White paper calls for more attention to endodontic oral care

Mary Otto

About Mary Otto

Mary Otto, a Washington, D.C.-based freelancer, is AHCJ's topic leader on oral health and the author of "Teeth: The Story of Beauty, Inequality, and the Struggle for Oral Health in America." She can be reached at mary@healthjournalism.org.

Photo: Lorenia via Flickr

A survey of dozens of dental organizations from Brazil to Vanuatu reveals that patients around the globe dread root canal treatments.

A new white paper from the Geneva-based FDI World Dental Federation aims to dispel the fear surrounding such procedures and highlight the tooth-saving potential of endodontics; which is the care and treatment of the soft tissues within and around the teeth.

It is not clear how many of the 4 billion people who suffer from oral disease worldwide might benefit from endodontic services, but the need is believed to be high. Untreated tooth decay impacts more than one-third of the people suffering from disease, according to the paper. Without timely restorative care, decay progresses, eroding the hard outer layers of the tooth, which allows pathogens to reach the vital pulp within. Intense pain and inflammation often result. Injury is another common pathway to pulpal harm, with an estimated 1 billion people worldwide have suffered dental trauma. Like decay, dental fractures can give microorganisms access to the pulp.

Dentists often employ pulp testing and radiographic imaging in diagnosing endodontic conditions and developing treatment plans.

Endodontic procedures range from pulp capping, which protects still-vital tissues within a damaged tooth to root canal treatment, in which diseased pulp is removed and the roots inside the tooth are cleaned, shaped and sealed. The placing of a crown restores the functionality of the tooth.

To reduce the future need for such treatments, FDI encourages a stepped-up global focus upon oral disease prevention through increasing the availability of community water fluoridation, reducing sugar consumption and improving access to routine clinical services. The organization also urges heightened attention to public safety measures that could reduce oral trauma.

To make endodontic care more broadly available, FDI calls for better training of oral health professionals in endodontic procedures. The organization also urges health care systems across the world to pay more attention to dental needs and support provision of endodontic care as part of broader efforts to advance oral and population health overall.

“A lack of political commitment to oral health and an absence of policies to strengthen oral disease prevention and care provision can act as barriers to optimal endodontic care,” the paper notes, acknowledging that increased access to care will come at a cost.

“Dentists may opt to extract teeth rather than perform endodontic restoration if remuneration for endodontic treatment is considered to be too low,” the paper concludes.

When it comes to covering endodontic services here in the U.S., private and public benefits regularly fall short. And in 2016, more than 74 million Americans had no dental insurance at all, according to the National Association of Dental Plans.

“Even with coverage, many people put off fillings, crowns and root canals due to high co-pays,” observed Monica Schoch-Spana, a senior scholar with the Center for Health Security at the Johns Hopkins Bloomberg School of Public Health in an opinion piece published last year in the Baltimore Sun.

In the essay, Schoch-Spana explored her own pain — and mulled treatment options — after suffering a cracked molar.

“I could choose an extraction now or keep hedging my bets to preserve the tooth: A $230 scan could gauge the crack’s severity. If the findings were inconclusive, then physically opening the tooth for inspection at $470 would determine if a root canal was justified. If so, then $800 more would complete the procedure,” wrote Schoch-Spana. She ended her piece with an agonized call to reform the American health care system to better meet such oral health needs.

“Resolved to have my molar pulled, if need be,” she said. “I also want our cracked dental system yanked and replaced.”

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