If you have a toothache, you want relief, and we want to recommend the best treatment to provide that relief. Sometimes, the best treatment to provide relief is root canal therapy. When performed in the right situations, root canal therapy not only eliminates pain, but preserves the tooth for decades of future function and beauty. It’s a good alternative to dental implants. But we have to proceed with caution. It can be very hard to distinguish between teeth that may be painful now, but will improve, and those that are infected and won’t improve without treatment.
In the future, tests of biomarkers in the blood or saliva may be able to help us make this decision with greater accuracy.
Deciding on Root Canal Therapy
Root canal therapy is a treatment for the soft tissue located inside the tooth, called the pulp. There are four states of the pulp. Normal pulp is functional and healthy. It doesn’t cause any pain. Reversible pulpitis occurs when the pulp is irritated and swells up. This can be very painful, but it will resolve on its own.
Irreversible pulpitis occurs when the pulp has become infected. It is painful, and won’t resolve on its own. It has to be treated to stop the spread of infection. Necrotic pulp is dead. It doesn’t cause pain, but it should be treated to prevent the potential spread of infection.
It’s very easy to identify normal pulp and necrotic pulp. But it’s harder to distinguish between reversible pulpitis and irreversible pulpitis. Sometimes, the characteristics of the pain will distinguish between the two, but not always. We’ll hit the tooth, expose it to heat, cold, or electrical stimuli.
Often, we rely on finding the source of infection (such as a cavity, crack, or other route for bacteria to enter the pulp chamber), but that’s not always visible. When in doubt, we may decide to treat a tooth without being entirely sure whether the pain will resolve on its own–we know treatment will eliminate the pain and will prevent future infection.
Diagnostic procedures for an infected tooth haven’t changed much in over a century. Their accuracy is also in doubt, so we would welcome a more definitive test to identify a tooth with irreversible pulpitis.
Biomarkers May Be the Key
In trying to design a new test for irreversible pulpitis, researchers focused on the key distinction between the two conditions: infection. The body responds in specific ways to an infection that it doesn’t respond to irritation, so researchers performed a literature review in the hopes of finding a characteristic test that could be used. There are a number of promising candidates.
There were 64 biomarkers that showed statistical differences between infected and uninfected tooth pulp.
The next challenge is getting access to the biomarkers. The most straightforward would be to drill into the pulp chamber and test it that way, but once we get to that point, there’s no real benefit to the test.
However, some of the biomarkers show up in the gingival crevicular fluid, which flows out from around the tooth. We can sample these without having to disturb the tooth. If we can confirm that these are reliable for diagnostics, we’ll have a new test for irreversible pulpitis that will virtually eliminate unnecessary root canal treatments.
Advanced Technology and Techniques
For the best dental care, it’s important to work with a dentist who remains at the forefront of dental knowledge. At Rice Dentistry in Irvine, we work hard to stay at the leading edge of dental technology and practice. Please call (949) 551-5902 today for an appointment with one of our Orange County dentists.