When there is no alternative… – Mark Allen – Coltene

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  Posted by: Dental Design      17th July 2019

What is a common response when you tell a patient root canal therapy is recommended? A flinch, followed by the question, “Is there anything else we can do instead?”

Often the only other viable option is an extraction. Extraction is a common surgical procedure and generally straightforward. But dental extractions are also the reason behind the most claims for compensation from patients, according to the Dental Defence Union (DDU).[i]In figures the DDU published in March, 24% of claims were made following an extraction gone wrong, more than root canal treatments at 20%.

Of course, extraction is often the recommended course of action for a host of scenarios, such as trauma and overcrowding. But most clinicians will favour saving teeth, if at all possible. Why would a patient prefer to extract rather than have root canal treatment – is it because they believe removing the tooth is the quickest, most cost-effective option? Would they rather live without a tooth rather than commit to the horror of a root canal?

Unpicking the myths around endodontics is something that dentists have got used to. But clearly things more can and do go wrong during extractions – hence the large proportion of claims. Common allegations include the tooth being incorrectly assessed as needing to be removed, when in fact it could have been treated and preserved. Extraction has a recovery time and aftercare requires the patient to avoid disturbing the blood clot, so as to prevent bleeding or a painful condition called alveolar osteitis, or dry socket. Extraction can also cause other teeth to move, or affect ability to chew. The patient may subsequently decide they wanted to replace the extracted tooth with an implant.

We can empathise with an individual who is in pain because of a pulpal infection, and/or experiencing functional problems and wants a speedy solution. We can also understand why many are fearful of the ideal of root canal therapy. But extraction will not always provide the quick (and cheap) fix that they are looking for.

Good communication is essential for successful dental treatment. Alongside the release of figures for compensation, the DDU produced a list of ways in which clinicians can reduce the risk of a patient making a claim; more than one would come under ‘communication’.[ii]Communication should be full and frank and cover all the alternatives and compromises, as well as limitations relating to these alternatives, including changing timescales and fees. For example, if they insist on an extraction, there will be cost implications if they decide on implant therapy or restorative work later on. Also, with an extraction, understanding how to be responsible for their oral health pre and post-op is fundamental. These are just two reasons why an extraction is rarely a quick fix.

Communication isn’t just something that happens in the surgery; your practice must have up-to-date, comprehensive patient resources available for the individual to take home when they are deciding how they wish to proceed. Or, you may prefer to direct them to information online. Modern dentists have to assume that smart and savvy patients will do their own research before saying ‘yes’ to treatment, so we may as well point them in the right direction.

Root canal therapy is safe, efficient and, in most cases, successful. It isn’t a quick fix – for most patients it is the best, long-term solution for better teeth for a lifetime. We can tell patients about the immediate and obvious benefits of root canal therapy – being able to retain the feel and function of their own tooth – but your treatment plan should highlight the on-going advantages as well. Endodontics can limit the need for future dental work and be the catalyst for embarking on an improved daily dental hygiene programme. Once root canal therapy has been completed, the patient can learn how to prevent a recurrence of infection, by refreshing their brushing technique with the help of a dental hygienist, discussing smoking cessation if appropriate and using adjuncts to support their oral health. All this while retaining a natural smile! A good endodontic specialist will complete treatment quickly and painlessly, especially if they use the high-quality products available to make the delivery of root canal therapy efficient and stable. COLTENE is a leader in the development and manufacture of endodontic tools and materials, such as its HyFlex™ EDM files, which have up to 700% higher fracture resistance than other systems, with less filling often required while preserving the anatomy of the canals. 

If, following examination, you are recommending root canal therapy, there really is no alternative. Endondotic treatment can remove a damaging infection then motivate the patient towards better dental hygiene. With high-quality tools, the treatment will stable and successful, offering the only long-term solution to an infection of the canal.


To find out more visit www.coltene.com, email info.uk@coltene.comor call 01444 235486


[i]Dental extractions are the most common reason for compensation. Dentistry.co.uk, 5 March 2019. Link: https://www.dentistry.co.uk/2019/03/05/dentl-extractions-common-reason-compensation/(accessed March 2019).

[ii]Dentistry.co.uk, 5 March 2019.

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