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Exposed: The Hidden Dangers of Ignoring Tooth Decay—What You Need to Know About Root Canals!

Chapters

Chapter 1: Introduction to the Podcast

[00:00:09 – 00:01:02]
Eon Engelbrecht introduces the podcast “Save Your Money, Save Your Teeth,” where dental care meets consumer insight. Best Cape Town Dentist Dr Clifford Yudelman is welcomed back to discuss the least favourable dental procedure from a consumer’s perspective—root canals.

Chapter 2: The Reality of Root Canals

[00:01:02 – 00:02:50]
Dr Yudelman and Eon Engelbrecht delve into why root canals are dreaded and pricey. They discuss the importance of early cavity treatment to prevent the decay from reaching the nerve, potentially necessitating a root canal.

Chapter 3: Detailed Explanation of Root Canals

[00:02:50 – 00:04:12]
Dr Yudelman describes the anatomy of a tooth and the root canal process, including cleaning and sterilising the canals to eliminate infection. The emphasis is on preventive care to avoid the need for this invasive procedure.

Chapter 4: Reasons for Root Canal Therapy

[00:04:12 – 00:05:52]
Various reasons that may lead to the need for root canal therapy, such as dental decay, fractures, and issues with existing dental work, are discussed. The conversation also covers emergency interventions like pulpectomy.

Chapter 5: Completing the Root Canal Process

[00:05:52 – 00:08:39]
The importance of completing the entire root canal process is highlighted. Dr Yudelman explains the steps involved in thoroughly cleaning and sealing the canals and the necessity of follow-up treatments like crowns to prevent further issues.

Chapter 6: Potential Failures and the Importance of Follow-up

[00:08:39 – 00:10:01]
Risks such as saliva contamination and fractures are discussed as potential causes for root canal failures. The need for timely and proper final restorations post-root canal to avoid reinfection and additional procedures is stressed.

Chapter 7: Choosing the Right Dental Professional

[00:10:01 – 00:13:06]
Dr Yudelman talks about the importance of selecting the right dentist or endodontist for root canal therapy, particularly for complex cases, to ensure the longevity and success of the treatment.

Chapter 8: Technological Advancements in Root Canal Therapy

[00:13:06 – 00:14:28]
The advancements in root canal technology, such as rotary endodontics and ultrasonics, are discussed, along with their benefits in making the treatment more efficient and successful.

Chapter 9: The Role of Technology and Retreatment Options

[00:14:28 – 00:16:10]
Continuing the discussion on technology, Dr Yudelman also covers the options for retreating failed root canals and emphasises the cost-effectiveness of retreatment compared to alternatives like dental implants.

Chapter 10: Importance of Comfort and Communication

[00:16:10 – 00:17:29]
To ensure patient understanding and satisfaction, the significance of comfort during root canal therapy and the role of effective communication and informed consent in dental procedures are highlighted.

Chapter 11: Patient Experience and Engagement

[00:17:29 – 00:21:46]
The episode concludes with a discussion on enhancing patient experience during dental treatments, including the use of special headphones to distract from the noise and discomfort of the procedure.

  • [00:00:09] Eon Engelbrecht E-Radio-SA: Welcome to Save Your Money, Save Your Teeth. This is your go-to podcast where curiosity meets dentistry, and it’s straight from the experts. It’s Eon with you. Every week, I’ll be chatting with Doctor Clifford Yudelman and taking a deep dive into the world of dental care from a consumer’s perspective. So whether you’re looking to brighten that smile or protect your wallet, we’ve got you covered with practical advice and also the latest insights. So stick around as we uncover the secrets to maintaining both your dental health and also your finances. Doctor Yudelman, welcome back once again.
  • [00:00:46] Dr Clifford Yudelman OptiSmile: Hi Eon, thanks for having me back. It’s great to be here, especially after last week’s episode about fillings. I know everybody hates fillings, but what do you reckon is worse than fillings?
  • [00:01:02] Eon Engelbrecht E-Radio-SA: Root Canals. Root canals? Yes.
  • [00:01:08] Eon Engelbrecht E-Radio-SA: You don’t want to. You don’t want to go there. You don’t want to go there. It was not my favourite experience. So, if you can avoid a root canal at all costs, avoid it because not only is it not a great experience, but it’s also a very pricey one.
  • [00:01:27] Dr Clifford Yudelman OptiSmile: Yes, exactly. And so sometimes the cost of not saving a tooth could be more. And back to, you know, the theme of our podcast, Save Your Money, Save Your Teeth. The best root canal is the one you don’t need, which means trying to avoid cavities in the first place. If you have a cavity and you know you’ve got a cavity, getting it taken care of while it’s still small, the longer you leave the cavity, the closer the decay gets to the nerve in the tooth. And once the tooth starts to hurt all on its own, or if you’re getting cold on a tooth and the cold makes the tooth hurt for more than 20 or 30 seconds, that’s called irreversible pulpitis. Or if you bang on a tooth, if you flick it with your finger or the back of a teaspoon and it hurts when you tap on it, that’s usually a sign of infection around the root. At that point, once the nerve of a tooth is affected it might not be infected yet, but it could be what’s called hyperemic or inflamed. That is when you have to make a choice to either extract a tooth or save the tooth by doing a root canal treatment. And so try to sort out things before it gets to that point.
  • [00:02:50] Eon Engelbrecht E-Radio-SA: Can you explain a root canal to us in more details? And why do we actually need that root canal procedure? Okay.
  • [00:02:59] Dr Clifford Yudelman OptiSmile: Yeah. So other than if someone has an accident and a front tooth gets cracked and the nerve of the tooth is exposed, even in cases like that, sometimes a root canal can be prevented if it’s in a young patient. There are ways to save the pulp of the tooth. You always want to rather try and save the pulp or the nerve of a tooth. The middle of the tooth is called the pulp, and it continues. There’s a pulp chamber which is in the middle of the tooth, and then it continues down to the bottom of the roots. And when a when a cavity or a crack allows bacteria to get inside the nerve canal or the pulp canal of the tooth, you get an infection at the bottom of the tooth, which is called an abscess and the process of a root canal is to get access, making a hole in the top of the tooth, removing all the decay, and getting access to these canals, and thoroughly, thoroughly cleaning them and sterilizing them. Getting rid of all of the bacteria and making sure that there’s no infection left in the tooth. And only then will everything heal properly.
  • [00:04:12] Eon Engelbrecht E-Radio-SA: Okay. And then, doctor, what causes may lead someone to need a root canal therapy?
  • [00:04:19] Dr Clifford Yudelman OptiSmile: So other than decay or a fracture, or if someone has a filling or a crown that is high and they are biting and they’re banging on it, or from severe clenching or grinding anything that causes irritation to the nerve beyond the point where the nerve can be saved. I think most of the reasons we’ve covered, I think something we should talk about is what happens if a person goes in. They’ve got a toothache. The dentist says, “You can have a root canal done, or we can pull your tooth out”. The patient says, “Okay, I don’t want to pull my tooth out. I’ll have a root canal done”. And the first visit is where the dentist just numbs the tooth and removes the nerve, and starts the cleaning process. But a lot of the time that’s like an emergency root canal or a pulpectomy, and they put medicine in the tooth. That is not the root canal. That’s just the very first part of it. And so many people, you know, spend a lot of money on that, and they don’t go back to finish the root canal, and then they end up losing the tooth because bacteria gets back inside and when you get an infection at this point, it will be even worse than before. So let’s just say you follow instructions, you go back, the dentist measures all of the canals and, like you’ve experienced, he’ll use special files to clean the canals and x-rays.
  • [00:05:52] Dr Clifford Yudelman OptiSmile: At OptiSmile, we have a 3D x-ray machine that will show us all of the canals. Sometimes a tooth, an upper molar with only three roots might have four or even sometimes five canals. Unless all of the canals are located, disinfected, and cleaned, the root canal will probably fail in the future. Once you’ve gone back for the second visit, the canals are all checked and made sure that all the infection is gone. They get sealed off and filled. And that’s not the end of the story because a tooth with a root canal is very weak, and it should get a crown or a ceramic onlay afterwards. It’s very rare that a large filling or cavity can get a root canal and then just get another filling. So again, like we said with fillings last week, is preventing root canals in the first place. It will go a long way to saving your money. By the time you need a root canal. It’s already a very expensive process and many, many visits. A root canal can be two visits, if not three, which is why it can be so expensive. And then you’ve still got to go back and get an inlay or a crown. And unless a dentist has a special machine like we have at OptiSmile, we’ve got something called a CEREC or a one-visit inlay or one-visit Crown Machine where we clean up the tooth, we scan it and the machine makes a new tooth, which we then bond on top of your root canal tooth the same day, you have to go back for the dentist to fit the crown. You know he’s taken a mould or a scan. He’s sent it to the lab. There’s the lab fee incurred. We use a very good lab. We pay R4500 just for the lab to make the crown. If you’re in a small town or you go to a medical-aid dentist, they might be using a lab that only charges them maybe R1000 or  R2000 rand. And, you know, there’s differences in economics. And also, you know, depending on the area that you are in and the level of technology that’s used, so to speak. I don’t want to equate technology with quality because some dental technicians are still making crowns by hand, and they do a very good job, but their prices may be very low. It’s not our experience. But yeah, once you get a root canal you have to get a crown. There are cases, for instance, on a front tooth where one can do a root canal and just fill in the little hole at the back of the tooth, where you don’t have to put a crown on a front tooth. In fact, on front teeth, we very rarely will put a crown once a tooth has had a root canal. I was talking more about molars there.
  • [00:08:39] Eon Engelbrecht E-Radio-SA: So there’s always a risk of saliva contamination or decay or fracture that could lead to the root canal procedure not being successful. And then they will have to be another one. Is that correct?
  • [00:08:54] Dr Clifford Yudelman OptiSmile: Yes, exactly. So that’s that’s what I was saying is if you go in and you get your root canal either started and you don’t go back and get it finished, or you get your root canal finished and say your dentist has sent you to a root canal specialist, which we’ll talk about shortly here. A root canal specialist might do the root canal and put a temporary filling in and say, go back to your dentist and get the permanent restoration or permanent filling or permanent crown, and you’ve just spent whatever it is R8,000 to R14,000 for a root canal. And now you’re broke, and you don’t have the money to do the inlay or the crown, and you leave it for six months or a year. Well, then you’ve just you’ve just thrown your money away because if that temporary filling leaks or you crack the tooth or the temporary comes out and the root canal, the seal on top of the root canal is broken, the bacteria can move in and reinfect the canals and you might as well have just had that tooth extracted. You’ve wasted your time and your money.
  • [00:10:01] Eon Engelbrecht E-Radio-SA: Doctor Yudelman, How important is the choice of a dental professional in the success of your root canal therapy?
  • [00:10:07] Dr Clifford Yudelman OptiSmile: Okay. So, thanks for that. So if a tooth has quite a large canal and it’s fairly straight like a front tooth, or any of the upper front six teeth, most general dentists are quite competent in treating those. Lower premolars – most general dentists are competent. A lot of general dentists these days, especially in the Western Cape have done advanced courses or have great technology. These days we have what’s called reciprocal or rotary endodontic files. We’ve got one that connects to an iPad, and it tells you when you’ve gotten to the end of the root canal. It’s got built-in electronic sensors. And basically, you can do a root canal with your eyes closed. Having said that, when you get to upper molars and or some premolars or lower front teeth, the root canal anatomy can be very, very complex. If the dentist, in that case, doesn’t have a CBCT, which is a cone beam x-ray, a very high-tech x-ray, or a 3D x-ray, or they don’t refer you for a CBCT, they could miss the canals. A dentist doing a root canal treatment should be wearing loupes, magnification glasses at the very least, or preferably if it’s a complex root canal, a microscope. At OptiSmile, we have three operating microscopes. If the dentist is not certain that he’s going to do a really good job and guarantee that the tooth has a good chance of being saved over the next five, 5 to 10 years, he might refer you to an endodontist, a specialist, or even another general dentist that he knows does very good root canals and has advanced equipment or training, knowing that you’ll go back to them for the inlay or the crown. It is very important on complex root canals, there is a difference in outcomes between general dentists and endodontists. I found that in general, most of the dentists I meet in South Africa are very, the word we use here in South Africa is “Kop-Toe”. They tend to stay in their lane. They will refer you to an Endodontist. They’re not going to do a root canal if they don’t feel confident. You know, some of these roots have got a like a J. They look like the letter J. They got a lot of curves in them and they’re very difficult to clean all the way to the end. And other times, there are complications. A dentist might be doing a root canal, and you can get a separation or breakage of an instrument in the canal. They are general dentists, you know, we’ve hosted some some study clubs, and there can be 60 dentists here at OptiSmile doing a course on root canals. And some of them are very keen.
  • [00:13:06] Dr Clifford Yudelman OptiSmile: And they’ve got the tools and techniques to remove broken instruments. But by and large, if if that happens, the dentist should tell you and say, you know, I’m sorry this has happened, it does happen sometimes, which it does. And I’m going to send you down the road or to the next town or, or to Cape Town to see a specialist and get this instrument removed, and for the specialist to finish up the root canal so that we can be sure to save the tooth. The root canal has to be done perfectly to work long-term. You can get away with it for a year or two or 3 or 5 years sometimes. But eventually, if a root canal isn’t done perfectly, it will have problems. And just to share a little secret, I don’t do any root canals at all. I don’t enjoy them. I haven’t done root canals in years and years. In Australia referred all of my root canals to specialists. The specialists in Perth, Australia, loved me, and in America, I actually used to refer to the founding father of microscopic endodontics. Certain parts on the microscope are named after him. A shout-out to Doctor Gary Carr. I think he’s in his 80s. He’s still one of the leading endodontists in America. I think he could be about 85 now and he still practices, which is amazing.
  • [00:14:28] Eon Engelbrecht E-Radio-SA: Wow. And that’s really amazing. Yeah, that is quite something. Doctor Yudelman, can you also quickly discuss the importance of technology and the approach to the success of root canal treatments?
  • [00:14:42] Dr Clifford Yudelman OptiSmile: The these days, it’s it’s commonly accepted that rotary endodontics, that’s where you have a special machine. The little files attached to it goes quicker. It can do a more thorough cleaning. There’s ultrasonics when you put the chemicals in the disinfectant, which is just like like Milton’s, like drain cleaner that you put in the root canal. It smells like drain cleaner. And then you activate it with ultrasonics, being able to see all of the canals when you access them. So using magnification, some endodontists have lasers where they can put a laser down all the way to the end of the canal to help with sterilizing it. It just makes things go quicker. It doesn’t necessarily do a better job in all cases. I’ve had a few root canals done. One of them was done with a laser that was five six years ago and the tooth is perfect. Another thing is retreatment. So I have a couple of general dentists in my practice that are very competent and can do a retreatment, which is where a root canal has failed or where there’s been a reinfection. But we have a policy at OptiSmile that 99% of the time if a root canal needs retreatment, we send them to the specialist because that’s what they are trained to do.
  • [00:16:10] Dr Clifford Yudelman OptiSmile: So just because a root canal hasn’t worked or a root canal has become reinfected, I want the listeners to know that there’s often a chance, unless the tooth is cracked, that you can actually get a root canal retreated. It doesn’t always mean that the crown needs to be removed. If the tooth has a crown, a specialist can drill through the crown, retreat the root canal, and then put a filling into the crown. You don’t have to always change the crown unless the crown leaking or decaying underneath is the reason for the root canal failing in the first place, in which case the root canal specialist will remove the crown. Clean up the root canal, clean it all out, seal it, build the tooth up, put a temporary crown on, and you go back to your general dentist for a new permanent crown and hopefully get another 10 or 20 years out of that tooth. And even then, in most cases, having a root canal or retreating a root canal and getting a crown will cost a lot less than putting an implant in. We can talk about implants next week since we’re on the subject of root canals.
  • [00:17:17] Eon Engelbrecht E-Radio-SA: Okay. And then just one final question. Doctor Yudelman, why would you say comfort and communication is so important with a dental professional in root canal therapy?
  • [00:17:29] Dr Clifford Yudelman OptiSmile: Okay. Yeah, that’s that’s very, very important. So there’s something called informed consent, which for procedures like root canals or even teeth whitening when we do injection molding. When we do implants, when we do root canals. Informed consent is having a conversation with the doctor or the specialist about why you need a treatment, what the advantages are, what the disadvantages are, what can go wrong, and what happens if it does go wrong. The communication before the treatment is very important. During the treatment, the specialist or the dentist should explain to you what to expect during the treatment. A lot of patients fall asleep during root canal treatment because it is a long procedure we have headphones. If a patient wants to listen to headphones just to take their mind off things. In general, you should not feel anything at all if you’re getting a root canal. If it’s painful, you should stop the dentist. Sometimes, there’s a situation where a patient has left a tooth, where the nerve is not dead, and the canal, some of the canal, is still alive. It’s called a hot tooth. And when you hear stories about root canals being terrible, it can be where it is no fault of the dentist, but the patient has left it just too long. And that’s something you really want to avoid. And there can be some discomfort for a brief moment while the dentist puts anaesthetic directly into into the nerve in one of those cases. But it’s very rare. We’ll we’ll always try to prevent anything like that. But there is a case, there are cases where you just have to “Vas-Byt”. And 99% of the time, that never happens. So we don’t want to scare people. Yeah. Look it’s it’s not fun, but it’s better than losing your tooth.
  • [00:19:29] Eon Engelbrecht E-Radio-SA: And then, doctor, just for interest sake, what do you play in those headphones when the patients put them on? Is it classical music, or are you playing these podcasts?
  • [00:19:39] Dr Clifford Yudelman OptiSmile: Patients. I always say to patients when I say, what would you like to listen to? They say, oh, my favourite is The Beatles, for instance. And I say to them, oh no, don’t play your favourite because every time you hear that, it’s going to remind you of when you got the root canal done. True story. Play like AC/DC or something. Something so you can’t.
  • [00:20:01] Eon Engelbrecht E-Radio-SA: Hear above heavy metal.
  • [00:20:03] Dr Clifford Yudelman OptiSmile: Maybe you play something that your teenagers listen to that you already hate and, you know, like some rap or something you hate more than the root canal.
  • [00:20:13] Eon Engelbrecht E-Radio-SA: Something nice and loud. Yeah, yeah.
  • [00:20:15] Eon Engelbrecht E-Radio-SA: I think.
  • [00:20:15] Eon Engelbrecht E-Radio-SA: That’s a very good idea.
  • [00:20:16] Eon Engelbrecht E-Radio-SA: Yeah. Look. Yeah.
  • [00:20:17] Dr Clifford Yudelman OptiSmile: You don’t want to ruin your favourite music. Something relaxing. I have patients that listen to podcasts. I actually had a patient yesterday that requested. I said, what music would you like? She was getting four fillings done in a crown, and she said, actually, I’d like to listen to a podcast. And I said, well, what would you like to listen to? She said, well, I saw your email about your podcast. Can I listen to your podcast?
  • [00:20:42] Eon Engelbrecht E-Radio-SA: Wow, that’s cool.
  • [00:20:44] Dr Clifford Yudelman OptiSmile: And she listened.Yeah. She was in the chair for about two hours, and I think she made it through four of my, my previous podcasts. That’s amazing.
  • [00:20:52] Eon Engelbrecht E-Radio-SA: Yeah, I love that.
  • [00:20:53] Eon Engelbrecht E-Radio-SA: That’s an awesome story. I love it. Yeah. Awesome. Oh, that’s great.
  • [00:20:59] Dr Clifford Yudelman OptiSmile: We have those special headphones that actually sit in front of your ear. So they’re hygenic and they go through the bone. So they do block out a lot of the lot of the noise. And they take your mind off things. They’re called shocks.   Open Shockz.
  • [00:21:19] Dr Clifford Yudelman OptiSmile: So they don’t go in your ear and I can still talk to the patient, but it does block out all the noise and so on.
  • [00:21:26] Eon Engelbrecht E-Radio-SA: That’s really. Cool, I love it. I love hearing that. And that is root canals today, on Save Your Money. Save Your Teeth with Doctor Yudelman. That’s another podcast in the bag. And a big thank you once again, Doctor Yudelman, for sharing your expertise with us. It’s much appreciated.
  • [00:21:46] Dr Clifford Yudelman OptiSmile: Thanks for having me on.
  • [00:21:48] Eon Engelbrecht E-Radio-SA: So remember, while we strive to provide valuable insights, always consult with your own dental professional for advice tailored to your personal health. Also, don’t forget to subscribe for more enlightening discussions and then join us again next week as we continue to explore the fascinating intersection of dental, health and financial savvy. Until then, keep smiling and taking great care of your teeth.
  • [00:22:20] Eon Engelbrecht E-Radio-SA: Discover the world of dental excellence with OptiSmile. Join us for a weekly podcast featuring Doctor Clifford Yudelman, a seasoned expert with 40 years of dental experience across four continents. Gain unique insights and expert dental advice by visiting OptiSmile.Co.za. For articles that illuminate the path to optimal oral health. If you’re seeking unparalleled dental care in Cape Town, get in touch with OptiSmile or book directly online at OptiSmile.co.za. OptiSmile, where global expertise meets local care.

Disclaimer: The content provided in this podcast, “Save Your Money Save Your Teeth” on Medical Mondays, is for informational and educational purposes only. It is not intended to serve as dental or medical advice. The insights and opinions expressed by Dr. Clifford Yudelman and any guests are designed to foster a better understanding of dental health, preventive measures, and general well-being, but should not be interpreted as professional dental or medical recommendations.Dr. Clifford Yudelman does not diagnose, treat, or offer prevention strategies for any health conditions directly through this podcast. This platform is not a substitute for the personalized care and advice provided by a licensed dental or healthcare professional. We strongly encourage our listeners to consult with their own dental care providers to address individual dental health needs and concerns.The information shared here aims to empower listeners with knowledge about dental health but must not be used as a basis for making health-related decisions without professional guidance. Your dental care provider is the best source of advice about your dental and overall health. Please always seek the advice of your dentist or other qualified health professionals regarding any questions or concerns about your dental health.

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Dr. Clifford Yudelman

Founder & Principal Dentist

As a globally recognised restorative and cosmetic dentistry expert, Clifford brings over 40 years of experience across four continents. A 1983 Bachelor of Dental Science graduate from the University of Witwatersrand, his career has spanned private practices in London, San Diego, Perth, and Cape Town. Currently the founder and principal dentist at OptiSmile, he is celebrated for transforming dental visits into positive experiences and fostering patient confidence through superior dental health, with a commitment to the latest dental technology for improved patient outcomes.

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