From Tooth-Worms to Technology: The Evolution of Root Canal Therapy
I thought about wishing you a Happy Monday, but that’s like saying enjoy your root canal…or you’re as much fun as a root canal. You’ve heard them all before. You hear the words ”root canal,” and you immediately cringe and say I don’t want one of those!
The Origins of Endodontics
The word “endodontics” itself comes from the Greek prefix “endo,” meaning “within,” and “odont,” meaning “tooth. The term endodontics was coined by Dr. Harry B. Johnston.1 In 1928, his practice was the first practice to be “limited to endodontics”.
Historical Treatments and Beliefs
The first evidence of treatment “within a tooth” dates back to around 200 B.C. when archaeologists discovered a human skull in the northern Negev Israeli desert containing a tooth that had a 2.5 mm bronze wire in it, which was believed to have been used by the Romans as a treatment for infected teeth.
The Romans were also assumed to have invented crowns and dentures. A few hundred years later, archaeological findings revealed that root canal infections were drained as a method of relieving pain. This is thought to have been the main method for the treatment of infected root canals, with the exception of extraction, until around the 1600s.
One of the original theories for the cause of tooth pain was the “tooth-worm” theory. This theory dates back to the Babylonian times, yet this belief in worms as the causative agent of dental caries continued through the late Renaissance. Specifically, the theory claimed that a tooth worm resided in the hollow portion of a tooth, where it would cause a toothache by gnawing at the structure of the tooth. One method of driving the worm from within its hiding place in the hollow tooth was to tempt it with honey smeared on the outside of the tooth; this would cause the worm to emerge to eat the honey, at which time it could be plucked from the mouth.
Pioneers and Progress in the 1700s
A few decades later, in 1700, Anton van Leeuwenhoek, the “father of modern microscopy,” worked with worm-infested cheese in response to receiving worms from the president of the Royal Society of London, the most august scientific body of its day. While his work did not completely invalidate the “tooth-worm” theory, it definitely did much to lessen its acceptance. Specifically, Leeuwenhoek attributed tooth pain to pulpal inflammation; however, he did not correctly discuss its etiology. He incorrectly ascribed the pain to a result of the worm eating away at the tooth, rather than the inflammatory action of the bacterial toxins on the dental pulp. In addition, he claimed that pain reduction was a result of killing the worms with the use of Oyl of Vitriol. The reality is that sulfuric acid destroyed any remaining vital nerve tissue in the pulp, which is what most likely led to the reduction of pain. The use of sulfuric acid was actually practiced to some extent until the end of the nineteenth century.
Nearly thirty years later, in 1729, Pierre Fauchard – known as the father of modern dentistry – wrote his book The Surgeon Dentist. In this book, he wrote descriptions not only of pulp cavities and root canals; but also regarding the practice of opening teeth to relieve abscesses and evacuate pus. He made mention of a few different remedies for relieving tooth pain, one of which was to leave a tooth open for up to three months, after which time he would fill the pulp chamber with lead foil. Another remedy Fauchard discussed involved rinsing the mouth every morning and also before going to bed with one’s own rinse (urine) immediately after it has been emitted, always provided that the individual not be ill. While these methods seem ludicrous today, they must be viewed in the context of the medical practices and knowledge of that time. Consider the number of diseases for which bloodletting was used as a treatment during that time period.
Finally, the last method of relieving discomfort mentioned by Fauchard is more directly related to endodontic issues as it involves pulp extirpation, or trepanation of the tooth, using a small needle or pin. Another common endodontic procedure found its roots in the mid-1700s when a German dentist discussed the first pulp cap. Specifically, this occurred in 1756 when Dr. Phillip Pfaff, dentist to Frederick the Great, discussed capping exposed pulps using gold foil or lead. This was done to prevent the exposed nerve from direct contact with the restoration.
Innovations in the 1800s
While there were many different treatment modalities within endodontic therapy during the late 1700s and early 1800s, a major advance came in 1838 when Edwin Maynard created the first instrument designed specifically for endodontics. He designed this endodontic instrument by modifying a watch spring. (In addition, he invented the Maynard Rifle, which is what he became most famous for, as his rifle was used by armies all over the world). A short time later, in 1847, Edwin Truman introduced gutta-percha to the field of dentistry. Gutta-percha was first used in dentistry as a filling and denture base material, and the first individual to popularize the use of gutta-percha as a sole root filling material was G. A. Bowman in 1867.
While there have been many other materials developed and used for the obturation of the root canal system, there is absolutely no question that gutta-percha has stood the “test of time,” probably more so than any other material in dentistry. Through the years, gutta-percha has been found to be useful for many different purposes such as golf balls, protection for the hulls of boats, insulation for underwater cables, manufacturing of corks, and surgical instruments, just to name a few of the more popular uses. There is no question that more obturation materials will continue to be developed and tested; however, at this time, gutta-percha is the most widely accepted material available.
Modern Advancements in Root Canal Therapy
Technology has taken root canals a long way from the painful to now not feeling a thing. The infection the tooth has is where the real pain comes from and it’s the memory of it that gives root canals a bad reputation. The local anesthesia puts your nerves to sleep so if you feel anything, it’s only pressure. We now have 3D Cone beam Cat scans, the X-Guide for real-time radiographic guidance, apex locators, and microscopy to get the true close-up of what is happening inside the pulp chamber as the instruments are guided for exact placement minimizing the time and precision accuracy.
UConn’s Contribution to Endodontics
Did you know that it was the University of Connecticut that first developed certification for endodontists (root canal specialists)? The UConn School of Dental Medicine Endodontology program is a three-year program having graduated from Dental School. The three-year clinical program is designed to prepare the student for the practice of endodontics. Enrollment in the Master of Dental Science Degree program is an interdepartmental program leading to the degree of Master of Dental Science. The program offers an opportunity for study and research in dental science, basic life sciences, and allied health fields.
The root canal specialists here in Manchester are all associated with UConn for their training. Dr. Mainkar is a board-certified Endodontist having earned his certification from UConn. Dr. Owart is in his third year of the certification program at UConn. Dr. Garcia completed his certification program at UConn and is board-eligible. Our team are specialists in root canal therapy and will provide all the modern techniques for painless completion of the surgery and work to save your tooth.
Why You Shouldn’t Wait
The key is not to wait for things to get worse. The sooner the therapy is done, the better the chance of saving your tooth. Call Columbia Dental before things get too bad. Call 860-645-0111 to see one of our root canal specialists. One Day, Same Day, 7 Days a week
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