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What is a Root Canal?

09 Dec 2014

Each week Dr. Larry Benge discusses dental health with Steve Price. In this interview Dr. Benge talks about Root Canal.

Steve Price Interviewer: Dr Larry good evening to you

Dr Larry Benge: Steven how are you?

Steve Price: I’m well, words you never want to hear from your dentist – Steven you need root canal work, thank you Larry!

Dr Larry Benge: Yes, that’s the dreaded one isn’t it, root canal?

Steve Price: What is it?

Dr Larry Benge: It’s where the nerve in the tooth dies either because of a number of reasons – it could be trauma, it could be from the fact that you have had a very very deep filling which has gone very close to the nerve. It could be if you’ve had a crown cut from a tooth and sometimes a nerve just gives up the ghost. So basically it means the nerve, which sits inside the tooth dies and when that happens it can actually cause one of two things – either terrible terrible pain like a pressure cooker, if you’ve got no escape for the gases and from the breakdown of the nerve, or if you have a big hole in your tooth it sometimes dies and you can be completely unaware of it.

Steve Price: And that causes toothache?

Dr Larry Benge: Yeah it can cause well, if generally there is a hole, then actually the gas can get out. It may or may not cause tooth pain but if it’s actually closed it can form a nasty abscess. Where one of the most devastating pains you can have and people are actually knocked out completely by it.

Steve Price: I’m pleased that I have never had to experience that! There was a study apparently released today, you have done a million of these procedures that show dentists might be visually tricked into drilling larger holes than necessary in teeth. It was a study published in the online journal Plosone P-L-O-S One, led by professor Robert O’Shea he studied 8 New Zealand dentists preparing 21 teeth for root canals, his findings were that of all the dentists drill larger holes than necessary due to an optical illusion that makes the small enclosed area the decay appear larger then a larger area surrounded by the tooth. Does that make any sense to you?

Dr Larry Benge: Look it could, I actually don’t do that many root canals anymore Steve, actually I’ve um, as a part of dentistry that often we send patients. It is something that every general dentist can do, but if they are more difficult they go off to specialist dentists called an Endodontist. Endodontits are a group of dentists that have done two years or three years more study and they actually do the root canals and most of them they use is done under a microscope, so, because the inside roots of the teeth – the little canals can be very fine and often you need a microscope to get down inside them. It’s particularly and probably for molar teeth, that happens but for other teeth in terms of front teeth or the canine teeth generally its one canal and a lot easier. One thing I will say that has happened is when I started learning root canal’s they were all done with little files that we used to hold, today the current dentists were all taught with machines and drills. So yes, the holes that people do drill into the teeth are smaller than they used to be when I learnt. And that can be quite significant because the smaller the hole, usually the stronger the tooth in the long term.

Steve Price: I’m sure I’ve had it done; you know what it’s like Larry you shut it out from your mind.

Dr Larry Benge: Exactly

Steve Price: You don’t want to ever remember it again. The procedure itself is not painful because you would be drugged up, wouldn’t you?

Dr Larry Benge: Um, it can be painful if you have what we call a ‘hot nerve’ that means the nerve inside the tooth has a ¾ dying, the pressure is built up and sometimes to get access into, that can be unpleasant. Generally with good anaesthesia it is really quite ok. I had a case Steve last week, which I just wanted to tell you about tonight, because it involved a patient that came and saw me three years ago for a consultation. And I said, she needed three or four crowns and maybe some fillings and she said I just can’t afford it, and then she said wanted to do some cosmetic work, and I said fine. She said I am going to go overseas and she went to Turkey. Well she came back two weeks ago and I examined her mouth and she came back with twenty eight crowns and…

Steve Price: What?!

Dr Larry Benge: And twenty-eight root canal treatments so we went back to the previous x-ray and she didn’t need one root canal. So what happened, in a lot of places and this is overseas, they do root canal treatments in teeth when they do crowning and they don’t need them. Well we had a look at the root canals and seven or eight of them became grossly infected and now she has gone off and got a quote to re-do the twenty-eight root canals, re-do the crowns over $100,000 dollars.

Steve Price: Wow!

Dr Larry Benge: So if the root canals are not done exceptionally well, they can break down and cause problems. Now I have actually talked to the Dental Association because I feel so sorry for this lady she’s absolutely had her mouth decimated! So you know she’s in a situation where she may have to have all of her teeth out put in dentures because she just can’t afford to have it going on. So this is a real classic example of what we have been discussing about overseas dentistry and I might even send you the x-rays just to have a look.  An amazing sort of thing, root canals are all done inappropriately. When you have root canals they have to be done under this special rubber, called Rubber Dam. They have to be done meticulously and sterile. If its not the case then you can have them done and spent all the money, you know they are expensive to have done and they can breakdown.

Steve Price: The Department of Foreign Affairs, the details of that women of who she went and saw. They should make an objection to the Turkish government about that.

Dr Larry Benge: I mean, you know I am really very upset with lady. She’s very upset she doesn’t know where to go, she can’t afford it. We’re hopefully going to send stuff, but the Dental Association can’t do anything. And look it really would be nice if someone can send her to one of those health funds, particularly if those health funds are going to pay for overseas sort of dentistry to see what actually comes on.

Steve Price: It’s a great case, isn’t it?

Dr Larry Benge: It’s great because as an Australian dentist you said, yes you need a few crowns but not twenty-eight! And even if we did the crowns we’re not taking the nerves out. She’s got twenty-eight crowns and twenty-eight root fillings. I think she paid $15,000 equivalent of, which would have cost over $100,000 in Australia. But the point is, she didn’t need the work.

Steve Price: And it was badly done!

Dr Larry Benge: And it was atrociously done!

Steve Price: Well someone…I hope NIB are listening by the way. Well someone better make that point and as I said somebody on her behalf, gather all the information and at least send it off. I would have thought to, either to the Health Minister Peter Dutton or the Foreign Affairs Minister Julie Bishop and say here’s a classic case of why you have to keep warning people not to do this.

Dr Larry Benge: Yeah I do, and I’ve got the case and she’s a lovely lady and I can’t name her obviously for medical and legal things. I just bring the case up because its really something that’s a classic case that should be highlighted, and people about. Particularly tonight we’re talking about root canals, if they’re not done appropriately and that means done under sterile conditions, with the right person doing it, it means not cutting a big enough, too bigger hole in the tooth, doing it right, sterilising it. Then they can come back and spend all that money and they can actually need re-doing it again. And if you open up the tooth too severely and you can spend all that money, put a crown on the tooth so you can be up for $3,500-4,000 per tooth, the tooth can split and you can have to take it out. So you know, there’s something to be said for Australian’s standards for the way when it’s done like that you’ve got the best chance of having a result.

Steve Price: Great warning Larry, thank you mate. Thank you for tonight I’ll talk to you next week.

Dr Larry Benge: Thank you, Cheers Mate.

Steve Price: Dr Larry Benge, ten to ten.

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