FACULTY OF ODONTOLOGY | Lecture
Inaugural Lecture – When Cavities Go Deep: New Insights into Cavities and Root Canal Treatment

Tooth decay is one of the most common public health problems. When tooth decay becomes deep, there is a risk that the tooth’s pulp will be damaged. By using gentler treatment methods for deep tooth decay, the need for root canal treatment can be reduced in many cases.

The fundamental purpose of a root canal is to preserve the tooth and avoid having to extract it. But how successful are we really at achieving this in the long term? Being able to keep one’s own teeth is important, since individuals’ perceived oral health—and thus their overall health—is closely linked to retaining their teeth.

In Sweden, we have a unique opportunity to track the results of dental treatments through national registries. We can thus study the outcomes for the nearly 250,000 teeth that underwent root canal treatment just over ten years ago. For most of these teeth, the treatment has been successful in the sense that they are still present in the mouth. However, some have been lost over time. The risk that a root-filled tooth will later need to be extracted is influenced, among other factors, by the patient’s age, the tooth’s location in the mouth, and how the final restoration of the tooth crown was performed. Since patients themselves bear a large portion of the cost of dental care, financial circumstances can also influence treatment choices. Patients with lower socioeconomic status may therefore forgo—or not be offered—more costly options for tooth restoration.

Even if a root-filled tooth remains in the mouth, this does not necessarily mean that it is completely healthy. It is relatively common for such teeth to show signs of residual disease, even though the patient usually has no symptoms or only mild discomfort. In some cases, the tooth can lead to a painful acute infection, and, more rarely, a more serious infection may develop. How these root-filled teeth—where the risk of future emergency procedures or serious infection is unknown—should be managed is not self-evident. A dentist’s decision to refrain from further treatment of a root-filled tooth showing signs of residual disease is complex and is often influenced by several factors beyond the tooth’s biological status.

In order for both dentists and patients to make well-informed decisions about these root-filled teeth, we need to address the prevailing uncertainty. More knowledge is needed about the risks, benefits, and costs associated with different treatment strategies. Such knowledge is essential for providing care that is both evidence-based and cost-effective.