We’ve all heard about root canal and it scares the hell out of people who don’t know anything about it. When they see pictures of “needles” (endodontic files) being poked deep inside a tooth, they virtually freak out.

“Over my dead body!”

Well, that’s if the pain from acute pulpitis doesn’t kill them first. So what is this thing called the pulp? Why should it be there in the first place?

Put simply, it’s that tiny shred of soft, bloody tissue encased inside the hard tissue of the tooth. When we do a root canal, we often tell patients that we have removed their “nerve”. The pulp tissue is more than just nerve, but calling it “nerve” makes it easier to understand. Nerve gone, pain gone. The pulp is actually made up of blood vessels, dentine-forming cells and of course, nerves. The function of the pulp is to “grow” the tooth. And this growth is mostly an inward kind of growth.

A tooth in a young person will have a large pulp chamber. We can say that they have “a lot of nerve”. That means that their enamel and dentine are relatively thin. As a person ages, the pulp deposits more and more dentine, pushing itself inwards. This function attempts to replace tooth substance loss from attrition, abrasion and other destructive forces our dentition has to deal with in fulfilling their masticatory functions. Hence, in the teeth of older persons, we will see smaller pulp chambers and thicker dentine.

Technically, a pulp would have already done its job when the root tip of the tooth is properly formed and a considerable amount of dentine has been laid out. With the kind of diet that most modern humans have, teeth do not wear out that quickly. Do we need the pulp to keep laying down dentine throughout our lives? Probably not.

So what’s the big deal about killing a tooth for a 30-year-old or even a 25-year-old patient? There are patients who walk into a clinic, presenting with mild attrition of a tooth but severe sensitivity on it. The tooth is still vital. Why kill it? The “natural” thing to do is to crown that tooth to protect the worn out areas. Sometimes, it works. Sometimes, it doesn’t. If the patient can afford to do both the root canal and the crown, then that would be ideal.

What happens if the patient only has $600? Well, if it’s the sensitivity that is killing the patient, then root canal is the only sure way to stop the sensitivity. And if the tooth is only slightly attrited, there is probably enough tooth structure to support it even after root canal treatment. I think we should go ahead and kill the tooth. Crowning is not any more conservative.

Another extreme, highly controversial and interesting case would be one of tetracycline staining. Take a look at these teeth.

To date, the most effective method to mask these discolourations is veneering. But in order to mask these deep stains, veneers have to be thick and opaque. When they are thick and opaque, they don’t look natural. Crowning may mask the discolouration well, but what about root canal?

Many people would be shocked by this suggestion and I’ve frankly not tried it myself, but practitioners who thought out of the box have reported very successful and “non-invasive” protocols which not only preserve valuable enamel, but produce highly aesthetic results. All that need to be sacrificed are the pulps of the stained teeth. After root canal is completed, very strong bleaching agents can be placed inside the non-vital tooth. While tetracycline may be virtually impossible to bleach through the enamel from the outside, there are pores located inside the pulp chamber which allow bleach to travel inside the dentine layer, effectively bleaching it. The beauty of this system is that aesthetics can be achieved with your original surface enamel (stronger than any porcelain) intact.

Would you kill 6 teeth and have them bleached from the inside? Or would you rather trim away part of your surface tooth structure and mask them with thick porcelain like below?