When planning a comprehensive oral rehabilitation — whether it’s for a single tooth or a full-mouth transformation — the decision to save or replace a tooth is crucial. One of the most debated treatments in this context is root canal therapy (RCT).In some corners of dentistry, root canals have been surrounded by controversy. From the early criticisms of Dr. Weston A. Price in the 1920s to the thriving biological dentistry movement today, many claims have been made about the supposed dangers of root canals. On the other side, mainstream dentistry has decades of clinical data showing root canals as a predictable, safe, and cost-effective treatment when done properly.In this article, we’ll examine:
• What a root canal actually is
• How it fits into oral rehabilitation plans
• The scientific evidence on safety and success rates
• Common myths (and where they came from)
• When a tooth is better off extracted
• How modern techniques have addressed old concerns
In oral rehabilitation — especially full mouth rehabilitation (FMR) — root canals serve a strategic function:
• Preserving strategic abutments: In cases where teeth will support crowns or bridges, keeping the natural root in place maintains bone structure and occlusal stability.
• Avoiding unnecessary extractions: Each extraction accelerates bone resorption, which can complicate future implant placement.
• Maintaining proprioception: Teeth have periodontal ligament feedback that implants lack, aiding bite control.A multidisciplinary rehab plan might include root canals, crowns, veneers, implants, and bite correction all working together. The goal isn’t just aesthetics — it’s function, health, and longevity.
In the 1920s–30s, Dr. Weston A. Price, a prominent dentist and researcher, published studies suggesting that root canal-treated teeth harbored harmful bacteria that could cause systemic illnesses such as arthritis, heart disease, and neurological problems.His focal infection theory proposed that a chronic, low-grade infection in one area (like a dead tooth) could “seed” bacteria to other parts of the body.
Why It’s Controversial Today:
• Methodology limitations: His bacterial culture methods were primitive, and many of his conclusions were based on animal implantation studies that don’t translate well to humans.
• Lack of reproducibility: Later research using modern microbiology has failed to replicate his systemic illness link.
• Changing context: Root canals in the early 20th century lacked today’s irrigation, sealing materials, and imaging technology.While Price’s warnings influenced generations of dentists, the broader medical community moved away from the focal infection theory in the mid-20th century — at least in the sweeping way Price applied it.
Success Rates
Bacterial Control
Systemic Health Links
Preservation vs. Extraction
Myth 1: Root canals “leave the tooth dead” and toxic
Fact: While the pulp tissue is removed, the surrounding ligament and bone keep the tooth biologically active. Sealed canals don’t release toxins under normal conditions.
Myth 2: Root canals always fail
Fact: Properly performed root canals have decades-long survival rates; many last a lifetime.
Myth 3: Implants are always better
Fact: Implants are excellent in the right cases but come with their own risks — peri-implantitis, surgical complications, and higher costs.
Even science-based dentistry recognises that root canals aren’t always the right call. Situations where extraction might be preferred include:
• Severe vertical root fractures
• Advanced periodontal disease with poor tooth stability
• Inaccessible canals or severe calcification
• Repeated root canal failures with persistent infection
• Teeth with little remaining structure to support a crown. In such cases, implants or bridges may be better for long-term oral rehabilitation.
Since Weston Price’s time, root canal technology has transformed:
• Microscopes and CBCT for better visualization
• NiTi rotary files for safer, more efficient canal shaping
• Ultrasonic irrigation for deeper cleaning
• Bioceramic sealers that are antimicrobial and biocompatible
• Single-visit protocols in certain cases to reduce bacterial exposureThese advances mean that modern root canals are nothing like those done a century ago.
Yes. Modern root canal therapy is considered safe and effective. Decades of clinical research show that a well-performed root canal, followed by a proper crown or restoration, can last decades without causing systemic health problems. Historical concerns, such as those raised by Weston A. Price in the early 1900s, have not been confirmed by modern scientific studies.
With proper treatment and maintenance, a root canal can last 10–20 years or even a lifetime. Longevity depends on factors like the quality of the treatment, how quickly the tooth is restored after the procedure, bite forces, and overall oral hygiene.
Not necessarily. If a tooth can be saved with a root canal and crown, it often provides better chewing comfort, preserves the natural bite, and avoids surgical intervention. Implants are excellent for replacing teeth that can’t be saved, but they carry their own risks, such as peri-implantitis (gum infection around the implant).
No high-quality scientific studies have proven that root canal-treated teeth cause chronic diseases. The myth comes from early 20th-century studies that used outdated methods. Today’s root canals use advanced disinfection and sealing techniques that address those old concerns.
Modern root canals are usually no more uncomfortable than getting a regular filling. Local anaesthetic and advanced techniques make the procedure virtually pain-free. Post-treatment soreness is normal for a few days and is usually manageable with over-the-counter pain relief.
In oral rehabilitation, a root canal allows a dentist to keep a tooth that’s strategically important for function or bite stability. By saving that tooth, the dentist can build a more stable bite, maintain jawbone health, and often reduce the need for extra implants or bridgework.
Yes, root canals can fail if bacteria re-enter the canal space, the tooth fractures, or the restoration is delayed or poorly fitted. However, success rates are high — over 90% when performed correctly — and failed root canals can often be retreated.
Dentists use a combination of antimicrobial irrigants, rotary and ultrasonic cleaning tools, and biocompatible sealers to disinfect the canal. A full-coverage crown is usually placed to seal and protect the tooth, preventing bacterial leakage.
• Root canal therapy remains a cornerstone of tooth preservation in oral rehabilitation when done to modern standards.
• Historical criticisms from Weston Price raised valid questions in their time but don’t align with current scientific evidence.
• Decision-making should be individualised — weighing tooth prognosis, patient health, cost, and treatment goals.
• Modern endodontics is safe, effective, and highly predictable when performed by skilled clinicians using up-to-date techniques.
For patients embarking on a full mouth rehabilitation, the choice between root canal and extraction is significant. While myths and old fears still circulate online, decades of high-quality clinical research support root canal therapy as a safe, effective, and long-lasting solution in the right cases.At our clinic, we approach each tooth — and each patient — with the same philosophy: preserve where possible, replace where necessary, and always follow the science.