GCD Flashback: It’s Alive!: New Ways to Save Dying Teeth
Originally posted May 15, 2019
When you look at your smile, it can be tough to realize that each tooth isn’t just some hard, lifeless mass. Each tooth is, in fact, a living organ surrounded by a coat of enamel.
Underneath that enamel is a softer layer of tissue called dentin, which is made up of miles – yes, miles! – of microscopic tubules. Fluid flows through these much like blood flows through your veins, so you can think of it as part of the tooth’s own circulatory system.
Dentin also protects the soft tissue at the tooth’s core, the pulp.
Rich in blood vessels and nerve endings, the pulp is what makes a tooth alive. It helps deliver nutrients to the tooth and provides the specialized cells needed to repair or generate new dentin.
So when its health is at risk – due to deep decay or injury – it’s a Very. Big. Deal.
Now, most dentists at this point would recommend root canal therapy. In this procedure, all the living tissue is removed from the pulp chamber and the canals that extend into the roots. The canals are disinfected and packed with a rubbery substance, and a filling or crown is then placed to seal off the tooth’s insides.
Unfortunately, the result is a dead tooth – and often a harbor of residual infection that can ultimately have systemic effects.
But unlike what was shown in the notorious documentary Root Cause, this isn’t the fate of every instance of endodontic treatment. (Endodontics is the branch of dentistry that deals with the health of the pulpal complex.) Nor is root canal therapy the only option we have for dealing with a damaged pulp.
We now have ways of actually restoring a diseased pulp to health: regenerative endodontics, in which biologically-based materials are used to stimulate natural healing of the pulp.
For younger patients, whose permanent teeth are still growing and developing, there’s an option called vital pulp therapy. Here, we use lasers to remove only the necrotic (dead or dying) pulp tissue, leaving the still vital tissues in place. The laser has the added benefit of disinfecting adjacent tissues, as well.
The next step is to thoroughly disinfect the pulp chamber and dentin. For this, we use ozone instead of the usual chemical rinses. As Dr. Val Kanter, a leader in regenerative endodontics, has written, ozone is a
more biological antiseptic agent that has shown success in endodontics. Ozone is considered one of the best bactericidal, antiviral, and antifungal agents available. With only 20 seconds of exposure, ozone effectively eliminates 99% of microorganisms in primary carious lesions and also has the ability to destroy oral biofilms and their byproducts. This highly unstable form of oxygen acts as a strong and fast oxidizer of the bacterial cell walls and cytoplasmic membranes. Ozone can penetrate several millimeters into infected dentin, making it possible to disinfect deep decay without risking a pulp exposure.
Ozone has another benefit, as well: It supports healing. It helps with immune system regulation and circulation, increases antioxidant production, and much more.
At this point, we cap the tooth and leave the body to do the healing work it was designed to do.
Vital pulp therapy tends to be most effective for immature permanent teeth, less so for older, fully developed ones. With those, a procedure called revascularization tends to be far more effective.
Much of the process is the same as for vital pulp therapy, but there’s one more critical component it includes: platelet rich fibrin, or PRF for short. This is a membrane we make out of a small sample of your own blood, centrifuging it to separate the red blood cells and concentrate the platelets. Those platelets are a great natural source of growth factors.
Since the PRF comes from you, it’s 100% biocompatible, and it’s well proven to encourage the regeneration of healthy new tissue. (That’s why we use it on surgical sites, as well – to stimulate healing.) So we place PRF on the area of the pulp needing healing before we cap the tooth.
This is a far cry from your parents’ dreaded root canal therapy, making use of advances in tissue engineering and laser dentistry to do what once only seemed a dream: restore life to dying teeth.