European medicine is divided into more and more narrowly specialized specializations, which is very clearly traced in the example of dentistry. A tiny part of the human body, the tooth, gathered around itself a number of narrowly specialized specialists – a general dentist treats dental caries, pins are implanted by a pins specialist, crowns, veneers and bridges are put by a prosthetic dentist, implant implanted by an implant specialist, and roots – and this is ubiquitous a trend in the center of European medicine, in Switzerland – the specialist treats only the roots – the endodontist.
The article uses interviews and materials provided to Airdoc by an expert, the author of numerous scientific and popular scientific reports and publications, the Swiss dentist, Dr. med. Michael Meier. A full video interview with Dr. Meier is being prepared for publication.
We must keep to the roots
Sometimes a person has a problem with the tooth, the nerve of which has long been removed, and the root is sealed. Often the cause of this relapse are untreated roots. They become the conductors of infection: bacteria pass to the very end of the root, then penetrate into the bone and enter the blood. To prevent this from happening, the roots of the teeth should be treated in the most careful way – the doctor must make sure that there are not the slightest signs of infection. In Switzerland, the roots of the teeth are handled by individual specialists – endodontists, and fortunately, in the vast majority of cases, the aching teeth can be saved from removal, if you turn to the right specialist. This tooth “salvation” is the main priority of modern dentistry, which is somewhat different from the still quite common practice of removing teeth early in some other countries, including, for example, the countries of the former USSR. None, even the most advanced implant, can compare to the real own tooth. An inflammation can appear around it in the gum. Therefore, you need to try to keep your teeth intact, and for this it is necessary to take special care of the health of their roots.
When you see young people who do not have some of their teeth, then most likely the scenario was something like this: they treated the canal again and again, but at some point the dentist decided that there was no point in continuing, and that the toot has to be removed. If the patient went to the endodontist on time, most of the teeth could be saved from such a fate.
The process of organization of tooth treatment in Switzerland
The process of organizing treatment in modern dentistry is as follows: first the patient, of course, goes to their doctor, the dentist, and he already directs to more narrow specialists. For example, if you have several problems, like you need to remove the root of the tooth and put an implant, then this should be done by a team, each member of which performs its part of the job. Then you will get the best result.
The Swiss are already accustomed to the narrow specialization of their doctors. But foreign patients entering the country of the Alps in the dentist’s office often perceive redirection as some kind of recognition by the doctor of their own professional incompetence. On the contrary: only a professional will refuse to work in a different field. A professional general dentist will not tend to your roots himself, but will refer you to the endodontist. In case of such a referral, it is important to adhere to the advice -it is really worth it. Here’s an example: the therapist says that your heart is at risk, and is going to do your ultrasound themself. You will doubt that they will do it professionally, won’t you? And you will be right. Because the normal course of events is when the therapist sends you to the cardiologist. The same principle can be applied to dentistry as well.
An experienced hand
The distinctive features of Swiss medicine, which from this small country of progressive medicine spreads around the world, is very narrow specialization of the doctors. Here there are surgeons engaged exclusively in the shoulder joints or only the knees, or only the hip joints; there are specialists in the hands or only on the soles of the feet. Even such a small part of our body as a tooth is divided into many specializations – there are specialists in implants, specialists in crowns and bridges, dentists and dentists who only treat caries. In particular, more and more dentists are giving such a delicate matter as treating the roots in the hands of endodontists. In one year, Switzerland’s medical schools produce only very few such specialists. Narrow specialization always gives a better result, no matter how good the dentist of the “general profile” is.
Of course, one can not deny that a high-quality dentist can independently conduct all the stages of treatment. But the time it takes is much more, and the quality can be different at different stages of treatment. Let’s take as an example another area of dentistry – implantation. The “average” dentist of general practice sets 30-40 implants a year, but there are specialists who put all 400. They have, so to speak, an experienced hand. Then it is better to send the patient, who needs implantation, to them. The same with the roots: if a dentist deals with one or two roots a week, then the endodontist treats about seven a day.
Root canals indeed have a bad reputation because of common relapses, but this is partly because not many experts can qualitatively treat the roots of the teeth. The treatment is not pleasant for the patient as well: the process is stretched out for a long time period and is often accompanied by serious pain. Therefore, you should try to get to a good specialist. Most patients are treated with problems that have arisen because of untreated root canals. Do not wait too long – because if you react quickly, you can avoid pain, and the cured tooth will eventually serve you as well as a healthy one.
Under the crown
Many older patients, who already have tooth crowns, and the pain begins under them, are very frightened that it is already impossible to cure such a tooth. However, even if the inflammation began under the crown, then modern dentistry allows you to begin to treat the tooth without even removing it. To do this, a hole is first drilled, through which the endodontist examines the internal content of the tooth through the microscope. When the picture is clear and the main part of the treatment begins, the crown is removed, the canal is treated, disinfected and completely filled with a special substance – guttapercha, and the tooth can still avoid removal. If there is an empty space inside, in which there are bacteria, then they multiply and will spread further. For example, in the case of upper teeth – bacteria can get into the sinus sinuses and cause chronic sinusitis. In addition, there are a lot of blood vessels in the bone tissue, and bacteria can get into the bloodstream, from where particularly aggressive can begin to spread throughout the body. Where the bacteria find the simplest path to the surface, for example in the gum, a fistula or abscess appears. It is extremely important that the roots are fully healed before the crown is placed – otherwise the consequences can be sad. For example, now we can say with confidence that inflammation and infection in the oral cavity increase the risk of cardiovascular diseases, stroke, diabetes, joint diseases, etc. That is, underestimate the condition of the roots of the teeth in the literal sense is dangerous for life.
Sometimes it happens that after receiving a general dentist, only a part of the nerve channel is healed. The number of nerve endings and roots may be different, in advance one can never tell how many of them are in the tooth. And at this stage the technical equipment of the endodontist plays an important role. Sometimes a dentist finds three nerves, and after examination under a microscope, the endodontist finds out that there are four of them. It’s dangerous: if you miss something, it will become a reservoir for infection, and bacteria will look for an outlet and always find it. And the crown should be placed solely on a strong base, otherwise it will not stand properly. It’s like building a house on the sand, not on a stable foundation. Do not also put the crown only for aesthetic reasons, if the tooth is still alive. This can lead to undesirable effects, such as inflammation and pain.
In some cases, without removing the crown, the dentist cuts the gum and cuts off the tip of the problem root – this manipulation is still carried out on the territory of the former Soviet Union. It is called “resection of the apex of the root,” and this is already a very outdated method of treatment. To conduct such an operation, you still need to make sure that there is no inflammation in the rest of the canal. If you simply cut off the tip of the root, and in the middle there is an infection, it will spread and again give inflammation and pain – i.e. the performed procedure as a result will not improve the condition of the tooth. But sometimes we do not succeed. For example, in the case of the so-called russian red, this is quite difficult.
“Russian Red” – so Western dentists call the “red tooth” – a tooth whose roots were treated with resorcin-formalin method. When the doctor could not find and cure the canals of the tooth, and the pain had to be urgently removed, the root was poured with a special substance called resorcinformalin. This mixture mummified the nerves and at the same time stained the teeth in a characteristic reddish color. This method has not been used anywhere in the world, except the countries of the former Soviet Union, hence the name “Russian Red” – “Russian red.” Resorcin-formalin is a very problematic substance, and it is extremely difficult to extract. Often it happens that the root canal is filled with Russian Red not to the end, and then the tooth is very difficult to save – unfortunately, almost impossible. Fortunately, the method has not been used for a long time and the “red tooth” is a thing of the past.
Of course, every dental case – whether it’s inflammation of the roots or something else – is treated separately, because each patient has an individual medical history and individual problems. In each case, the necessary specialists are involved, the doctors receive a comprehensive assessment of the situation and opportunities, and this, in turn, allows for treatment at the highest possible level.
Michael Meier: Doctor of Medical Sciences, Swiss dentist at the Swissparc clinic, founder of the first children’s dental emergency clinic in Zurich (2011). Since 2011, he is engaged in private practice in the medical center Perfect Smile. He is the author of numerous reports and publications.