Root canal options

What is the difference between the nerve in a tooth and the pulp in a tooth?

The nerve and the pulp in a tooth are one and the same thing. Dentists call the living tissue in the center of a tooth, “pulp tissue” or “pulp”, for short. The pulp has both nerves and blood vessels. The pulp extends from each root tip, to the “pulp chamber” in the center of the crown of the tooth. The tooth crown is the part that is visible in the mouth.

Most people are familiar with calling the pulp the “nerve”, which is how it will be described for the remainder of this article.

What is a root canal and why is it done?

A root canal is a treatment by a dentist which is intended to eliminate infection in a tooth by removing the infected nerve tissue inside the root or roots of a tooth. The infected nerve tissue may be alive at the time of the root canal, it may be dying, or it may already be dead. When a dentist starts a root canal, the space that was occupied by the nerve is enlarged slightly and filled with a special filling material called gutta percha.

The gutta percha is “glued” to the inside of the root with a root canal sealer, which also fills in any gaps between the gutta percha and the internal surface of the root. Dentists say that a tooth with a root canal is now a “non-vital” tooth. Isn’t that just a nice way of saying that the tooth is dead?

Dentists are taught that the purpose of root canals is to help people save teeth they would otherwise lose from infections in the nerve. Infections in the nerve usually start as cavities. So dentists believe that root canals are totally beneficial, without any significant risks. After reading this page, you may decide that the risks far outweigh the benefits.

What is the major problem with root canals that dentists won’t tell you?

In theory, at least as taught in dental schools, the root canal filling material seals off the root of the tooth and any germs remaining in it. Assuming that the space is completely filled and properly sealed by the dentist, any infection that has spread to the jaw bone at the end of the root or roots should then heal, because the jaw bone contains a blood supply to bring white blood cells to the infected area.

Unfortunately, this rarely happens, because the roots of teeth contain millions of microscopic pores or channels, called dentinal tubules. These tubules are normally filled with living nerve tissue extensions which go from the dental nerve within the tooth root to the outside surface of the root in the jaw bone. In a healthy tooth, the dentinal tubules serve as pathways for nutrients to reach the nerve and for waste products to be removed. However, when the nerve dies from infection or trauma, all the living tissue in the dentinal tubules also dies, creating relatively large spaces that attract germs, especially the germs that are already in the infected nerve tissue.

The result is that the dentinal tubules become a breeding ground for all kinds of germs, where they can grow and produce toxic wastes. The germs in the dentinal tubules and their poisonous wastes can easily reach the jaw bone around the root or roots. This is true even after a dentist has done a root canal, because dentinal tubules are difficult to disinfect and impossible to fill and seal off with the commonly used gutta percha filling material.

Another good reason to avoid root canals with gutta percha is that gutta percha is rarely used by itself. Usually, it requires the use of a cement sealer material to fill in the minute gaps that remain between the gutta paercha and the internal surface of the empty root canal spaces where the nerve tissue has been removed. The sealer is a synthetic material made up of a variety of chemical substances, and, as such, will have some degree of innate toxicity.

In most teeth with root canals, a chronic infection from the germs in the dead dentinal tubules will persist within the jaw bone next to the tooth, without causing any symptoms to make you aware of the infection. Even a dental x-ray won’t reveal any infection.

What dental alternative is available for doing a root canal?

As you will find out by reading further on this page, you may not always need a root canal recommended by your dentist. However, assuming the nerve in your tooth is truly dead, and you want to retain the tooth in your mouth, a holistic or biological dentist may offer you a root canal with an alternative root canal filling material called Endocal, which is made from calcium oxide.

The original name for Endocal was Biocalex. This unique root canal filling material is very alkaline, which is toxic to disease germs. It is claimed by the manufacturer to penetrate into the dentinal tubules, thus killing the germs in the tubules. Another biological advantage of Endocal is that it does not require a chemical sealing material, such as is used with gutta percha.

Traditional dentists and root canal specialists (endodontists) usually claim that Endocal causes the roots of teeth to fracture. Neither clinical evidence nor scientific evidence supports this claim.

There are some problems with using Endocal. Endocal is difficult to see on an x-ray, and it doesn’t have the x-ray appearance of a traditional root canal. This means that another dentist may say that the root canal was not done properly, or not done at all. Unlike traditional gutta percha filling material, Endocal is very difficult to remove once it has set hard, so if a dentist recommends retreatment, which means removing and replacing the Endocal, they will likely not be able to do so.

Therefore, if you choose to have a root canal done with Endocal, please be aware of its limitations and please use a holistic dentist who is familiar with Endocal. It is highly unlikely you will find a root canal specialist or a traditional family dentist who will use Endocal.

If you are looking for a referral to a holistic dentist or physician, please go to Resources and Referrals. Read the description for each organization. Most of the organizations listed have a search field on their home page to help you find an appropriate holistic health care professional.

If I already have a root canal, what options are available if it fails?

All root canals eventually fail. This happens because the material used to seal the gutta percha filling material deteriorates over time. You can usually tell if the seal around a root canal filling material is breaking down, and your root canal is failing, because you will start to experience symptoms of acute infection, such as pain when you chew on the tooth, or perhaps a pimple draining pus will become visible on the gums adjacent to the tooth. If a pimple, which is called a fistula by dentists, should appear, you will most likely not experience much pain because the toxins from the infection are able to drain away through the fistula.

Basically you have three options for failed root canals.

The first option is to have the failing root canal re-done. Dentists call this a re-treatment. This can be done with new gutta percha filling material, or with Endocal. Your dentist will have to drill a hole through any fillings or caps in order to gain access to the old root canal filling material, so it can be removed and replaced. The benefit you will gain from re-treatment is to have a new, and presumably better sealed, root canal filling, which will help control the acute infection. Re-treatment will not prevent or stop a chronic infection from remaining in your jaw bone around the re-treated tooth.

The second option is to let your dentist try to help you save your tooth with a surgical procedure called an apicoectomy. An apicoectomy literally means to remove the tip of the root. The root tip is surgically cut off because it is presumed that the failure of the root canal is caused by the root canal filling material no longer creating an adequate seal at the root tip, thus allowing germs to grow inside the root. The germs and their toxins also contribute to additional infection in the bone surrounding the root. The amount of the root tip that is cut off is entirely arbitrary, as your dentist cannot see how far beyond the root tip the gutta percha seal has failed. The remainder of the old root canal filling material in the root is not touched.

Surgically accessing the infection around the root tip in your jaw bone avoids the necessity of having a hole drilled through any filling or cap in your tooth to remove and replace the old root canal filling material. As part of the apicoectomy procedure, your dentist will also remove any infected tissue in the jaw bone around the end of the root.

In addition, an attempt is sometimes made to re-seal the root canal at the end of the shortened root by inserting a small filling at the cut end of the root. Dentists call this a retrograde filling. Usually, dental amalgam containing mercury is used because it will set and harden even if the filling material becomes contaminated with blood or body fluids during the surgery.

Never let a dentist insert an amalgam filling in the root tip, because amalgam fillings always contain large amounts of poisonous mercury. If you already have an infection in your jaw bone, how can the addition of mercury at the site of the infection help? There are other much less toxic dental filling materials that dentists can use for this purpose. Ask your dentist how much the retrograde filling will improve the probability of healing. You may be surprised to find out that your dentist doesn’t really know.

So the complete procedure involves removing the infected tissue in the jaw bone next to the root tip, cutting off the root tip, and then sometimes putting in a tiny filling into the end of the root. The anticipated outcome is that the surgical wound will heal and that your tooth will be saved. If the dentist doing the apicoectomy is not holistic, you can expect to be given a prescription for an antibiotic. As you can imagine, this is a challenging dental treatment at best, which should be done by a dentist who is surgically skilled.

Dr. Gilbert does not recommend apicoectomies. The unfortunate reality is that an apicoectomy is a last ditch attempt to save an infected tooth with a failed root canal that is impossible to disinfect, surrounded by an already infected jawbone. What do you think is the likelihood an apicoectomy will save your tooth?

The third option is to have the tooth removed or extracted, especially if you do not want to save your tooth. If your dentist determines that your tooth has split or fractured, you have no option except to extract the tooth. Further down on this article there is a comprehensive description of what you need to know regarding an extraction, including complementary ozone treatment.

Remember, all teeth with root canals are dead teeth which harbor germs, which results in the jaw bone around them remaining chronically infected and a challenge to your immune system.

Reduce the stress and challenge to your immune system from germs in root canals, by taking all natural, organic and whole food supplements. There’s lots of information and details on the Supplements page.

If I choose to save a tooth with a root canal, what is the best way to re-build and restore my tooth?

Although it is not always necessary, typically, most conventional dentists will recommend a cap. Dentists call a cap a crown. Sometimes a post will also either be recommended or included with the cap. A post is a steel rod that is cemented into a hole that is drilled into the largest root of a tooth. The hole for the post is made by removing the approximate top half of the root canal filling material.

Dentists have been taught for years that posts are needed to strengthen the tooth to support the crown that is placed on top of the tooth. This is simply not true.

Never let your dentist put a post in your tooth with a root canal. Posts do not provide any additional strength to a tooth that has had a root canal. Posts actually weaken the root they are in. The sideward chewing forces on the crown will be transmitted to the post which will eventually cause the root with the post to split in half. If your dentist says that the post is made of flexible reinforced fiberglass which can’t fracture the root, then the chewing forces will cause the post to break. Either way you will probably lose the tooth.

Instead of any kind of post, always insist that your dentist use modern bonded composites to create the foundation for the cap. If your dentist says that there isn’t enough of your tooth remaining to support a crown unless a post is used, then have the tooth removed. If you try to save it under these conditions, it will fracture somewhere and fail prematurely. If your dentist still insists, then remove your dentist and find a holistic one.

Always ask your dentist if your tooth can be rebuilt with a less invasive restoration than a cap, such as a filling, an inlay or an onlay. If a filling is possible, always avoid amalgam fillings, because they contain large amounts of poisonous mercury. Insist on a composite plastic filling. If your dentist says that your tooth needs something stronger than a filling, ask if it can be an inlay or onlay made of composite plastic or porcelain.

These types of tooth restorations are biologically suitable for most people and they are both esthetic and very natural appearing. Ask your dentist if he or she routinely does inlays and onlays. If not, your dentist will likely insist that you need a cap, simply because they are easier to do and more profitable than inlays or onlays.​

Any duly licensed health care professional who would like to learn Dr. Gilbert’s MTA treatment protocol for vital pulp capping is welcome to e-mail Dr. Gilbert or call 732-329-8713 between 10 am and 6 pm, Monday through Saturday Eastern Time.
hroughhat dental options are available instead of a root canal?

Basically you have two options instead of a root canal. The first option is truly holistic because it takes into account your body’s natural and innate ability to heal and regenerate injured and damaged tissue, in this case nerve tissue. This holistic, alternative option is called a “vital pulp cap”. Think of it as a vital nerve cap.

A vital nerve cap is a distinctly different dental procedure from a root canal. A vital nerve cap functions as a permanent band aid over the exposed part of the nerve. It involves sealing off the injured, exposed nerve tissue with a special dental material. A vital nerve cap avoids a root canal, giving the protected nerve tissue the opportunity to regenerate and heal, instead of being destroyed by your dentist. A vital nerve cap is only possible if the nerve in your tooth is alive. Generally speaking, bleeding is a good sign that it is still alive. If the nerve is dead, or a root canal has been started, it is too late for a vital nerve cap.

Any dentist can perform a nerve cap and seal off the injured nerve tissue, as long as the injured nerve is alive, and providing they use a special dental material called Mineral Tri Aggregate or MTA for short. A holistic dentist is more likely to be familiar with it than a conventional dentist. Mineral Tri Aggregate is essentially sterilized portland cement. MTA works extremely well because it is sterile, bland, slightly alkaline, which promotes healing and stops bleeding, and it adheres to the tooth surface, just like portland cement sticks to hard surfaces. It even stops the pain of an injured nerve. Once the MTA has been successfully applied, a dentist can then protect it with a temporary filling, until the tooth can be properly rebuilt and restored.

For a nerve cap to have the greatest likelihood of being successful, it should always be done immediately after the dentist cleans out the tooth decay in the cavity and discovers that the nerve has been exposed. The nerve must still be alive, as evidenced by bleeding. Furthermore, the dentist must be prepared in advance for the possibility of the nerve being vital, must have the MTA on hand, and must be familiar with how to protect the MTA until it hardens.†

If the dentist does not perform a nerve cap with Mineral Tri Aggregate immediately, but just puts in a temporary filling, the nerve will in all probability become so infected with germs that a later attempt to successfully cap the nerve with MTA will fail.

The next step is for you to help the delicate, injured nerve tissue heal by supplying your body with as much high quality nutritional support as possible. The simplest, easiest and best way to accomplish this is with all natural, organic and whole food supplements.

If your dentist says that “pulp caps” don’t work, make sure your dentist is not referring to an old material called calcium hydroxide. Dental schools have been teaching the use of calcium hydroxide for nerve capping procedures for years, in spite of the fact that nerve caps using this material almost always fail.

Why don’t conventional dentists use MTA for nerve capping, instead of always recommending a root canal?

This is a very good question that you should ask your dentist to answer.

The most likely reason conventional dentists don’t recommend vital nerve capping is because they believe that the nerve cannot heal once it is injured. They have been taught in dental school that the swelling that occurs in an injured nerve chokes off the blood supply and the nerve will eventually die. Hence, many dentists will tell you that you need a root canal if you want to save your tooth.

This belief that the nerve cannot heal once it is injured is total nonsense, because it defies our biology created for survival. Consider this. Why would teeth, which are essential for the survival of all mammals, be created with virtually no ability to heal? Mammals in the wild cannot live for long if they have a painful, infected tooth with a wounded nerve that prevents them from eating. Even our ancestors couldn’t. Only modern man can eat with or without natural teeth. So, providing that it is still alive, the nerve in the teeth of all mammals, including humans, must be able to heal. It’s just plain common sense.

In summary, most traditional dentists will be reluctant to discuss alternatives to root canals with you because:

  • They are not familiar with using Mineral Tri Aggregate for capping nerves.
  • They already know that nerve capping with calcium hydroxide doesn’t work.
  • Root canals are a low overhead treatment procedures, so there economic motivation for traditional dentists to recommend them.
  • Root Canals are the only treatment they have been taught in dental school for saving teeth with infected nerves.

The truth is that the nerve in any of your teeth is perfectly capable of regenerating and healing even if it is injured, as long as it is still alive. The dentinal tubules, which have already been discussed in the beginning of this article, provide an outlet for fluid swelling and for nutrients to be brought in to the nerve tissue to help with the healing process. The holistic key to successful healing is to clean out the germ laden decay in the tooth, seal off the injured nerve tissue from further contamination by germs, using Mineral Tri Aggregate, and supply the infected nerve tissue with as much nutritional support as possible.

The remarkable supplements recommended on this website are perfect for accomplishing this. It’s all on the Supplements page.

If you would like to personally find out how these all natural supplements may help you, fill out our simple Nutritional Consultation form for a free, no obligation nutritional consultation with Dr. Gilbert.

To avoid any confusion caused by the similarity of the names of two of the dental materials discussed on this page, here is a summary of all three:

  • Calcium oxide, marketed as Endocal, is used as an alternative root canal filling material.
  • Calcium hydroxide has been taught and promoted as a dental pulp capping material. Dentists don’t like using it because it rarely works.
  • Mineral Tri Aggregate or MTA is sterile Portland cement used for pulp capping. It almost always works.

The second option instead of a root canal is to remove the tooth. If you chose to extract the tooth, it is important that your dentist thoroughly remove any remaining soft tissue in the opening or socket in the jaw bone where the tooth was, in order to reduce or prevent the possibility of your jaw bone remaining chronically infected.

You can significantly increase the likelihood of eliminating all chronic infection in the jaw bone with ozone treatment. Ozone treatment effectively kills all the germs in a wide area of the jaw bone. For more information on Ozone treatment, contact Dr. Philip Mollica in New Jersey at 201-587-0222, or find a holistic dentist who is familiar and experienced in its use.

These organizations can help you, if you are looking for a referral to a holistic dentist:

  • The International Academy of Oral Medicine and Toxicology (IAOMT)
  • The Holistic Dental Association (HDA)
  • International Academy of Biological Dentistry and Medicine (IABDM)
  • Dental Amalgam Mercury Solutions (DAMS)
  • International Association of Mercury Free Dentists (IAMFD)
  • Consumers for Dental Choice (CDC)

If you chose to replace any extracted or missing teeth, it is also important that you discuss how you will do this with your dentist. Here are a few pointers:

Implants are generally better than dental bridges because they are stand alone replacements that do not depend on adjacent teeth for support. The implant itself is made of either titanium metal or a zirconia based ceramic material.​​

Titanium implants have been used very successfully for many years. However, titanium is a metal and, like all metals, it can possibly corrode. Although titanium implants are exceptionally resistant to corrosion, it does occasionally occur. Compared to titanium implants, the newer zirconia implants cannot corrode because they are metal free, which makes them biologically healthier for you, plus they are actually stronger than titanium implants.

Since ceramic implants are white, they eliminate the possibility of any metal showing at the gum line, which can be a problem when upper front teeth are involved. Both kinds of implants are now approved by the Food and Drug Administration. If a dentist recommends implants for you, make sure they are of the newer zirconia type. A holistic dentist is more likely to be familiar with zirconia implants than a traditional dentist.​

The tooth or teeth that are attached to the implant(s) should be made of zirconium based ceramics for the foundation, and lithium disilicate porcelains on the exterior, because the combination of the two different ceramics will be biologically safe, very strong and extremely natural looking.

For people who grind their teeth (called bruxism), all zirconia ceramics for the teeth attached to the implant are preferable because zirconia is as strong as steel and highly resistant to breaking. For implants that replace front teeth, especially where appearance is critical such as with upper front teeth, all lithium disilicate porcelain may be preferable because lithium disilicate is more lifelike than zirconia.​​

Dental bridges are now considered to be a poorer choice over implants, because dental bridges must be attached to the adjacent teeth, usually with caps. If you choose a dental bridge, make sure it is made entirely of zirconium based porcelain and conventional porcelains, the same as for implant teeth.

Never allow your dentist to use teeth with root canals for the supporting teeth on one or both ends of the bridge because these teeth, in as much as they are dead teeth, are relatively brittle and lack adequate strength. They will crack prematurely, causing the bridge to fail.

After an extraction, whether you choose to accept ozone treatment or not, you must do everything possible to nutritionally strengthen your immune system, because it is your first line of defense against infection and disease. The germ killing benefit of ozone treatment will be greatly reinforced if you nutritionally strengthen your immune system.

Healing of your jaw after removal of a tooth will be significantly enhanced. Either way, you will benefit immensely with the nutritional support provided by all natural, organic and whole food supplementation. A detailed description of these supplements is available on the Supplements page. After you have read about these unique supplements, you will understand why Dr. Gilbert recommends them so highly.