Know Before You Go [Plus, Alternatives]

A root canal is a common dental treatment for a tooth with inflamed or infected pulp, usually due to a deep cavity or trauma to the tooth.

Few dental treatments inspire fear like the root canal. But unlike what you might see in the movies, root canal treatment is associated with very little pain.

On the other hand, root canals do carry some risks. They are often prescribed when another treatment is more appropriate or should be preferred. Biological dentists, in particular, generally avoid this procedure and recommend alternatives.

Below, we discuss exactly what a root canal is, how to know if it’s right for you, what to expect, and other common questions.

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Root canal therapy is a type of dental procedure used to preserve a tooth after the pulp of the tooth has become inflamed or infected. This is typically caused by a deep cavity or physical trauma to the face or teeth.

Dental pulp is the soft tissue found inside the tooth containing connective tissue, nerves, and blood vessels.

During a root canal, a dentist or endodontist will clean out the infected tissue from your pulp chamber, then disinfect, fill, and seal the tooth. In most cases, a crown will be placed on top of the tooth structure to prevent cracking or chipping.

A root canal procedure allows your dentist to preserve (not save) an infected tooth by removing infected tissue and sealing it.

Root canal procedures may also be referred to as:

Root canals are an appropriate treatment for a tooth with irreversible pulpitis.

Pulpitis, or inflammation of the tooth pulp, can be reversible or irreversible. Once the nerve tissue has died as the pulp’s infection has spread, irreversible pulpitis results.

At that point, a tooth cannot be saved as a living structure.

A root canal procedure can “preserve” a tooth, but not “save” it.

By the time you need a root canal, it’s too late to save the life of the tooth because it’s already infected and dying.

Some people refer to this as “mummifying” a dead tooth.

Preserving tooth structure benefits your oral health because it won’t affect orthodontic growth or your bite. If your dentist extracts a diseased tooth without filling its space with an implant, your teeth may shift and cause orthodontic problems.

The most common risk of root canal treatment is tooth fracture. The inside of the tooth has been scraped out, leaving the outer shell of the tooth dry, brittle, and prone to breakage.

That’s why a root canal procedure almost always requires a second procedure shortly afterward: a dental crown. A root canaled tooth needs the protection of a crown because you’ve carved out the tissue inside it.

A dental crown is a rigid covering, formed to look like a natural tooth, that is stronger than enamel. It preserves the structural integrity of the tooth and reduces the risk that it will break as it weakens over time.

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How do you know if you need a root canal?

What causes the need for root canal treatment? Irreversible pulpitis (infection and inflammation of dental pulp) is what caused the need for a root canal or similar treatment option. This is usually caused by a deep cavity or injury/trauma to the tooth.

Irreversible pulpitis cannot be healed or reversed by any natural or conventional means.

In the case of tooth decay, you may be able to catch pulpitis before it becomes irreversible. To increase your chances of catching it early, practice good dental care, don’t skip dental checkups, and talk to your dentist anytime you develop a toothache.

Signs you need a root canal may include:

Diagnosing a root canal is a complex process that differs between dentists. There is no cut-and-dry way to diagnose a root canal. This process is part science, part art form, to discover the degree of infection within a tooth.

Do you need a root canal if there’s no pain?

If your dentist identifies irreversible pulpitis, you will need a root canal regardless of whether or not pain is present.

Your tooth nerve may die, temporarily relieving pain. Your dentist may put you on antibiotics that shrink the infection, which would also cause pain to subside.

However, irreversible pulpitis must be treated by root canal or extraction. Otherwise, it can cause serious systemic health issues.

What to Ask Before Agreeing to Treatment

In my practice, I’ve met many patients who were prescribed root canal therapy because a practitioner was in a hurry or looking for the “simplest” option, rather than the best option.

For instance, a dentist may suggest a root canal for a large cavity even if the pulp is not irreversibly inflamed and a filling would suffice.

Dental insurance covers it, the general dentist doesn’t have to place a filling that requires more-than-average finesse, and — I hate to say it, but it’s true — the price tag is higher.

In general, many root canal symptoms can often be attributed to causes other than irreversible pulpitis. Until your dentist or endodontist is fairly certain that irreversible pulpitis is to blame, root canal treatment should not be prescribed.

What to Expect During a Root Canal Procedure

A root canal procedure can be done in 1 or 2 visits. For retreatments (in which a tooth has already received endodontic treatment), 3 visits may be requested. Each visit should take 90 minutes or less.

How long does a root canal take? A root canal procedure takes 30-90 minutes per visit. For simple cases of teeth with one root, each visit will probably 60 minutes or less. Complex cases take closer to 90 minutes per visit.

Should your root canal be done by your dentist or a specialist? Specialists in root canal therapy are called endodontists. An endodontist should perform your root canal procedure if you have complex canals or if your general dentist refers out root canal cases. However, all dentists are trained to perform root canals during dental school.

Before the Procedure

Before your root canal procedure, your dentist will probably take x-rays or a cone-beam CT (CBCT) and perform a physical exam to identify irreversible pulpitis.

Your dentist may prescribe antibiotics before the procedure if:

During the Procedure

This is how a root canal procedure is performed, step-by-step:

Do root canals hurt? Root canals do not hurt at all during the procedure. If the dentist is skilled at delivering the local anesthesia, you won’t feel a thing. There may be minor pain and soreness as you recover.

Root Canal Procedure: Before and After

Sometimes, a dentist will begin the root canal and things go wrong — this can be a good thing!

If your dentist gets inside the tooth and is presented with new information that changes the chances of success of a root canal, he will stop to tell you. This gives you the choice to abort the procedure before proceeding with a root canal with lower chances of success than you both originally thought.

Reasons to stop a root canal include:

Your dentist should only do the root canal if conditions are ideal.

You can still drive home if you’ve been given only local anesthesia.

Getting a Crown or Filling

After your root canal treatment is complete, you’ll need to go back to your dentist for a crown or a filling. Crowns or fillings should be placed within 1-4 weeks after a root canal.

Do you need a crown after a root canal? If you have a root canal done on a molar or pre-molar (your back chewing teeth), you need a crown after root canal treatment. Most incisors and canines (front teeth) do not require a crown.

Some people wait to get a crown so that they don’t max out their insurance, but this can be a dangerous risk. If the tooth fractures before a crown is placed, you lose the investment of the root canal entirely.

In some cases, your dentist will recommend only a filling to protect the tooth.

The procedure for placing a crown is done in these steps:

Antibiotics & Root Canal Therapy

Antibiotics have been part of the standard of care for root canals for many decades. However, more recent research shows they are frequently unneeded and may contribute to antibiotic resistance.

Dentists frequently prescribe antibiotics before and after endodontic treatment for reduced chance of systemic infection, reduced pain, increased success rates, and a variety of other reasons.

The problem is that antibiotics actually have no significant impact on root canal outcomes in almost any case.

One review of antibiotic use for root canals found that dentists are most likely to prescribe antibiotics for root canals due to the placebo effect and a lack of education, not a clinical need.

A 2016 review by the American Dental Association (ADA) found that the only legitimate reasons for antibiotics before or after a root canal were a present systemic infection, fever, or both.

How long can I go before getting a root canal?

Once your dentist has diagnosed irreversible pulpitis, you need to get a root canal (or alternative treatment) right away. Your provider may prescribe antibiotics before treatment, in which case you may need to wait to finish your round of antibiotics.

When you find out you need a root canal for irreversible pulpitis, it’s like a ticking time bomb because the infection will eventually get out of control.

Pressure, swelling, and pain are likely to get worse. You might develop a bad taste in your mouth or experience numbness. The infection could spread to more vulnerable tissues, like your heart.

Yes, a tooth infection can kill you.

In the 1600s, tooth infections made the list of the top 6 causes of death in England. As recently as 1908, tooth infections had a mortality rate of up to 40%. That’s worse than smallpox!

Complications of infections like these, such as those from a tooth abscess, are extremely dangerous. Don’t wait for treatment!

Root Canal Recovery

For fast root canal recovery:

Can you drive after a root canal? You should be able to drive immediately after a root canal procedure unless sedation was used. Root canals usually involve local anesthetic, but sedation may be requested for patients who are anxious about the procedure.

Pain After a Root Canal

It’s common to have a little soreness after your procedure, but extreme pain after a root canal is abnormal. One study estimates that long-term pain happens after only 12% of root canal treatments.

If you do have pain, it usually peaks 17-24 hours after the procedure. To avoid this, keep your head elevated with a wedge pillow while sleeping for the first 1-2 nights.

Soreness from keeping your mouth open for a long period of time should go away after 1-2 days. However, if you have persistent TMJ pain, this soreness and stiffness may remain for 6-8 weeks, particularly if a dental dam was used.

You may have pain in the gum or other soft tissue around the root-canaled tooth from inflammation or damage during your root canal treatment. This should clear up within a week or two.

You can use over-the-counter pain medications like ibuprofen (Motrin) or acetaminophen (Tylenol) to relieve any pain for the day or two after a procedure.

Persistent pain (3 months or more) after root canal usually happens when you bite down or palpate the treated tooth. It’s frequently associated with:

More women than men tend to develop long-term root canal pain.

If you experience severe or sudden pain in the tooth weeks, months, or years after your root canal, it may be a sign of root canal failure. Contact your dentist immediately.

Root Canal Cost

Before dental insurance, a root canal procedure in the United States costs anywhere from $500-$2,250. A crown after root canal ranges from $600-$2,500, depending on the material.

When performed by a general dentist, a root canal for a front tooth will cost between $500-$1,000. Molars (back teeth) cost between $1,000-$1,500 with a general dentist. Endodontists (root canal specialists) usually charge about 50% more for a root canal procedure.

A high-quality cubic zirconia (new porcelain) crown costs around $1,300, while a gold crown — which lasts longer than any other material — runs about $2,500.

Your total cost may be as little as $1,100 and as much as $4,750 for a single root canal and crown.

The cost of your treatment will also differ depending on where you live. In general, a higher cost of living will mean a higher cost for dental treatment.

How much are root canals with insurance? Root canals are almost always covered by dental insurance but the rate of coverage differs by plan. In addition, your coverage probably applies only after you’ve met your yearly deductible.

Many traditional plans cover root canals at 80% and crowns at 50% of the billed cost. However, check your insurance plan and talk to your insurance company before treatment to be sure.

And remember: Most dental plans cap yearly coverage amounts at $1,500 or less. You may be responsible for a higher percentage of the cost than you initially expect if your dental plan reaches its cap.

Are root canals worth the cost? Root canals are often worth the cost because they have a high success rate and cost less than high-quality alternatives. The price tag for extraction with a dental implant, for instance, is significantly higher than a root canal and crown (potentially 2-3 times more).

Complications of Root Canal Therapy

Potential complications of a root canal (not including those related to anesthesia) include:

The main concern of root canal therapy is that they are never 100% clean, meaning there is always bacteria left behind in the auxiliary canals off the main root canals.

This is true for every single root canal procedure, but the quality of treatment has a major impact on this. As a study in the Journal of the American Dental Association puts it:

“Endodontic procedural errors are not the direct cause of treatment failure; rather, the presence of pathogens in the incompletely treated or untreated root canal system is the primary cause of periradicular pathosis.”

In other words, a badly done root canal is far more likely to fail and cause problems in the future.

I recommend all patients get a cone-beam CT (CBCT) every 3-5 years after root canal therapy to properly check for lesions or other signs of root canal failure. CBCT is a far more reliable method to recognize failure than a traditional x-ray.

Lesions and reinfection can occur with or without pain, so don’t rely on symptoms to determine whether or not your root canal was successful.

Prognosis & Long-Term Outlook

Root canal success rate and long-term prognosis are remarkably high, particularly when a crown is placed on the treated tooth.

The overall success rate for root canal procedures is between 80.1%-86%.

The success rate decreases most significantly (below 90%) after 5 years have passed.

A patented same-day root canal treatment known as the GentleWave System boasts a success rate of 97.3% after 12 months. This is similar to the treatment outcomes of traditional root canal therapy. However, the GentleWave system does result in significantly fewer reports of postoperative pain than traditional root canals.

Factors that reduce the chance of root canal success include:

How long does a root canal last? On average, root canals last 10 years or more. Some root canals last a lifetime.

Are root canals safe?

Root canals are safe for most people but may cause problems over time. To watch for root canal failure, get a cone-beam CT (CBCT) every 3-5 years after endodontic treatment to check for failure.

Major organizations, like the American Dental Association (ADA) and American Association of Endodontists (AAE), speak highly of the benefits of root canals. According to both the ADA and AAE, root canals pose no major danger whatsoever.

Other groups, including the International Association of Biological Dental Medicine (IABDM), do not recommend root canal therapy.

The Root Cause documentary and some alternative dental practitioners present root canals as extremely dangerous. Their theories often cite root canal treatment as a hidden cause of any number of systemic, chronic diseases.

However, if you are at a high risk of root canal failure due to compromised immunity or other factors, you may want to opt for an alternative treatment.

Pros & Cons of Root Canal Treatment

Is a root canal right for you? If your dentist has identified irreversible pulpitis, a root canal is one of only a few options for treatment.

Many dentists will recommend root canal for cases of reversible pulpitis for a number of reasons. In these situations, I would ask about getting a large filling instead.

Consider the pros and cons before deciding if a root canal is the best option for your case.

Root Canal Pros:

Root Canal Cons:

If possible, ask a trusted friend or family member to help with your decision if you’re already in significant pain. “Deciding under the influence,” as I call it, can lead to hasty decisions — especially if your tooth hurts a great deal.

Root Canal Prevention

Preventing the need for root canal therapy involves reducing your risk of untreated tooth decay and trauma to your teeth.

To reduce your risk of tooth decay:

To prevent tooth decay from progressing to the point of a root canal:

To reduce your risk of trauma to teeth:

Root Canal Alternatives

There are risks to root canal therapy, which is one reason why many functional dentists may not frequently prescribe this dental treatment.

Depending on what kind of specialist you talk to, their recommendation for treatment may be different. Oral surgeons often prescribe an extraction with an implant, while an endodontist is more likely to recommend a root canal.

Depending on your case, there are 3 possible alternatives to root canal treatment:

Root Canal vs. Fillings

For cavities that have not caused irreversible pulpitis, a large filling may be a better option than a root canal. A filling allows you to retain a living tooth, which will be more resistant to new cavities and fracture than an endodontically treated tooth.

Fillings are not an option once the tooth pulp has become irreversibly inflamed or died.

Why would a dentist recommend a root canal instead of a filling for a tooth with reversible pulpitis? Each practitioner has preferences for treatment protocols. Many dentists turn to root canal when a filling could work for a few basic reasons:

If you’re not confident in the prescription of a root canal and believe a filling would be better, consider getting a second opinion to be sure.

Restorations that can be done after an extraction include:

A dental implant is the preferred option if you decide against a root canal, as it is less likely to lead to bone loss or gum problems than dentures. It’s a highly effective procedure and the implant allows for natural chewing and aesthetics.

Both a root canal and extraction with a dental implant have the same probability of long-term success. Dentists make treatment decisions in these cases based on factors like cost-benefit ratio, patient preference, systemic health issues, and the probability of root canal success.

After extraction of multiple side-by-side teeth, your dentist may suggest a bridge connected by implants on either side.

If you are missing a large number of teeth and are on a limited budget, you may opt for dentures instead of multiple dental implants and/or a bridge.

Root Canal vs. Regenerative Endodontics

Regenerative endodontics is a relatively new method of endodontic treatment to restore inflamed dental pulp.

First introduced in 2004, this practice involves irrigating and disinfecting root canals of a tooth with pulpitis but not removing the infected pulp. Then, the tooth is agitated to cause bleeding at the apex of the tooth roots.

This bleeding provides the inflamed pulp of the tooth with a large number of mesenchymal stem cells (MSCs) that may heal the root of the tooth. Other stem cells may be manually injected into the tooth root.

Regenerative endodontic therapy may be successful in 91% of cases at reversing pulpal inflammation. In some cases, treatment is effective even when the pulp has initially been diagnosed with irreversible pulpitis.

This may not be the best option for many people because:

However, this could be the future of what we currently know as root canal therapy.

What root canal irrigants are used to clear the pulp chambers and kill bacteria before the tooth is filled?

Root canal irrigants include:

Integrative endodontic treatment is partial to ozone treatment. More than any other bactericidal solution, ozone may effectively eliminate a significant amount of bacteria in the small canals off the main pulp chamber.

There is also no risk of antibiotic resistance with ozone, unlike other alternatives, which could lead to stronger bacterial strains. Ozone may also be used on its own or with other antimicrobial agents.

More recently, the use of antimicrobial photodynamic therapy (aPDT) has been studied as an adjunct (add-on) to these agents. aPDT can result in a significant reduction of bacteria within the pulp chamber.

What are my options for root canal sedation?

Root canal therapy does not require sedation. However, if you want or need to be sedated for a root canal due to dental anxiety, there are 3 options:

Can I eat before a root canal?

Yes, you can usually eat up to an hour before a root canal. However, if you are undergoing sedation, you may need to stop eating earlier. Talk to your dentist to be sure.

Do root canals cause cancer?

No, there is no reliable evidence that root canals cause cancer.

Scientific methodologies from the 1950s drove this theory. The science on this is correlative, not causative. Root canal methods and materials have evolved many times over since those times and have been completely different since the 1970s.

That said, a poorly done root canal can and will have effects on the health of the rest of the body. Get a cone-beam CT (CBCT) every 3-5 years to check for root canal failure.

Will a root canal give me a blood infection (bacteremia)?

Bacteremia after a root canal happens in 15-20% of cases. This occurs when dental pathogens spread to the bloodstream. In a healthy individual, this lasts around 20 minutes and your body can easily fight off the bacteria.

For context, bacteremia is very common after dental cleanings — it’s generally not something to cause great concern.

In rare cases, patients can develop infective endocarditis, inflammation of the heart lining, as a result of bacteremia. Dentists used to — and still may — prescribe antibiotics as a prophylactic measure, but it’s unclear whether or not these are effective.

Why would my dentist not use a rubber dam for my root canal?

Rubber dams during root canal are controversial for patients with TMJ pain.

With a temporomandibular joint disorder (TMD), keeping your mouth open with a dental dam for up to 90 minutes during a root canal can cause significant discomfort. Some patients have TMJ pain for 6-8 weeks after the procedure.

In these cases, dentists may forego the use of a rubber dam or divide an appointment into multiple shorter sessions. Talk to your dentist about these options if you have TMD problems.

Can I get a root canal while I’m pregnant?

Available evidence suggests that root canal treatment is safe during pregnancy, particularly between weeks 13-21 of gestation. This treatment is associated with no significant increase in serious medical issues or adverse pregnancy outcomes.

The American Pregnancy Association emphasizes that, while root canals are considered safe while pregnant, it’s important to consider the risks of sedation, antibiotics, and x-rays that may be involved.

A single x-ray should not pose a risk to you or your baby. If possible, request a lower level of local anesthesia and skip other sedation. You should only take antibiotics if your dentist feels this is the only safe option, as antibiotics can affect fetal health.

Recently, major dental organizations created an uproar about the Root Cause movie.

The American Association of Endodontists (AAE), American Dental Association (ADA), and American Association of Dental Research (AADR) all requested Netflix remove the film because it’s so misleading.

Update: Netflix quietly pulled  from their library as of February 27, 2019. No explanation has been given, but experts believe this might be to protect the integrity of the high-quality documentaries offered on the streaming service.

The Guardian covers the topic from a free speech perspective, but I was eager to look at the movie from the perspective of a functional dentist. I might add that I’m also committed to being honest about proven science when it comes to natural dental and oral health—so I can still be a bit of a skeptic.

(Plus, who doesn’t want to watch a dentist movie? Those don’t come around often.)

From articles like “Root Cause Movie: Debunked” to “Is Your Root Canal Causing Cancer,” I found most of the information on the movie to be limited and questionable.

What is the Root Cause movie about?

Bailey describes his time as a nearly invalid man as one filled with searching. He looked to every medical, emotional, and spiritual avenue for an answer to his pain and had nearly given up by the time he found it.

According to Bailey, it took an entire decade for someone to point out that he had a failed root canal. Through a series of alternative medicine “diagnostics,” they determined the root canal was making him tired, depressed, and generally ill.

Then, Bailey interviews many experts with lots of letters behind their names. The titles of each subsequent expert seemingly gives a lot of credence to the progressively startling and extreme claims made throughout the movie.

For example, Dr. Dawn Ewing connects root canals and breast cancer in a shockingly certain manner. 98% of breast cancer patients have root canals on the same side as their cancer?!

Dr. Minkoff, the first expert to speak, essentially insists that his patients constantly have chronic, systemic diseases arising from root canals.

This new Netflix documentary raises many questions for patients who have had or may need root canals. Below, I’ll take you through what the Root Cause movie says and the facts we’ve proven. Then, let’s go through some Q&A about the movie.

Is the Root Canal documentary accurate?

Below, I’ll get into the specifics on what this movie claimed versus what we know to be true.

But let me say this: Root canals are helpful for the vast majority of patients who get them.

I’m not saying that because I’m a profiteering jerk—I say it because, if you need a root canal, I’d hate for a fear-inducing movie to prevent you from losing the use of one or more of your teeth.

There are a few things they’re correct on, though.

For one, there is a major link between what happens in the mouth and what happens in the body. (1)

I’ve been saying it at Ask the Dentist for years—more needs to be understood by doctors and dentists everywhere about the overall health of the mouth and body. They aren’t two separate parts that never intersect. I call it the mouth-body connection.

One of the clearest ways this plays out is the link between gum disease and diseases like diabetes. There’s definitely a correlation there!

Another true point in the Root Cause movie is that no root canal is 100% clean.

This is something else I’ve been saying for a long time that dentists and endodontists know. When you root canal a tooth, there are lots of tiny tubules that can potentially play host to bacteria. On occasion, these bacteria do overgrow and can escape into the bloodstream to cause infection.

But the extent to which they silently remain undetected, causing all forms of chronic disease was grossly overstated in this movie.

What are the dangers of root canals? Most often, the danger of getting a root canal involves the potential for a lesion (an abscess or cyst) within the root canaled tooth. This happens when bacteria left in the horizontal tubules throughout the tooth grows and damages tissue.

This bacteria can indeed cause symptoms and even get into your bloodstream. However, not only is this rare, it’s going to cause an infection and probably cause you pain. It’s incredibly unlikely that you’ll have no oral pain that would point your dentist to investigating any root canals you’ve had done.

*Important note: From the brief glance I got at Bailey’s x-rays showed in the film, he clearly had a badly performed root canal. These are always more likely to result in infection later on.

What are some specific facts Root Cause stated that aren’t totally fact?

Root Cause Says: “98% of women with breast cancer have a root canal on the same side as their offending breast cancer.”

There’s no scientific evidence I’ve ever been presented that supports this theory. I’m unable to find any review of breast cancer (of which there are many) that includes any statistic like this.

In fact, the idea of the cancer being on “the same side” as a root canal is based on the premise of the meridian system, not proven scientific fact. While I don’t challenge that traditional Chinese medicine has its benefits, there’s no solid proof that this system is real in the way it was presented in the Root Cause movie.

There’s been a lot of sensationalism around statistics that include people who have root canals and those who die of cancer. It’s true that a lot of people who die of cancer have had a root canal.

But it’s also true that a lot of people (in general) have had root canals. Over 15 million teeth have new root canals each year. (2) Since less than two million new cases of cancer are diagnosed in a calendar year and a little over 600,000 people die of cancer each year, the fact that cancer and root canals exist together isn’t surprising. (3) It certainly isn’t proof of causation.

Root Canal Says: The number one cause of heart attack is a root canal tooth. This is specific cause and effect, not correlation.

In fact, some evidence points the opposite direction. For instance, one study found that just over 50% of patients with major heart diseases had some evidence of endodontic lesions and about 23% had definite abscesses under teeth—but only half of them had even received endodontic treatment! (4)

Another study found an inverse association between number of teeth and cardiovascular disease. This means that the number of teeth pulled (which Root Cause recommends over a root canal) was associated with more heart disease. (5)

There’s a rare, but real, connection between bacteria entering the bloodstream during dental work and endocarditis. This condition is called infective endocarditis and is more common in people with heart disease. It happens when bacteria settles on dead heart tissue and causes infection.

Interestingly, this is more common (although still incredibly rare) with cleanings than it is root canals. That’s why I often consider preventatively premedicating patients with heart disease with Penicillin before giving them cleanings.

Root Cause Says: “The biggest toxic influence in the body of a chronically ill person is a root canal tooth.”

It’s true that a failed root canal can lead to systemic infection in a very limited number of patients. But there’s no reason to believe that all (or most) chronically ill people are ill due to a root canaled tooth or that everyone (or most people) with a root canaled tooth will become chronically ill.

In fact, when it comes to the connection of the mouth and body, I think we should be talking far more about the connection of gum disease to diabetes than the small number of failed root canals.

Root Cause Says: “The root canal is a fatally flawed procedure.”

If the root canal procedure was fatally flawed, how do the majority of people with root canals live productive, healthy lives?

On the other hand, there is data that people who have more teeth pulled (not root canaled) have higher chances of many diseases. This includes heart disease and cancer. (6, 5)

Root Cause Says: The root canal was invented, in part, because wealthy patients didn’t want to have decayed tooth removed. This would make them appear to be poor, so they’d rather hang onto their natural teeth, especially when capped with a gold crown.

Root canals were invented to solve three problems: 1) relieving pain from tooth decay, 2) removing diseased tooth pulp, and 3) preserve existing teeth rather than pulling them. (7)

In short, there may be some truth to this claim in the Root Cause movie. However, it was also a procedure that was designed to prevent pain. Those who get root canals aren’t simply choosing an elective procedure for aesthetic reasons.

The other options you’d have would be to get dentures or a bridge. Both of these options are far more problematic scientifically than root canals.

Root Cause Says: The vast majority of chronic degenerative diseases begin with problems in the mouth (infections/toxins). 80-90% of people are sick at least in part because of an infected tooth. Those have to be addressed if you want a clear, positive response with the treatment of your degenerative disease.

I’ve been saying for years that the mouth and body are far more intrinsically connected than most doctors realize. What happens in the mouth happens in the body.

It’s absolutely true that if you have a degenerative disease, you need to have oral infection and disease corrected to get better with the best possible results.

What I don’t think is true here is the statistic given. It’s stated, again, as a sensationalistic one-liner, and I can’t find evidence to support the 80-90% number.

Root Cause Says: “No dead tissue is left anywhere else in the body, except with a root canal.”

It’s true—if your foot has gangrene, you must have it amputated.

But the same doesn’t exactly apply with teeth, because a root canal does remove the tissue that’s still living (the pulp). What’s left behind is non-living, calcified tooth structure.

The remaining tooth will experience some remineralization and could possibly decay in the same way as a normal, living tooth would.

This comparison, though, is misleading at best, because a gangrenous foot will continue to experience necrosis and spread infection 100% of the time. On the other hand, a root canaled tooth structure will only experience decay if your diet and hygiene would cause decay in other living teeth, too.

Plus, only a small portion of root canals result in lesions or cysts that must be treated later.

There’s no part of the body that’s more well encapsulated than the inside of a calcified tooth. The anatomy of a tooth versus a gangrenous foot are not alike and the comparison doesn’t work.

Root Cause Says: Dentists will do anything they can to save a patient’s tooth, even if it means the patient dies.

It’s ludicrous to make this type of claim about a respected profession like dentistry. This is an emotional, unfounded statement.

Dentists go through four years of training and continued education after college in order to best serve their patients. While no one is perfect, and I do have many concerns about some common practices in dentistry, none of these are concerning to me because dentists themselves are willing to hurt patients (or even kill them)!

The very notion is clearly meant to strike fear. It doesn’t reflect the vast majority of men and women who practice dentistry.

Root Cause Says: Root canals cause systemic problems including (but not limited to) insomnia, fatigue, stress, anxiety, depression, cancer, and heart disease.

There are many reasons these symptoms can happen to people, and some of them are indeed connected to oral health. For example, sleep apnea, TMJ/TMJ, grinding/bruxism, and mouth breathing can all impact several of these symptoms. There’s no reason to think that these are caused by properly done root canals.

One major question I had about this movie is the connection of the producer’s concussion from being punched. Why wasn’t that more of a focus? Concussions can indeed cause many of the conditions listed above.

As stated earlier, there’s actually an inverse relation with both heart disease and cancer based on pulled teeth. (5, 6)

As for biotoxins more dangerous than found elsewhere in nature, the only toxin named in the film was botulism. This is found in untreated water and soil in some parts of the world. It’s not typically found in the body, so if it’s in a root canaled tooth, it would have gotten there from untreated water.

Endodontists and dentists sterilize instruments before root canals, so the chance of botulism or similar environmental toxins finding their way into the root canaled tooth is incredibly slim at best.

Root Cause Says: Medical doctors don’t pay attention to bodily issues that could be referred from dental problems.

In this case, Root Cause gets it pretty correct. If there’s an oral infection due to a poorly done root canal, it’s true many physicians wouldn’t consider it in their diagnosis. The same would be true for gum disease or tooth abscess caused by other issues in the mouth.

That’s why I urge readers to consider oral health problems alongside the health of the rest of their body in my article on CRP and Oral Health.

The good news is that most patients are aware of the fact they have an oral infection and are already working with a dentist to treat it.

Unlike what the Root Cause movie implied, the majority of patients with toxins in failed root canals have pain symptoms. (8) That’s why it’s not very likely an endodontic lesion or abscess would be ignored for years on end.

That’s an insulting and untrue statement to the profession of dentistry. These sorts of broad generalizations aren’t helpful to a discussion about life-and-death matters like those discussed in the Root Cause movie.

In dental school, curriculum teaches dental students a lot about how oral and dental health impact the rest of the body. Plus, the required accreditation of dental schools mean that educational standards are consistent throughout the United States, so there isn’t a major variation in what dentists are taught.

No, root canals do not cause cancer.

Here are a few things we do know about root canals and cancer.

First, it is fairly routine for cancer patients to undergo assessment and correction of any failed dental work before chemotherapy. Doing so helps ensure chemotherapy will be most effective, since an infection in the mouth is taxing the immune system already. (9)

Second, there’s an inverse relationship between number of teeth and cancer. The less teeth you have, the higher your cancer risk. (6)

Note here: Having your teeth pulled is actually an indication of higher cancer risk. In the study, root canaled teeth don’t count as missing.

Do root canals cause other systemic diseases?

Root canals can occasionally become infected and pass infection into the bloodstream. In these rare cases, infection can occur throughout the body and tax the immune system and/or cause symptoms (usually beginning with pain in the mouth).

However, the idea that root canals cause a huge number of diseases from cancer to depression is called the “focal infection” theory. It was disproven in the late 1970s, but some dentists cite much older research by Weston A. Price to insist this theory is true. (10)

Focal infection theory is the concept the Root Cause movie starts with, but there’s no reason to believe this is actually happening according to the data we have.

How do I know if it’s safe for me to get a root canal?

The vast majority of people who get well-done root canals each year live healthy and vibrant lives. According to available research, there’s no reason to believe a well-done root canal will cause major issues.

If you have diabetes, there is a somewhat higher chance that you’ll get endodontic lesions (cysts or abscesses under a root canal tooth). (11, 12) That’s because many diabetics don’t heal from any surgical procedures as well as a non-diabetic. In these cases, it’s a good idea to talk to your physician and dentist about this so that you’re aware of your options.

If you have a dilacerated root system of the teeth, meaning your roots are curved, root canals may not be the best choice for you. It’s very difficult to clean the roots in these cases.

High blood pressure can also increase the chance of a root canal failing. (13)

Finally, patients undergoing treatments for cancer or who have immune-compromised systems may not be the best candidates for root canals. Similar to diabetes, these conditions can limit the body’s ability to heal after any type of surgery or invasive procedure.

Ultimately, the most important thing you should know when you get a root canal is that your dentist and/or endodontist will do a good job. Root canals will fail almost every time if they aren’t performed properly, using the right kind of sterilization and clinical protocol. (14)

How do I decide if I should get a root canaled tooth removed? Do I need to see a specialist?

If your tooth is tender when you tap it with the back end of a fork or is sore while chewing, I’d recommend getting a 3D cone beam (CBCT) scan of your tooth. This 3D scan can help reveal any lesions that would suggest a failed root canal.

In any case, I’d recommend getting cone beam scans on your root canals every 5-10 years, depending on what you and your endodontist decide. This is a great way to have peace of mind that your root canal has been successful and isn’t causing any residual pain in the mouth or infection elsewhere in the body.

Any general dentist or oral surgeon skilled at removing teeth can remove a root canaled tooth. There’s no difference between removing a recently root canaled tooth or a regular tooth.

Sometimes, a root canaled tooth can ankylose to the bone, meaning it’s rigidly connected to the jawbone. Those are more complicated root canal removals and probably require the care of an oral maxillofacial surgeon.

Was Weston Price’s research as revolutionary as the experts in the film made it out to be? Why isn’t more modern dentistry based on what he discovered?

Dr. Weston A. Price was a maverick of a dentist. He was, in many ways, ahead of his time in creative research. He discovered what he termed “Activator X” that is probably what we now refer to as vitamin K2. He was also the first person to recognize that nutrient was so vital to the development of the facial structure and health of teeth.

In addition, his work uncovered the link between aboriginal diets and strong bones and teeth versus a Western diet that led to far more cavities and poor growth, even within one generation.

However, in conventional dentistry, Weston Price isn’t a highly regarded name. This is likely due to the fact that a large portion of his research had major issues in its methodology. The rabbits experiment, for example, had very flawed logic from the beginning.

As I mentioned before, the focal infection theory was disproved almost 50 years ago. (10) That theory led many dentists to believe that all decayed teeth should be pulled, no matter what.

I respect a lot of what Weston A. Price accomplished, but with the quality of much of his research, it’s important to be cautious when using his results to make strong conclusions.

There are no idols in any field with perfect records. His marriage to the idea of focal infection clouded much of his research. However, it’s good to learn from the things he discovered that can be replicated.

Is there less risk of infection if I have a tooth pulled rather than root canaled?

When you pull a tooth, you’re removing all the infected tissue and connected tubules, unlike with a root canal. There may be a slightly lowered risk of infection, but then you have to deal with the ramifications of losing a tooth.

For example, if your tooth is pulled and you get an implant, you’ve now got to put a foreign substance in your mouth, rather than leaving a calcified tooth that your body recognizes as part of itself.

Implants are susceptible to infection of their own. They’re also rigidly connected to the bone and don’t have the give that a root canaled tooth does.

If you choose not to have a pulled tooth replaced with an implant, your teeth will shift over time. This may lead to the need for orthodontic treatment like braces or aligners.

Are some people more susceptible to toxins found in a root canaled tooth like they mention in the Root Cause movie?

In the film, one “expert” points out that the supposed reason many people with root canals are perfectly healthy is because some people are more susceptible to these horrible toxins.

Yes, root canals can’t ever be 100% clean and yes, some people, even after a well-performed root canal, will develop lesions in the root canaled tooth. Certain subsets of the population are more likely to suffer infection after a root canal, such as diabetics or people with compromised immune systems.

However, as I pointed out earlier, there are two major issues with the concept the film suggests.

One, there’s no reliable evidence that tells us root canals definitely cause chronic systemic diseases in any predictable way. Failed root canals are rare and their impact is more well-understood than that. They certainly aren’t responsible for the types of disease this film claims.

Second, root canals aren’t the site of super-toxins that are worse than anywhere else in the world. This is simply not a true statement.

Should I have a cone beam (3D scan) done on my root canals to check for cysts or lesions?

I believe patients who get root canals are smart to get cone beam scans about once every 5-10 years after a root canal, or more often if you and your endodontist choose to do so.

Is it true that a root canaled tooth can look fine on an x-ray but actually contain a cyst or abscess?

Conventional x-rays may fail to reveal a lesion in a root canaled tooth. However, cone beam (3D) scans are far more reliable.

Even if you don’t see a dentist that offers cone beam scans, a failed root canal will almost always reveal itself. I’m not talking years here—in a few months, you’ll have pain that should send you to a dentist, who would find the cause in the root canal (if it’s there).

Is it possible that anesthetizing a root canaled tooth with an abscess could relieve pain elsewhere in the body?

No. This is based on the meridian theory used as a differential diagnosis, but there’s no scientifically proven reason the demonstration in the movie would work.

Are a lot of lesions or abscesses left by a root canal asymptomatic within the mouth for long periods of time?

No, most of these will cause pain within a few months at most. If they’re asymptomatic, it’s unlikely they’re a true abscess.

Can a Lecher antenna determine what’s causing an illness in my body?

Marketers call the Lecher antenna “the best kept secret in science”—that’s because it’s not science.

Does ozone gas travel throughout the mouth when injected into one tooth?

No, it doesn’t travel as far as the Root Cause movie claims. There’s no credible evidence-based data on this topic that suggests ozone moves throughout the entire mouth.