root canal. When I was old enough (about 18), my dentist did another root canal on the same tooth and then capped it. When I was about 24, I began to have some pain inside the tooth and was told it was infected. Went through the whole root canal procedure AGAIN, then got a new crown on it by a dentist in Norman, OK. I’m now 27, and I’m beginning to feel some slight pain & thinking it may be getting infected again, but I’m not sure. Either way, it has me thinking.

    This has been, as you can see, a near life-long issue, and I really want it fixed and left alone for a while with a good trustworthy solution. With front teeth, I know my options are limited, because I need it to be cosmetically appealing (I occasionally model), & I would prefer something that wouldn’t dampen my immune system in any way.

    The success rate of implants concerns me, however, & I’ve heard it can also cause infection. Does this make it any better than a root canal, in that case? With front teeth, I know my options are limited, but if it’s a better option than the root canals. I’ve had no health issues that I’m aware of due to the root canal, but I’m not sure since I’ve had this issue for 20+ years.

    I would love your input, although I know nothing could really be said for certain without an office visit.

    Thanks so much!! So glad I stumbled upon your website!

    • Sounds like you pretty much already know the answer to your own question. With a front tooth, there is no perfect option. Ceramic implants are a great stride forward as they eliminate many of the problems associated with metals, including rejection (studies from Europe show a high success rate, but studies can always be up for interpretation) and cosmetics (the implant itself is white, so you don’t get the gray lines and the darkening of the crown). Of course, it’s a newer material, so new studies could bring to light new problems down the road.

      I wish I had a great answer, but essentially it comes down to your comfort level. You could leave the root canaled tooth alone or remove it and replace it. The best thing you can do is study the risks associated with root canals (try to watch the movie Rooted if you haven’t already. You can see it on our site at http://naturaldentistry.us/become-a-patient/welcome-new-patients/) and those associated with implants (especially ceramic or zirconium oxide implants). Once you feel you have a good knowledge base, it boils down to whatever you’re most comfortable with.

      Good luck!

  26. Hello Dr Marvin,

    Excellent website and great to see you’re commenting with measured but accurate advice.

    I’m seeing a dentist tomorrow due to some gum pain on one of my top front teeth/”toothache” and having searched up on root canal treatment only tonight discovered the work of Dr Price and natural dentistry as a ‘thing’.

    Basically just wondering if I am diagnosed as needing a root canal, because it’s my top front tooth that’s at stake, and understanding full removal is the alternative to root canal – what would one do to ‘replace’ it for aesthetic/practical purposes? Implants sound like surgery and a bridge would seem cumbersome/crap at my age (<30)..

    Also – for fillings and general equipment do you have some sort of general advice to finding a good dentist aware of these issues? I'm in Sydney, Australia- had I been in the US I would have already jumped a plane for a consult.

    Cheers,

    • Thanks for the complements. It’s appreciated. As for your front tooth, you’re spot on with the tooth replacement options: Implant (I would recommend a ceramic implant. You can get some information at http://IAOCI.com), bridge (not the best option for a front tooth for a variety of reasons), or a removable partial denture. In your case, an implant would probably be the most appealing, but that doesn’t mean that you would be a good candidate (you have to have good bone density, enough bone, etc.). If you went with a bridge, you would want to talk about a cantilever bridge (for reasons that are too expansive to discuss in the comments section, but I will try to write about at a later date), but again, it may not be the best option for you.

      Wish I had better news. When you’re talking a front tooth, it’s a tough proposition. No matter what you choose, you also have to make sure your lab technician really knows what he/she is doing so you end up with a crown or new tooth that looks natural and isn’t obviously a “fake tooth.”

      Good luck to you… wish I could offer more help.
      Dr. Marvin

  27. Dr. Marvin,

    A large portion of my tooth (#14) was broken. It was suggested that I have a root canal or as a last option an extraction, but the tooth was filled to give me time to make the decision of whether I wanted to have a root canal, extraction, or to see if the sensitivity would subside. Prior to having the filling there was no sensitivity, but the tooth had been broken for several years. With the filling it is sensitive when I bite, so I have been avoiding eating on that side of my mouth. Are there any options I should consider before have the tooth extracted?

    • Unfortunately, without seeing the tooth, I can’t really say what your options are. In our office, we would use advanced diagnostics to see what’s going on and propose the most conservative option possible that will fix the root problem.

  28. Dr. Marvin,

    Oh…forgot….you prefer the conservative approach to a bridge – preserve tooth structure and thus inlay/onlay bridges if possible and go further only if necessary. Do the inlay/onlay bridges hold up pretty well? Can most things be chewed on them that are chewed on a full (non inlay bridge)? Do you think they have a similar life span? I haven’t totally made up my mind to have inlay/onlay but am heavily leaning that way. Function is a huge consideration for me as I would like to eat what I normally eat.

    Thanks!!!!!! : – )

    • Kathy, the strength should not be compromised at all by doing an inlay or onlay bridge as long as the prep on the surrounding teeth is done properly. There are several ways to do the bridges, but an experienced dentist shouldn’t have any problem designing a strong inlay bridge. Of course, if you regularly chew on rocks, you might have a problem with any type of bridge (or your natural teeth, for that matter)!

  29. Dr. Marvin,

    I will send pictures of my new bridge when I get it. I am going to do it but have to hold off a bit first so it might be a couple months. : – ).

  30. Dr. Marvin,

    Just wondering how long a standard vs. onlay/inlay bridge – all ceramic, would likely last.

    Thanks!!!!

    • Thanks for the popular question.

      It depends on too many factors.

      1. Age of patient
      2. Condition of teeth
      3. Type of ceramic
      4. Quality of bonding/cementation
      5. Choice of cement
      6. Shape of preparation
      7. Bite
      8. Location of bridge
      9. Other teeth
      10. Color
      11. patient expectations

      I’m sure there are more but these are the main ones.

      For me, I like doing more conservative bridges to conserve tooth structure. If the bridge fails, I can always take off more tooth and do a new one. Conventional bridges fail due to cavities that are not found until it is too late. When this happens, the teeth fail and extractions are likely. For me, I’d rather have a restoration failure than a tooth failure.

      Most dentists care more about what material will last and what is easier to do. That’s why conventional crowns and bridges are the most popular restorative procedures.

      Most of my patients agree with my conservative approach and choose biocompatible bonded inlays/onlays/bridges.

  31. Charles Says: July 8, 2010 at 10:13 pm

    Dr Marvin,

    My dentist recently recommended a root canal on my tooth #7. The tooth does look dark on the inside and Xray of the tooth apparently confirms the need. The inside looks dark on the Xray too.

    What I don’t get is this: inspection of the tooth reveals NO cracks or breaks. I do not recall injuring the tooth. How could I have developed the infection?

    Also, I have good feeling in the tooth (if I tap on it) and no pain. I am not sensitive to hot or cold on #7 any moreso than my other teeth. Is this necessarily going to get worse as my dentist suggests? Have I caught it in time for an alternative treatement?

    Is there a systemic antibiotic like penicillin that can treat such infections?

    • If the tooth looks dark compared to its neighboring teeth, then the nerve and blood vessels inside the tooth are not working properly. Is it “dead”? It probably is or approaching death. There’s no clear definition of a “dead tooth.” Many consider a dead tooth one that doesn’t have a normal functioning nerve or one that doesn’t have a nerve altogether. (if it has a root canal for instance).

      On an xray, the nerve or root canal space is always dark.

      There are many ways a tooth can die. You don’t need to have visual cracks/breaks or obvious signs of fractures/decay or a traumatic event. Some things are unexplainable. A combination of things could have caused the tooth to die.

      Tapping on the tooth is just one test. An asymptomatic tooth is neither a sign that the tooth is a live or dead. Neither is hot or cold sensitivity. These are just tests to help determine a diagnosis and hopefully a treatment plan.

      Dentistry is far from an exact science…and probably never will be. Dentists are taught to use certain tests that they feel are useful to determine a plan of action. That’s why it is called the “practice” of dentistry!

      I understand your concern and confusion. Most likely the tooth will get worse with time as your dentist suggests. Having not seen your case personally, it is up to you and your dental provider to come up with a solution. It can be a root canal, an extraction, or delaying treatment. It is ultimately your decision. I can’t give you your options without seeing you first.

      I don’t know if antibiotics would work.

      I know my answer is vague but that’s why we do exams. If deciding what to do was as easy as searching the internet, then there wouldn’t be many dentists.

      Good luck.

  32. Anjali Anne Says: July 7, 2010 at 3:35 am

    I need urgent advice. I am in India in terrible pain because of mistakes that unqualified dentists seem to be making plus distance to travel to better ones who are always too busy to see me.
    I refused root canal for some time but every dentist I went to refused to extract. I have a lot of intestinal infection due to living in India.
    Finally I let one try root canal. After 4 sittings and 2 weeks it was still infected and antibiotics did not help.
    I told them to extract and when they did I nearly went unconscious. Could not see or stand for some time and have been in extreme pain for 2 months unable to even go out to see anyone.
    They have told me now to see a neurologist.
    I can hardly travel alone in chaotic India. I have to travel 3 hours to get to doctors and dentists. I need to contact someone qualified to tell me what to do. It is unbearable.
    Thank you

    • You’re right, I think you need medical advice. I would suggest you go to the hospital or go see a doctor that can help find out what is going on. I wish I could help, but as a dentist (who’s not in India), I’m afraid there’s not much I can do other than suggest you seek medical help as soon as possible.

      I wish you the best of luck. Sorry there isn’t more I can do.
      Dr. Marvin

  33. Dear Dr. Marvin,

    My traditional dentist just gave my #30 tooth a preliminary diagnosis of internal resorption. I have an appointment to go see an Endodontist to confirm diagnosis and hear about potential treatment plans, which my primary dentist thought best case scenario would be a root canal. I’ve been reading and reading and reading about the warnings of root canals, but find little commentary in the holistic dentistry world regarding internal resorption. Do you have any experience with this diagnosis or suggestions on alternatives to a root canal/extraction?

    Thanks for your help!
    Signed,
    Lost and Desperate to make the right, healthy choice for my teeth

    • It is my understanding that internal resorption is an unexplainable inflammatory response. The dental school treatment is to do the root canal to save the tooth.

      Unfortunately, I don’t have a proven natural/holistic solution for internal resorption. If you come across one, please do share it so we can do further research. The best suggestion I could make right now would be to consider extraction and a fixed inlay bridge or ceramic implant.

  34. Dr. Marvin,

    I asked my dentist about the bridge with the inlay, they can do it – all ceramic, and this is likely the way I am going to go. You asked about my other two teeth. The very last molar already has a crown and the tooth on the other side is totally health. I would do full crown on the one and inlay on the other one. How long do you think these things last?

    By the way, in some ways, just a few days ago, I was actually leaning back towards the zirconia implant but I just recently and unexpectedly (this past weekend) had an issue related to my tendency to easily get infections and this has pushed me back to the other side of the fence I was sitting on. I have an actual diagnosed immune system deficiency and I know that makes it more likely for me to have a failure with an implant than someone else. But, part of me is kind of bummed about not trying it in a way because I have read in one study that zirconia seems to have less of an issue with infection than even natural teeth, while titanium had more. But, you are right that there is not a lot of data or research on the zirconia. And, given my situation, it seems even if I am trying to be careful, I am taking a risk that I could get an infection, and sometimes getting these infections has been very, very serious. I really appreciate your input.

    Just out of curiosity, I see you were trained in placing zirconia implants but are holding off on using them. Are you waiting for more years of data from placed implants? I know there other holistic dentists that have concerns about implants and are not doing them or suggesting them – waiting to see what happens, etc. Why do you think most holistic dentists are on board and less concerned?

    Thanks again for your input. It really helped and I feel really comfortable with the inlay bridge because I can leave more of that healthy tooth and didn’t know that was an option.

    Thanks!!!!!

    • I’m glad I could help… let us know how the bridge turns out!

      As for your question about ceramic implants, we will be placing them very soon. The reason we have held off thus far is because they didn’t have FDA approval to be placed in the United States. That was important to me because we want to adhere to regulations and also to ensure we don’t use our patients as test cases in our practice. Every dentist is different and must take into account his or her own beliefs, skills, and the facts and research available to make the best decision for the practice and the patients. While we will place ceramic implants, we are very picky about who we will place them in (all the right conditions — bone, patient health, etc. — must be in place to ensure a successful procedure. If it’s not the best choice for the patient, we will recommend a different treatment.

      Thanks Kathy. Good luck with that bridge! Send us pictures of the unit both in and out of your mouth if you can… would love to see your new tooth!
      Dr. Marvin

  35. Addendum

    Oh….and what about bone loss without an implant? What are your thoughts on that?

    Thanks!!!!

  36. Dr. Marvin,

    Thank you for your input. It is very helpful. This is indeed a difficult decision for me. The dentist who would do the zirconia implant has at least one year’s worth of experience and is well respected in holistic circles and otherwise. The dentist does want me to do a 3D Cone Beam Scan and it has been ordered. I just haven’t gone and gotten it yet because if I am not going to proceed with implant, I don’t want to pay for the scan. Originally I was going to do the scan to see how decent a candidate I would be structurally for the implant on tooth #14 but recently just felt more concerned about doing the procedure at all, unless getting the scan could make it clear whether the job would be straight-forward or more complicated and thus worth it.

    I know for a fact I would not do a titanium implant due to the micro gap issue between the two pieces of the implant itself (where bacteria can thrive – with my immune system deficiency) and the metal issues. I have a local holistic dentist who sees no issues with titanium implants and the holistic dentist I would have to travel to who will only do zirconia. My biggest concerns are chance of infection either now or later after the implant seemed to be okay, and the longetivity of the implant.

    My current local dentist has seen nothing but positives with implants and doesn’t seem to understand why I hesitate, so am I being too paranoid? It sounds like from what you have said – not necessarily. It really seems like a very invasive procedure to me – putting a screw into your jaw. Yet, there are not always great options when teeth are missing. Currently, I am living with two root canaled teeth that I had electro dermal tested and they are not bothering me per that, and I am using partial at #14 and getting by, but it’s not my favorite thing. #14 was a root canaled tooth that I had removed because it was making me very, very ill.

    Even titanium which is considered the gold standard, there are enough failures that make it quite concerning to me. I am not sure why implants seem to be the method that is becoming the accepted choice. Does the 35 years data claimed for titanium really make implants look that good? – lasting, safe, etc.?

    • Your welcome Kathy. I think you’ve answered a lot of your own questions already. It sounds as if you’re trying to convince yourself that an implant would be okay. But I still go back to my original question: why not a bridge? Do you have #15 and #13? Are they healthy enough to support a bridge?

      Implants are surgical — they are more invasive than most dental procedures. That’s not to say they aren’t a valid option. For many patients, an implant is a good alternative to a bridge or partial. In your case, given your stated health concerns, a bridge might be the “safer” way to go. And I say this as a dentist who can place FDA approved zirconia implants. I’m not “anti-implants” by any stretch. But every patient has a different set of circumstances that should go into the decision making process. In the end, you need to make a decision that is best for you and your situation. Will the benefits of an implant far outweigh any risks? If so, go for it. If not, there are other options available that may be better for you.

      Good luck in making your decision! Let us know what you ultimately decide.
      Dr. Marvin

  37. Dr. Marvin,

    I saw your answer re. implants. You said the failure rate was still 1 in 10. A lot of people quote 95% or 98% success rate. I am thinking about getting an implant for tooth #14, which is missing – got it out 10 months ago. I would only go with zirconia and not titanium because I am under the impression that zirconia implants are less prone to infection. I have an immune system deficiency that puts me more at risk for infections, yet I have had a couple successful surgeries with no problems, so I am only slightly worried about that aspect. Do you think that zirconia will have the same infection issues (peri-implantis) issues as titanium, and my husband who is a biomedical engineer said that a 1 in 10 failure rate would not be acceptable at his company. Is it really about that level? I believe some practitioners have better rates than that. What is your thought? I don’t want to put my health at risk over one tooth at this point.

    • The success rate is all over the board, depending on how you define success (does success mean they last at least 6 months? At least a year? At least 10 years?) and even then, there are lots of different numbers. The bottom line is this: Your husband is right — the success rate is not high enough.

      With your health concerns, why don’t you consider a bridge? Doing a metal-free, conservative inlay or onlay bridge would conserve surrounding tooth structure and give you a long term solution without having to worry about the implant issues.

      As for the ceramic implants. As far as I know, there is only one company that has gained FDA approval in the United States (there could be more, just one I’m aware of) for their ceramic implants. Have you spoken with any dentists who place ceramic implants? If so, are they using an FDA approved system? The data you find on success rates will all be based on international studies, where ceramic implants have been used for a longer period. Even then, sample sizes for data will be very small. My guess is that over time, oseointegration will be slightly higher than metal implants. I have no idea on infection rates right now.

      Remember that when you read information about success rates printed by dentists who place implants, they are not going to say “my success rate is terrible!” Yes, some dentists are better at placing implants than others. Some use guided surgery (in which a CAD/CAM system designs a guide for the dentist to use, which makes placement far more precise than doing it free-hand). Some dentists are excellent at placing implants, some are not. Some dentists have a very healthy group of patients, which may increase success rate. Some dentists only place implants in ideal situations, while others are willing to push the limits of implant placement. Remember, this is a surgical procedure in which a screw is inserted into your jaw and a tooth is placed on top. Almost any dentist is allowed to place implants. Most have undergone additional schooling. But how much experience does he/she have? Can you talk to past patients about their experience (including patients who had a failed implant?). Also, much of it depends on your bone structure. Will the dentist have to do bone grafts (this typically decreases success rate)? Where are the sinuses located now that the tooth has been pulled (have you had a 3D Cone Beam Scan to measure bone density and location of the sinuses)? How long will the screw be? There are so many factors in the success rate, and even then, there are no guarantees.

      There are tons of variables in any procedure. The best advice I can offer is to do as much research as you can, ask difficult questions (and be prepared for difficult answers), and weigh the pros and cons for your individual situation. Are the risks associated in your situation worth it when you can do a very conservative bridge, which has a much higher “success” rate?

  38. p.s. On another note, I’ve also come across enough professional websites that state that abfractions don’t need treatment(I have about 11 teeth that have abfraction lesions, leading to receeding gumline and root sensitivity). What is your take on that? The concern that I have with no treatment is that it’s extremely easy for food particles to get caught at the notched base of the tooth and is very hard to keep clean, thus making it much more susceptible to tooth decay. Also, I would be a little concerned about no treatment possibly leading to deeper abfractions (deeper receeding gumline). The positive with not getting them treated is that I won’t be putting my body through toxic dental materials.

    Lisa

    • The abfractions would be on a case-by-case basis. There’s a chance nothing would need to be done as long as you can keep the area clean. It would just depend on your situation. As for dental materials, we use a variety. We typically don’t use 3M because we have found many of their products are not biocompatible (based on our EAV testing). 3M is just like any other composite. The key is to find the material that you are most biocompatible with (which is why it’s important to find a doctor that understands this concept rather than a doctor that uses what’s most convenient to him or her). Dental materials aren’t one-size fits all… there are hundreds of options available, and many are very good in certain circumstances and for certain people, while others work better for other things. As for your abfractions, the bonding agents could seal the tubules, which causes the sensitivity, but it won’t fix the problem.

  39. Dr. Marvin,

    Thanks for your input. Since I don’t have the time to conduct a biocompatibility testing of dental materials right now (due to the upcoming move), I need to go with whatever filling or bonding material that is generally considered less toxic than others to fill my abfractions for this time around. I will most likely be making an appointment for sometime this week to get it done.

    1. Do you recommend a particular brand for fillings that don’t contain the harmful substances you mentioned?

    2. My dentist uses the 3M brand for dental material. Is that something I should avoid or is it a safer brand?

    3. My biggest question: my hygenist said that all bonding material may be metal-free, and that may be an option for my abfraction (it will not be filled, but at least the bonding will protect the tooth and food won’t get caught as easily as it would without it). Are bonding materials generally metal-free? Do you know if the 3M bonding material is pretty safe? If so, I would like to pursue this option for this time around.

    Thank you!

    Lisa

  40. […] of them, just check out under The Root Canal Controversy section of our website (we talk about Alternatives to Root Canals, Infections from Root Canals, Sargenti Paste, Ozone Therapy for Root Canals, and much more.), I […]

  41. David Spence Says: May 6, 2010 at 2:46 pm

    I don’t want my enamel to be scratched and cavities to take advantage of that. This is why I am looking for a dentist who does cleaning with the wooden, not the new metal ‘torture instruments’. I see this bit of knowledge as an indicator of the actual competence of any potential dentist. Dr. Nara has written alot on his blogs.

  42. Dr. Marvin,
    Thanks for the ozone article.
    What is your opinion about zirconia dental implants? Would a bridge be preferable? I have 2 anchoring teeth on both sides but would need to have 2 good teeth ground down to make the bridge work.

    • Steve, Zirconia is a step in the right direction, but it’s still more invasive than a bridge (despite the anchoring teeth needing work to hold the bridge). That being said, I understand where you’re coming from. Dental implants have made huge strides in recent years with the advancement of surgical guides, faster procedures, better materials, and better training for the dentists. There are still a couple of concerns to be aware of: 1) Implants still have a 1 in 10 failure rate. 2) An implant breaks the infection barrier provided by the gums, allowing for the possibility of infections, etc.

      With any procedure, you always have to weigh the risks and benefits. If you’re looking for least invasive, you could always give a metal-free, biocompatible partial denture a try (these aren’t grandma’s dentures anymore). Finances may also play a part (implants will typically be the most expensive option, with partials costing the least) and longevity.

      We don’t place dental implants at the moment, but are always exploring the new technologies and options available in order to provide the best, safest alternatives for our patients.

      Good luck to you!
      Dr. Marvin.

  43. Dr. Marvin

    Thank you so much for taking your time to thoroughly answer my whole list of questions! It is so helpful to be able to get timely professional advice from a holistic doctor.

    This is an update: I had a chance to see an endodontist to get a definite diagnosis on tooth #31, and it turns out that I won’t be needing a root canal afterall at this time (the original x-ray was misleading. It was confirmed when he took another x-ray from a different angle). The answers you have provided are definitely helpful though because I was told that I will most likely need to get a root canal done on that tooth sometime in the future.

    Just one thing to clarify-for question #3, you mentioned the importance of completely removing the periodontal ligament when extracting a tooth. What is that and why is it important?

    Since I don’t need to address the root canal issue at this time, I’ve been looking into getting the silver filling in that tooth safely removed, and came to the conclusion that this is not the right time to do it due to time constraints. I’ve read about the importance of having a detox protocol before, during and after the removal to ensure safety.
    Now, I have some questions pertaining to safe amalgam removal and dental fillings (so much to learn!).

    1. Do you have a set of detox protocols you use for amalgam removal (if so, what)or do you work closely with a holistic doctor for that?

    2. The tooth that will most likely be needing a root canal in the future and the tooth that has amalgam is the same tooth (#31). If in the future, I am told I definitely need a root canal and decide to extract, can the dentist remove the tooth without disturbing the amalgam filling, or do they have to drill through the amalgam to remove the tooth?

    3. If the dentist can remove the tooth without having to disturb the amalgam filling, I am thinking that it’s wiser and simpler to wait till I am told I definitely need a root canal and extract that tooth then and take care of both issues at once. That way, I don’t have to go through the risky procedure of removing the amalgam (even with safe removal, I know there’s always a risk) and maybe can keep the cost down (??). However, if the amalgam needs to be drilled in order for the tooth to be removed, that means that I would have to go through 2 big steps (first, safely remove the amalgam and then extract the tooth-I hope that’s not the case). I will be interested in hearing your advice on that.

    4. If the tooth can be extracted without disturbing the amalgam, is extracting the tooth and properly disinfecting it enough to ensure all amalgam is removed or are there some special steps that need to be taken to ensure that all amalgam has been removed from the mouth?

    5. Since I know that this is not the right time to safely remove my amalgam, is there anything else that may be there as an option meanwhile to minimize the harmful effects of the amalgam until I get to either safely remove it or extract the tooth (for example, can a “cover”/crown be put on the tooth to minimize the mercury vapor and particles from getting released into the mouth? I’ve seen a special mouthwash that’s supposed to capture the bad stuff)?

    6. I do need to get the bonding done for three teeth now (due to receeding gums from brushing my teeth to aggressively growing up. I’m seeing a metal-free dentist in a couple of days for it). I am finding out that even the non-metal, non-amalgam white fillings have their own set of problems when it comes to health safety (for example, the presence of Bis-GMA or other chemicals). My understanding is that eventhough non-metal white fillings are not perfect, they are significantly safer than silver fillings, right (because they don’t contain mercury)?

    7. What are some of the dental bonding materials that you generally recommend (doing a biocompatibility testing of dental fillings would I’m sure be the best, but with the time constraint, I just probably have to choose the material that’s most biocompatible in general)? I’ve read about DiamondLite as being a highly biocompatible product for many people. What are your thoughts on this?

    Sorry for a long list of questions again. Your website is very informative and inspirational (not to mention your practical advice), and I will be recommending it to my friend who is very health-oriented (also to my husband). Thanks again for your time!

    • Lisa, it sounds like you’ve talked your self trough most of your answers! Once an amalgam filling is removed, the mercury itself is removed from the mouth. It is possible that trace amounts of vapor could remain in the mouth or in the tooth itself but most of that gets removed during the cleaning and irrigating of the tooth after the filling is removed. There are various detox products and chelation therapies that may be able to help remove the mercury from your body depending on your mercury levels. You may want to consider being tested for mercury levels (we have a kit here that you can order, if you’re like). That will tell you if you have elevated levels of mercury or other toxins in your body. As for an extraction with mercury, it all depends on the situation and the dentist performing the extraction.

      As for the fillings, you are correct. There are no perfect fillings out there. Some are better than others. Some contain BPA, some have mercury, some have Bis-GMA, some have none of the above. The bottom line is that you need to find the material that is best suited for you and least harmful to you… and prevent problems in the first place. Speaking of which, that tooth may never need a root canal or extraction if you take proper care of it. Remove the mercury filling, remove the decay in the tooth, replace it with a more biocompatible filling (and have a good technical dentist place the filling so it will last and prevent further decay), and then practice proper prevention and at-home hygiene in order to prevent further problems.

      Prevention is always the best method. Stay healthy and take care of your teeth with the proper tools and techniques!
      Dr. Marvin

  44. Hi Dr. Marvin,
    Lisa has some very good questions.
    On topic, have you ever heard of ozone for treating infections rather than a root canal? There is a dentist in la Jolla who uses it and claims it is very effective.
    Also, do you always advise against getting root canals?
    Thank you

    • Steve, I have definitely heard about ozone treatment. In fact, it’s been a popular question in our practice recently. Rather than provide a long reply here, I’ve added a new blog post to address the issue of ozone therapy and hopefully answer your questions. Here it is: Ozone Therapy in Dentistry. Hope that helps!

      Dr. Marvin

  45. Dr. Marvin,

    Thank you for your prompt response and clarifying things for me. Now I have further questions responding to your comments.

    1. Just to make sure, please confirm that extraction (removing the tooth) is the only safe alternative to root canals.

    2. I know diagnosis without the actual x-ray and exam is not possible, but just to get your general feeling-does a shadow at the root of a tooth on the x-ray usually always indicate tooth decay that requires a root canal (what typical dentists recommend) or extraction (what you recommend)?

    3. Now, the most pressing question – Is safe extraction of a tooth a simple procedure? i.e. Is it safe to have my tooth extracted by any general dentist (not holistic/metal-free)or does extraction frequently cause infections (or other procedures involved in extraction & replacement by a man-made tooth that are not safe)that necessitates a specific protocol to ensure that the extraction site is 100% disinfected, etc. (just like there is a specific protocol for safe removal of silver fillings to ensure that you are protected from mercury exposure)?

    4. The tooth that my dentist recommended a root canal was tooth #31 (I think-it’s the furthest molur of the bottom right side of the mouth. I have had all my wisdom teeth extracted years ago). Would your top choice be the metal-free bridge? If so, why as supposed to the other options you mentioned (metal-free partial denture or ceramic dental implants). My understanding is that if you leave the spot vacant, there could be negative side effects (other teeth shifting, imbalanced bite, affecting chewing ability, bone, etc). Is that right?

    5. What is a metal-free bridge made of ?

    6. What does the procedure of extracting a tooth and replacing it with a man-made tooth (such as a bridge) involve? How long does it take (how many visits)? Do you have to wait for the extraction site to heal completely to put a man-made tooth or is the man-made tooth placed on the extraction site right away (is it like extraction of wisdom teeth in which the patient needs to disinfect the site daily and it takes a while for the site to heal, making it very difficult to eat for at least a week?)? Does the patient get local anesthesia or do you have to go through full anesthesia like with the case of wisdom teeth extraction?

    7. I found a general dentist in my area who practices metal-free dentistry, but also performs root canals. Since he’s the only holistic option in my area (Oklahoma city, OK/Lawton, OK/Wichita Falls, TX), and I need to take care of this quickly before the upcoming move, I am looking into it, but not completely comfortable because he still performs root canals (I am planning on asking him about his views on extraction and if he would be willing to perform that for me). Do you happen to know of a holistic dentist with a similar philosophy as yourself who practices in my area (I doubt it, but just in case)? What dental organizations are you a part of (since it is a good resource for finding other dentists with similar principles)?

    Thanks for taking your time to educate patients!

    Lisa

    • Lisa, I re-posted your questions, followed by my answers, below. Please let me know if you have other questions.

      1. Just to make sure, please confirm that extraction (removing the tooth) is the only safe alternative to root canals.

      Answer: Extraction is the safest alternative to a root canal, although complications can always arise from any procedure.

      2. I know diagnosis without the actual x-ray and exam is not possible, but just to get your general feeling-does a shadow at the root of a tooth on the x-ray usually always indicate tooth decay that requires a root canal (what typical dentists recommend) or extraction (what you recommend)?

      Answer: The shadow could be any number of things, including decay, infection, a lesion… x-rays images are based on bone density. The shadow means that the x-ray machine believes that area is less dense. I would be surprised to see decay isolated at the end of a root without being present anywhere else in the tooth. I would recommend more detailed images depending on what I saw in the x-ray and exam (a 3D Cone Beam Scan, for instance) to confirm or deny any diagnosis.

      3. Now, the most pressing question – Is safe extraction of a tooth a simple procedure? i.e. Is it safe to have my tooth extracted by any general dentist (not holistic/metal-free)or does extraction frequently cause infections (or other procedures involved in extraction & replacement by a man-made tooth that are not safe)that necessitates a specific protocol to ensure that the extraction site is 100% disinfected, etc. (just like there is a specific protocol for safe removal of silver fillings to ensure that you are protected from mercury exposure)?

      Answer: It is safe and simple if done properly and if the conditions in the mouth are perfect. No two extractions are alike, so seeing a dentist who is very experienced at extractions would be good. Seeing a surgeon might be better. Just make sure whoever you choose plans to remove the infection (if present) after the extraction (it should be manually removed), completely remove the periodontal ligament (not all dentists take the time to do this step), and irrigate the extraction site for several minutes to ensure the area is clean.

      4. The tooth that my dentist recommended a root canal was tooth #31 (I think-it’s the furthest molur of the bottom right side of the mouth. I have had all my wisdom teeth extracted years ago). Would your top choice be the metal-free bridge? If so, why as supposed to the other options you mentioned (metal-free partial denture or ceramic dental implants). My understanding is that if you leave the spot vacant, there could be negative side effects (other teeth shifting, imbalanced bite, affecting chewing ability, bone, etc). Is that right?

      Answer: I would not recommend a bridge if it’s tooth 31 and your last tooth. The bridge would have a difficult time withstanding the biting pressure in that location since it would not have an anchor tooth on either side. I would most likely recommend no replacement and a bite guard to wear at night that would act as a retainer to keep your teeth from shifting. There are many theories floating around about the “dangers” of not replacing a missing tooth. One thing that you have to keep in mind is that bone deteriorates over time so if you plan on doing a titanium implant (which we do not recommend), then it would be good to keep as much bone as possible.

      5. What is a metal-free bridge made of ?

      Answer: It depends on the situation. Some bridges are more biocompatible than others. Some are more esthetic than others. Some are more durable than others. Some require less tooth removed. We have made bridges out of plastic and ceramic materials. One commonly used material is zirconia, of which there are many different brands. Zirconia is a white transition metal.

      6. What does the procedure of extracting a tooth and replacing it with a man-made tooth (such as a bridge) involve? How long does it take (how many visits)? Do you have to wait for the extraction site to heal completely to put a man-made tooth or is the man-made tooth placed on the extraction site right away (is it like extraction of wisdom teeth in which the patient needs to disinfect the site daily and it takes a while for the site to heal, making it very difficult to eat for at least a week?)? Does the patient get local anesthesia or do you have to go through full anesthesia like with the case of wisdom teeth extraction?

      Answer: You have to wait for the extraction site to heal. This usually takes 6-12 weeks depending on the extraction and location and the healing. It typically takes 2-3 visits to have the bridges cemented on permanently. Still others — if the bridge doesn’t fit properly, wasn’t a high quality bridge, or was placed incorrectly — can take many more visits. We would not put you under full anesthesia (just local), but many dentists can provide an option of full anesthesia with the use of a dental anesthesiologist.

      7. I found a general dentist in my area who practices metal-free dentistry, but also performs root canals. Since he’s the only holistic option in my area (Oklahoma city, OK/Lawton, OK/Wichita Falls, TX), and I need to take care of this quickly before the upcoming move, I am looking into it, but not completely comfortable because he still performs root canals (I am planning on asking him about his views on extraction and if he would be willing to perform that for me). Do you happen to know of a holistic dentist with a similar philosophy as yourself who practices in my area (I doubt it, but just in case)? What dental organizations are you a part of (since it is a good resource for finding other dentists with similar principles)?

      Answer: I do not know of anyone in your particular area, sorry. I’m a a member of several organizations, but they typically aren’t the best way to find the right dentist for you in your area. First off, you should never choose a dentist based on proximity to your home, despite what dental listing services may say (you wouldn’t choose a surgeon based on location to your home or business, right? Choose the best doctor for you and your experience will be much better and will far outweigh the extra travel time). That being said, you can start by checking for dentists at IAOMT.org (http://iaomt.org/patients/search.aspx). Just remember that anyone can join most organizations, so membership alone doesn’t dictate that the doctor is a good choice. Arm yourself with the right questions and choose the dentist that best answers your questions to your satisfaction and that you are comfortable with. Choosing a dentist is a big choice that shouldn’t be made based on a good Yellow Pages ad or slick website… you’re talking about your health. Make sure that you ask questions and choose the dentist that’s right for you based on your knowledge of that dentist.

      Many of our patients come from out of town and we are well versed in helping with travel arrangements, etc. If you do decide to come out and see us, please give us a call and we can help you make your arrangements.

      Best of luck to you Lisa. Thanks for the thorough, well-thought questions.
      Dr. Marvin

  46. P.P.S. By the way, I’m moving in a month and a half to go overseas, so a resolution on this root canal issue is rather urgent so that I can get it taken care of before the move.

  47. Dr. Marvin,
    Thank you for work on promoting healthy dentistry.
    My main question is this – if my root canal diagnosis is right and extraction of the tooth is the only healthy option, what am I supposed to do after the tooth is extracted (leave it like that without a tooth or place some kind of a synthetic tooth in place of it-if so, what would be the safe option?)? I listened to your podcast (very interesting)and you mentioned dental implants, partial dentures and bridges as options, but also stated that all of them have metal in it, so those don’t sound like good options either. Are you saying that those options are the better of two evils (compared to the metal toxicity and infection resulting from a root canal) or are there actually other safe/safer options out there that doesn’t use metal at all?

    FYI, this is my recent dental background:
    I was told by my dentist that I most likely need a root canal for the lower right molar (#31 I think). I have a silver filling in that tooth and it started becoming sensitive when brushing my teeth (I also have problems with root exposure with many of my teeth due to brushing too hard growing up and have bondings for those, and this tooth may have a bonding too). I have no other visible symptoms and it doesn’ bother me. But when my dentist took a x-ray for the routine exam, she saw a shadow/darkening at the base of the tooth that she said necessitates a root canal (does the shadow mean it’s infected or decaying? Does that necessitate a root canal?). Since she doesn’t do root canals, she gave me referral options to an endodontist and a general destist that does root canal therapy.
    Now that I am more aware of the harmful effects of root canals, my feeling is that it’s best to extract the tooth (that is if the diagonosis was right). I used to live in San Diego, but am no longer there (been moving all over the place because husband is active duty army). If I were in San Diego or the surrounding area, I would make an appointment in a heart beat, but since I’m not, this is the next best alternative.
    I’d really appreciate your professional input on this.

    p.s. I’m thinking that the extraction could do good because I can get rid of the silver filling at the same time.

    • Lisa, you said “My main question is this – if my root canal diagnosis is right and extraction of the tooth is the only healthy option, what am I supposed to do after the tooth is extracted (leave it like that without a tooth or place some kind of a synthetic tooth in place of it-if so, what would be the safe option?)?”

      If you have a tooth extracted, you have many alternatives that are metal-free. What I was saying in the podcast was that most replacement options contain metal, but that they do offer metal-free options instead. Depending on the location of the tooth, you could leave the spot vacant, you could replace it with a biocompatible, metal-free bridge, or you could use a biocompatible, metal-free partial denture. Another option, although new to the market in the United States, is a ceramic dental implant.

      Depending on the location of the tooth, I would lean toward the bridge option. I know you aren’t in San Diego, but if you’d like to have us take a look and create the bridge for you, please give our office a call. We have many out-of-town patients and can help you make arrangements to come see us and get all the work done before you head over seas.

      Best of luck to you!
      Dr. Marvin.

  48. Age: 67 Started invisilign treatment November 2009.I’m on my last liner now. #31 is cracked. Now has temporary crown. Don’t know if crack went into root or not.

    #30 has crown from 5 years ago. #28 has a twinge of pain occasionally. My bite is off. Have slight discomfort in # 31. Jaw hurts, neck hurts, ear hurts including inner and outer part, off and on. Have always had very healthy mouth and teeth until now. Please advise. I was concerned about doing invisilign, but had more than one dentist say it was perfectly safe.
    Thanks for your input.

    • Invisalign is safe. The bite just needs to be “fine tuned” now that the orthodontics is over. That’s the final step that most dentists don’t employ.

      “How do you fine tune the bite?”

      We balance the jaw then the bite by using chiropractic and occlusal adjustments. We do this daily for our patients. Please call to schedule an appointment to have your bite adjusted.

  49. I have a treatment plan (phase one) from a dentist that involves electronic bite registration, electro-sonography, rhinometer-nasal function study,pharyngometer/laryngeal study,muscle testing, tek scan, surface electromyography(3),cone beam 3D reconstruction,casts,orthotic splint, orthotic adjustments(6),trascutan. electric. stimulation(2),and computerized mandibular scan(4) which is for the initial ,temporary phase to adjust my bite. Then he will enter phase two and reconstruct my teeth to adjust my bite.I do have severe notching from grinding and a malocclusion, and want to do everything needed to save my teeth.However, I was so hoping that there was an alternative to such an extensive and costly plan. I also think my bite may shift due to dental, neck, or trauma issues in the future and was hoping for an alternative that seemed more fluid. Thank you, Lucy

    • Lucy,

      You have quite a plan worked out for you. Now I can’t explain all the tests that this dentist has in store for you… that is up to him/her to explain. By the way things sound, your case seems pretty complex. The info you provided is not enough for me to provide a diagnosis and treatment plan as you well know. However, I’m glad to see you understand the importance of the bite and how it can affect your life.

      Feel free to schedule an exam and consult with our office if you want me to give you my advice. We may have the solution for your bite and who knows, it may be quite simple.

  50. Could you please comment on the use of a dental laser with EndoCal 10 as a safer and less toxic way to do a root canal.

    • I don’t recommend any root canal treatment as it does not remove the infection in the bone surrounding the tooth. No treatment will ever eliminate the bacteria in the dentinal tubules or bone. Many biological dentists are ok with using dental lasers with endocal as an alternative to root canal therapy using gutta percha and typical disinfection techniques. However, it has not been proven to be effective for more than 1 year in the mouth. I always error in the side of safety and health and in most instances, a root canal is not the treatment of choice.

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