The Real Story about Root Canals with Dr. Sonia Chopra: Rational Wellness Podcast 314
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Dr. Sonia Chopra discusses The Real Story about Root Canals with Dr. Ben Weitz.
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Podcast Highlights
2:02 Dr. Chopra was born without eight teeth, so she was born to be a dentist. When she was in high school, she developed a toothache and her dentist could not figure out where it was coming from. She saw several different dentists and it took nine months and she eventually had her tooth pulled, but they pulled the wrong tooth. Finally she got to an endodontist, who gave her the root canal she needed.
5:53 Healthy practices to keep your teeth healthy. Flossing regularly is really important because a lot of the decay happens from the contact point between our teeth where the toothbrush can’t go. While the waterpik may have some benefits, it does not replace flossing. Dr. Chopra uses two different types of floss–the thin floss and an expanding floss. You should make a C around the side of each tooth with the floss and then go up and down gently into the gums.
11:22 Biofilm. While the healthy bacteria in the oral microbiome do form a biofilm, generally you do want to break up most of these biofilms because if this biofilm that we call plaque gets too thick, it will cause you to have gingivitis.
13:12 Toothbrush. Dr. Chopra prefers the Sonicare toothbrush and she feels that the ultrasonic action of the brush will help to break up the bacterial cell wall.
14:05 Toothpaste. Dr. Chopra feels that some patients benefit from flouride in the toothpaste because it can protect the teeth against cariogenic bacteria. Her daughter was having a lot of cavities and they stopped after she started using a toothpaste with flouride.
17:45 Root Canals. With a root canal procedure you save a tooth that has a deep infection in the pulp area instead of having it pulled. According to Dr. Chopra, if a root canal is done in the right manner by properly disinfecting the tooth, it is a regenerative process and some of us can actually regrow our own bone back without a bone graft and without extra calcium. “There’s just so much value to our teeth and we were born with them for a reason. We’re not supposed to take them out.”
19:52 Root canal myths. Some people claim that root canals are dangerous to our health because when you do the root canal you kill the nerve and the blood supply to the tooth, so now the tooth is dead. The second argument why root canals are bad is that there’s no way to remove all the bacteria, and the bacteria will fester and lead to various chronic health problems. Dr. Chopra explains that most of the time the tooth is already dead before the root canal because the bacteria got in there and already killed the nerve. Some people have been living with a dead tooth for years and that’s when you can grow spaces in the bone due to bone reabsorption. Even after root canal, you still have proprioceptors that are in the periodontal ligament that attach the tooth into the bone, which is swimming in these haversion canals that continue to provide the tooth a blood supply. Therefore, root canals are regenerative and often a better alternative to an extraction.
28:26 Implants. Some teeth are fractured or split and cannot be saved by a root canal, so in this case, an implant is the last resort. Implants can sometimes fail and sometimes they don’t take. One potential problem with implants is that you are putting a piece of heavy metal such as titanium in your mouth and your tissues may react and you can have bone loss around the implant.
Dr. Sonia Chopra, DDS, a board-certified endodontist, TEDx speaker, author, and E-School founder, argues that it is time to debunk such myths. Science has proven, over and over, that root canals are hugely beneficial to our oral health, not harmful. The thing that can really be harmful is the premature removal of teeth which leads to the loss of money, time, self-esteem, and self-confidence. Her website is DrSoniaChopra.com.
Dr. Ben Weitz is available for Functional Nutrition consultations specializing in Functional Gastrointestinal Disorders like IBS/SIBO and Reflux and also Cardiometabolic Risk Factors like elevated lipids, high blood sugar, and high blood pressure. Dr. Weitz has also successfully helped many patients with managing their weight and improving their athletic performance, as well as sports chiropractic work by calling his Santa Monica office 310-395-3111. Dr. Weitz is also available for video or phone consultations.
Podcast Transcript
Dr. Weitz: Hey, this is Dr. Ben Weitz, host of the Rational Wellness Podcast. I talk to the leading health and nutrition experts and researchers in the field to bring you the latest in cutting edge health information. Subscribe to the Rational Wellness Podcast for weekly updates and to learn more, check out my website, drweitz.com. Thanks for joining me, and let’s jump into the podcast.
Hello, Rational Wellness podcasters. Today is the first time we’ll be talking about the teeth. In the functional medicine world, root canals are often criticized as harmful to our health because now you have a dead tooth in your mouth. And while dentists or endodontists attempt to remove all the bacteria, they may or may not be capable of removing all the bacteria. And if the bacteria is still in there, it may fester and spread around the body. And critics of root canals claim that the bacteria can potentially cause chronic conditions like immune dysregulation and even possibly trigger heart attack, strokes, or cancer. But it’s not clear to me that either that is necessarily the case or that pulling your tooth out and putting a metal implant is necessarily a great alternative either. To sort this out, we have Sonia Chopra, who’s a board certified endodontist, a TEDx speaker, author, an e-school founder, and she argues that it’s time to debunk some of the myths about root canals. So Sonia, welcome to the Rational Wellness Podcast.
Dr. Chopra: Well, thank you so much for having me. It’s really an honor.
Dr. Weitz: Absolutely. So perhaps you can tell us about your personal journey and how you came to become an endodontist.
Dr. Chopra: Yeah, so I kind of started when I came into the world, I was born without eight teeth, so I always say I was born to be a dentist. I just came in having a lot of stuff to do in my mouth, and I was just a constant patient. And then once I got through my growth and development and I had all these missing spaces, my mom was adamant on making sure to restore my inclusion before I went to college. And then quickly after some of those visits, I developed a toothache and that toothache, nobody could figure out where it was coming from. So the diagnosis of the source was really complicated for many people. They even thought that I had trigeminal neuralgia. I ended up seeing several different specialists even outside of dentistry because they didn’t know where my source of pain was coming from.
That saga lasted about nine months, and then finally I developed the abscess. That was the sign that it was clearly a tooth. I went to my dentist, they said I needed my tooth out, I got my tooth out, and then unfortunately, I still had my toothache because they had diagnosed the wrong tooth. So then they realized, “Oh, I can’t take out any more teeth on this poor young girl.” So then they said, “Oh, let me introduce you to the endodontist.” And then I got the root canal that I needed, saved my tooth, and I was like, “Oh my goodness.” And so my journey to after college I knew was going to be in medicine, and this event in my life really kind of had such an impact on me that I was like, “Okay, maybe not medicine-medicine. I don’t want to be a medical doctor, but maybe I need to be a dentist,” because I had so many experiences as a patient and I just felt like that was going to be my path.
So I went to dental school, and then during dental school I was really intrigued about my own tooth story and why I experienced that. And so I went down the path of specializing in endodontics after I went to dental school, and then now I’m in my own private practice. I’ve been doing this for 15 years and I still see my own tooth story every single day. So it’s become my passion to really talk about what happened to me, talk about what I see in my practice every day, and how I truly believe that root canals can be regenerative.
Dr. Weitz: I know I had a root canal not too long ago. In fact, I was sitting in the office of my endodontist when your email came through about possibly appearing on the podcast. And so I thought, “Well, I have some interest in that topic.” And he made a big deal out of exposing different teeth to hot and cold. We’re pretty sure which tooth needed a root canal because I had had a deep cavity and we tried to correct a tooth without having to need a root canal, and then it didn’t work. And I ended up having all this pain. So my dentist said, “You got to get a root canal.” But even then, we still super careful to make sure, tested couple of different teeth to see which one was symptomatic.
Dr. Chopra: Awesome. Sounds perfect. Which wasn’t my situation, unfortunately. So for me, diagnosis is really important and making sure you get the right tooth because you can really have a lot of referred pain and there’s nothing worse than somebody still having their toothache after treatment.
Dr. Weitz: Right. So what are some of the most important healthy practices to keep your teeth healthy?
Dr. Chopra: So prevention is key. I would love it if I had not as busy of a practice.
Dr. Weitz: So people should smoke and eat McDonald’s and eat candy and chocolate as much as possible?
Dr. Chopra: Absolutely not. I would love it if people actually floss more. I say flossing is life. A lot of the decay happens from the contact point between our teeth where the toothbrush can’t go and it’s really not… you shouldn’t replace it even with a Waterpik. That little click that you hear when you floss, that’s the point where the decay starts. And the only thing that can really get in there is the little piece of floss.
Dr. Weitz: Let me ask you, does it matter what kind of floss? They have dental tape versus dental floss because sometimes I know when I floss and I use it just to floss, it’s always breaking. So I prefer the dental tape.
Dr. Chopra: So it depends on how tight your contacts are. So I have some, because I have a lot of restorations because remember I was born without eight teeth. So I have some areas where my contacts are really tight and only the tape goes through and I have other areas that are a little wider. And I actually like an expanding floss. So I actually travel with two different types of floss.
Dr. Weitz: Oh, wow.
Dr. Chopra: So that’s kind of the way I’ve needed to adapt to my oral environment. But-
Dr. Weitz: Does it matter what the floss is made out of? Is there an ideal?
Dr. Chopra: No, I don’t really think so. I think it’s really making sure you know how to floss properly. It’s more than just hitting that click. It’s also making sure you wrap the floss around the tooth and making a C around the tooth, and then being able to glide along the surface. And then do the same thing-
Dr. Weitz: So you go around the side or around the front of the tooth or the back of the tooth or all of the above?
Dr. Chopra: So the toothbrush is going to get the cheek side and the tongue side and the occlusal side. So everything that’s missing is going to be the stuff where we call, it’s an embrasure, which is kind of where everything peaks up. And that’s where people get food traps too. So you want to make sure the floss glides down into the tissue, because you have a sulcus, it’s almost like there’s a moat that goes between your gingival tissue and your tooth, and that’s where you’re going to get a big accumulation of plaque. So that’s where you really want your floss to touch. Plus you want it to make sure that it’s touching the tooth surface. So you have to make that C around one tooth and then the adjacent tooth on the other side. So I wish I had-
Dr. Weitz: Oh, so you want to push on one tooth and then the opposite one, you want to push the opposite way. And then do you want to go down into the gums? Is that good, bad?
Dr. Chopra: Yeah, a little bit. That’s-
Dr. Weitz: I mean, can that damage the gums? Does it stimulate the gums?
Dr. Chopra: You’d be surprised at how forgiving the mouth is. So be gentle, listen to your body, listen to the comfort level of it. I do think the expanding flosses are a little bit more comfortable than the tape. The tape can kind of feel like it’s lacerating a little bit, but the expanding floss is a little bit more comfortable, I think.
Dr. Weitz: What is expanding floss?
Dr. Chopra: It’ll kind of sponge out a little bit and then it’ll grab the plaque. So that’s my favorite.
Dr. Weitz: I don’t think I’ve seen that one.
Dr. Chopra: Try that next time.
Dr. Weitz: And so you don’t think the Waterpik is that good? Because I’ve heard other dentists say that there’s other benefits to the Waterpik.
Dr. Chopra: It’s a great adjunct, but I don’t think it can replace floss, which I think is a misconception to a lot of people. So flossing is such a special little skill and a practice that you need to have a daily practice of. Everyone has their morning habits, like this should be one of your nightly habits. I think if you’re going to pick a time of day you’re going to do it, pick it at night, because at night, that’s when we lose our saliva production. Our saliva is so protective because that’s the buffer.
So when we have something sugary, when we have carbohydrates, our pH in our mouth is going to drop, but it’s our saliva that keeps it around that neutral seven pH so that you don’t get that acidic environment. But at night that does drop. So you really want to make sure that you’ve eliminated as much bacteria as possible. But guess what? As soon as you brush your teeth and floss, the bacteria starts to recolonize after one minute. So that’s why we have morning breath when we wake up. So just making that a really daily ritual is so, so important. So for me, that’s-
Dr. Weitz: Now when you talk about bacteria, there’s also healthy bacteria. We were talking for a couple of minutes before we started. There’s a healthy oral microbiome that’s supposed to be in your mouth, right?
Dr. Chopra: Yeah. There are bugs that are going to protect you. But even so, sometimes it’s not just the bug, it’s sometimes it’s the relationship of one bug to the next. They talk to each other and you just want to prevent them from really creating those biofilms in your mouth. So you have to break up those colonies mechanically.
Dr. Weitz: Now isn’t it the case that those biofilms to some extent are beneficial? In other words, the healthy bacteria live in a biofilm. So isn’t it the case you don’t necessarily want to get rid of all the plaque?
Dr. Chopra: I would think you want to get rid of most of it. I mean, you’re never going to be able to get rid of 100% all the time. And again, like I said, within a minute of brushing your teeth, it’s going to start recolonizing, but you don’t want them to really make a happy home right next to the tissue because then you’re going to develop gingivitis, which will then lead to periodontal disease and then you’ll get pockets. And then pockets are deep probing depths. Imagine if you think about a pair of pants with a shallow pocket and you have some change in it, a shallow pocket, you’re going to easily be able to grab your change. If the pocket is really deep, trying to get that change is a lot harder to clean out. So you really want to keep your pockets at a natural two to three millimeters of depth, which is our natural biological width that we have around our teeth.
Dr. Weitz: What about those little spiky things you can put in between your teeth, like in the car? Are those a good thing?
Dr. Chopra: You can do that, but I feel like again, it’s not going to get that little click. You got to get the click.
Dr. Weitz: But I feel like, I’m in the car, I got extra time, I might as well do something for my teeth.
Dr. Chopra: That’s a glorified toothpick in my opinion.
Dr. Weitz: So no benefit really? Or a little bit, but nothing great? It doesn’t-
Dr. Chopra: It’s just cooking in the kitchen. You can get all these fancy gadgets to make stuff in your kitchen or you can stick to the simple utensils. So just keep it simple. And then that way you keep it economical too.
Dr. Weitz: So when it comes to brushing, what’s the best kind of brush and what’s the best kind of toothpaste?
Dr. Chopra: So I love my Sonicare toothpaste or toothbrush, sorry. I love it because the ultrasonic action of the brush will also kill the bacterial cell wall. And it also allows me to not be too heavy-handed on my gums. So I don’t really push my gums away and create more recession than needs to be there.
Dr. Weitz: Now what about the sonic care versus the Oral B? Because the Sonicare-
Dr. Chopra: I think that’s just personal preference. For me, Sonicare works. I don’t get paid by them, but I just like it. I’ve always liked the way it works. I’ve tried both. Sonicare is for me. So some things are just going to be personal preference, like dental tape for you, expanding floss for me.
Dr. Weitz: Okay. Toothpaste.
Dr. Chopra: Toothpaste. Again, I think it’s personal preference. I try to shy away from whitening toothpaste because they’re pretty abrasive and I don’t really love those. You’re probably not going to like me for saying this, but I do think that there is a little value-
Dr. Weitz: You going to talk about the F word?
Dr. Chopra: The F word? Yeah, I am.
Dr. Weitz: Not a big fan.
Dr. Chopra: And I get it and I get it, but I do think that there is a place for certain people with cariogenic bacteria because some people do need fluoride when they’re younger. And also when you’re older and you lose that manual dexterity and you can’t brush and floss like you used to. So a geriatric population, their mouths are going to dry out and they’re also not going to have that same dexterity as they did when they’re young. So some people will benefit from fluoride.
So here’s a perfect example. My daughter, I was anti-fluoride when she was younger and I was like, “That’s it, I’m going super clean. I’m going to feed her organic everything and I’m going to take all the fluoride out of her toothpaste.” And then when I took her to her first dental visit, she actually had eight cavities and the only change that I made was her toothpaste. I went back to fluoride while she’s going through that growth and development, and it’s not a lot of fluoride. I’m not telling her to eat it, I’m not telling her to put a lot, I just need a little bit of surface because she does have a cariogenic type of microbiome. So some people don’t need it. And you need to figure out which individual are you.
Dr. Weitz: When you say you need it, so as far as what I know, and I’m sure you know a lot more about what fluoride does is, we know that there’s studies showing that it gets incorporated into the teeth. But it’s my understanding that it’s only incorporated in the tooth replacing calcium. And if you had the right amount and the right type of calcium, then you wouldn’t need the fluoride and perhaps wouldn’t want it. And unless there’s fluoride added to your water, your toothpaste, you’re probably not naturally getting the fluoride. So wouldn’t it be better arguably to have a toothpaste that had the right type of calcium in it rather than fluoride?
Dr. Chopra: So I mean, I’m just going to say for the record, I am an endodontist, so I am typically just doing root canals and I’m not seeing patients at a hygiene level. Does that make sense?
Dr. Weitz: Okay, I get it.
Dr. Chopra: And I’m a specialist through and through. I’m just going to say for my personal experience-
Dr. Weitz: I realize I’m kind of getting off on a tangent.
Dr. Chopra: And it’s funny because everyone wants to talk to me about flossing and Waterpiks and toothpaste, but I’m like, “No, I really want to talk how root canals are regenerative-“
Dr. Weitz: Right. That’s what we’re going to get to.
Dr. Chopra: But anyway, after I switched her toothpaste again, she stopped having cavities. So there is something to be said, and again, I think it depends on the individual that you are and what kind of bacteria you do have in your mouth. There are definitely some people that don’t need it, for sure. And then you also have to balance it with how much is in your water and if you could have definitely too much and then develop fluorosis, which are those people who have the white spots on their teeth. So having the knowledge about how much is actually getting into you, whether you’re consuming it systemically or using it as a topical toothpaste, I think these are all important questions to ask and know based on the home that you live in too.
Dr. Weitz: So let’s get into root canals.
Dr. Chopra: All right.
Dr. Weitz: Why don’t we start, what is a root canal?
Dr. Chopra: So a root canal procedure is when you are trying to save the tooth once it’s become infected by bacteria. So bugs essentially get inside to the pulp area and at that point you’re at a point of no return. So you can either do a root canal or do an extraction at that point. I’m a tooth saver because I will-
Dr. Weitz: And those are pretty much the only two choices at that point?
Dr. Chopra: At that point, that’s it. And I’m a tooth saver. I believe that we were born with teeth for a reason. They give us so much, they give us nutrition, they give us hydration, they give us airway and breath, they give us confidence, they make us attractive. There’s just so much value to our teeth and we were born with them for a reason. We’re not supposed to take them out. So is there a safe way to save teeth? And I believe that there is. I’ve seen thousands of cases at this point where when you do the root canal in the right manner, then you are going to see something that’s actually regenerative and you’ll actually witness the superpowers that we have in us as humans where we can even grow our own bone back. It’s remarkable how much bone we can regenerate without bone graft, without extra calcium, without doing anything else, but simply disinfecting the tooth properly.
And I’ve been practicing endodontist for 15 years. I’ve done eight root canals a day for the past 15 years. And I’ve seen such a huge shift in our industry in terms of technology. How I started my practice is so different than how I’m practicing today. So I really want to give people the confidence that they can save their teeth safely, they can save their teeth. And there’s just no better time to get a root canal than now if you need one. Hopefully you don’t. We’ll always stand by the fact that I want everyone to prevent ever seeing me, but when you do need somebody, there are people that you can turn to.
Dr. Weitz: And so what about some of the claims that root canals are dangerous to our health? First of all, people argue that now it’s a dead tooth and it’s not good to have a dead tooth there because you’ve killed the nerve, you’ve killed the blood supply to the tooth. And then the second thing people argue is that there’s no way to get all the bacteria out and the bacteria’s going to fester and it’s going to lead to all these problems.
Dr. Chopra: So when you’re doing a root canal, you’re basically taking out the… Well, the tooth usually most of the time is already dead before they even need the root canal because the bacteria got in there, killed the nerve. So what are you going to do? Just leave it there?
Dr. Weitz: The nerve’s not dead because you usually you have pain that you get the root canal?
Dr. Chopra: Well, some people have been living with a dead tooth for years before they even know that they had a dead tooth.
Dr. Weitz: Really?
Dr. Chopra: And then that’s when they grow those spaces in the bone, that’s where the bone starts to reabsorb because it’s been sitting there for so long. So a lot of times the nerve is already dead before I meet them. But what happened is all we do in a root canal or when a nerve dies is you’re taking away the ability of your tooth to feel hot and cold. That’s it. The function of the nerve is actually to create the tooth. So the tooth starts out as a tooth bud when you’re a kid. And then over time the tooth forms and the formation of the roots in the tooth comes from that pulp, which is removed. So that’s why when you’re younger and you have trauma and the tooth isn’t fully developed, you actually don’t want to do a whole root canal. You want to see if you can preserve the vitality of that nerve so the nerve can continue to complete that root formation. And I kind of digressed there for a second. I’m sorry.
Dr. Weitz: No, that’s okay.
Dr. Chopra: So what we’re doing is just taking out the tooth’s ability to feel harmful. You still have proprioceptors that are in the periodontal ligament that attach the tooth into the bone, which is swimming in these haversion canals that have all this blood supply. So the tooth is still living in a lot of blood.
Dr. Weitz: So after a root canal, the tooth is not dead?
Dr. Chopra: I mean people are going to say it’s dead, it just can’t feel hot or cold anymore. But then you’re asking, “Well, if my tooth is dead, how come I can feel pain to biting?” And that pain to biting comes because the periodontal ligament, those proprioceptors that are attaching into the root of the tooth and into the bone, those are inflamed and that’s where the pain comes from. And then once you remove the bacteria, then all that inflammation goes away and actually that bone starts to heal. I’ve had lesions, like huge, almost the whole side of the face that I do one root canal and all of that bone comes back and their jaw bone is reconstituted.
Dr. Weitz: Wow.
Dr. Chopra: It’s really a beautiful process. And if people just appreciate just what kind of superpowers we have naturally without doing anything. When I show my patients, I love to bring them back for follow-ups. And I’m like, “Okay, this is where you were. Remember that black shadow on the x-ray and how much bone loss you had? Look at you now, one year later, and you’ve just reconstituted all that bone.” So when I say root canals are regenerative, I mean it. And I love educating my patients about it because then it just takes away the fear. And then they believe, “Okay, I have an alternative to an extraction. I don’t have to take out my front tooth or my back tooth.” I don’t know why people are okay taking out their back teeth and not their front. I get it’s in the back. But those back teeth are really responsible for keeping that airway patent so that you can get in the breath, which is the most important part of life.
Dr. Weitz: So what’s the proper way to do a root canal?
Dr. Chopra: So there’s a few cardinal rules. You have to find every canal and you have to get to the end of every canal. So I work in millimeters and a millimeter in my world is like a mile. So it’s very technique sensitive. And I’m just going to paint a little picture. And this is part of the reason why root canals get a bad rep. You really only have to do two to three to graduate from dental school.
That’s the truth. Well, when you be go to a specialty, you do 200 to 250 before you get your certificate for your specialty, and then you learn on the advanced equipment. So I do every root canal in a microscope. I don’t use my naked eye, I don’t even use the loops, the little glasses with the magnification. I have this giant microscope that comes out of my wall and I’m looking through this thing the whole time I’m doing the procedure. Why? Because some of those canals are itty bitty, and if you violate those cardinal rules, your treatment is not going to work. And it’s funny because sometimes you won’t even have a symptom for years after the root canal and then all of a sudden you’ll get this weird pain and you’re like, “Oh, I have these sinus issues. Why do I feel this way? Why am I getting these headaches?” So people do not feel good.
So these stories that you hear, they’re absolutely true. But if we take a deeper look and we’re like, “Okay, well what can we do differently?” Sometimes these root canals need to be revised. And when you revise them with modern day technology, nowadays we have 3D imaging and that 3D imaging allows us to cheat a little bit. Now we can see what’s going on inside the tooth. And I say, “Oh…” I always talk in tooth stories. That’s the way I actually educate other dentists because they just didn’t get that education in school. I educate them to let them know, “Hey, through tooth stories, like this is what happened to this patient, this is how we did it differently. And look at the follow-up.” And that’s really the key.
And so using my 3D, before I even go in the tooth, I already know the tooth story and I know now where I’m going to fix it and it gives me a map so I know where I need to go inside the tooth and then I can see it with my microscope. And let’s take it a step further. And that five years ago, so not even until like 2018 did we have this, but now there’s things that actually activate your irrigant. So I use this piece of technology called the gentle wave, which uses sound waves to pump the irrigation fluid through the tooth. And so it actually gets into those little connections and those tiny little spots. And you can actually see the evidence of that on the final x-rays because you’ll see the root canal filling material pop these little areas like little pompoms. It’s really neat.
But we’ve seen such a shift in our success rates ever since then. And so normally it’s going to be a specialist or an endodontist who has all this equipment. A general dentist is probably not going to have this. I mean, some of them are, some of them really are passionate about root canals as well. They’ve really done a lot to educate themselves as well. So you need to know how many does somebody do in a day or in a week in a month? That may make an impact on who you choose as your provider. But ask those questions and see what kind of technology that they’re using and do what’s right for you. I think being that informed patient is really important and finding who’s going to be the provider of your care.
Dr. Weitz: So you’re saying one of the keys is to get all that bacteria out through all those little canals, right?
Dr. Chopra: And you could get it close to sterile. I don’t know if I want to use the word sterile or 100%. And I don’t think our body needs that either because we are capable of getting rid of a common cold without medication either. We naturally can do it because we have a beautiful built-in immune system that also can clean up the rest. Our job is to really decrease the bacterial load as much as possible so that the immune system can take care of the rest.
Dr. Weitz: And as an alternative, what about implants? I’ll say for implants.
Dr. Chopra: Implants are a great resource when you need them because some teeth are not root canalable. Some teeth are fractured and they are split and they cannot be saved with root canal. So implants should really be the last resort. And we’re so lucky to have that as an option. But implants can also fail. They’re not 100% either. Sometimes an implant won’t take. And then what? Do you want to live with a denture? Do you want to live with a bridge where now you have to floss underneath or maybe you have to take something out and put it on your nightstand when you sleep? So you really have to think about things. There’s really nothing better than your natural tooth and really try things to save the teeth. A lot of teeth that get sent to me, people are like, “Oh, I don’t think it’s saveable, but if anyone can save it, Dr. Chopra can,” and they send it to me. So that’s the reputation that I’ve built is that I kind of do the heroic root canals because I really want to prevent that implant.
And now as we’re finally getting that long-term data of implants, we’re starting to see they’re not as great as we thought they were, that you can develop peri-implantitis, you can have a lot of bone loss around the implant, and then the metal threads show. And that’s not very aesthetic. So they’re not as foolproof as we once thought they were. And that now the more recent studies are showing that people are… that paradigm shift is happening where they’re saying, “Go back to root canal therapy.”
Dr. Weitz: And you’re putting a piece of heavy metal in your mouth.
Dr. Chopra: Yeah. It’s titanium. But again, it’s not natural and your tissues are going to respond and you’re going to get recession, you’re going to get bone loss, all that stuff is going to pull away and you’re going to… the aesthetics that I see sometimes where people have black triangles or you can see that grayness around the tooth. It’s not ideal. So if we can save your teeth, I think that’s always best.
Dr. Weitz: So who typically does the implant? Would that be the dentist or would that be a separate person who does the implant?
Dr. Chopra: So a general dentist can typically do anything. They can do regular stuff like crowns, bridges, implants. They can do ortho and braces and Invisalign, they can do root canals, they can do it all. There are some people who like to be that super dentist and they can do it all. I love the dentist who really understands their boundaries and makes referrals when something is outside their comfort zone. Now a lot of patients don’t love that because now they have to go to a different office. But I actually respect people who do that because there’s a lot to learn in dentistry. Just like you wouldn’t go to a dermatologist for heart surgery. I believe dentistry should be just as specialized. And that’s why you have all these horror stories about dentists, because we really should be that sub-specialized, but we’re not. And if I were president, I would probably make that change. But you could choose to go to somebody that you have a relationship with and maybe they do a little bit of everything, or you can choose a specialist. Oral surgeons do implants as well as periodontists.
Dr. Weitz: Now do you think that sometimes there’s financial incentives for recommending one treatment over another?
Dr. Chopra: Sure. Unfortunately, I’ve seen some people treatment plan implants because they don’t know how to do a root canal or maybe a root canal revision. And so they’ll just treatment plan the implant. And I’ve seen that happen, unfortunately. That’s why I really love people who… I respect dentists who do know when to refer and they do know what’s in the best interest for the patient. Some people will do the easier root canals too, and then when it gets to be a molar they’ll refer those out. And so there are ways to really assess good risk assessment because there are root canals that can be done by general dentists, for sure, but there are some that should really be managed by a specialist. So even though I teach general dentists how to do root canals better, I also teach them how to have that good risk assessment. That’s a big, important piece of what I teach.
Dr. Weitz: So the teeth in the back, the molars, they have more complicated nerve structures, so that makes the root canal more difficult?
Dr. Chopra: Oh, yeah. It’s more difficult just from an anatomy perspective, but also from a tooth location perspective, it’s further back, patients have to open wider, there may not be enough accessibility. Sometimes those are just hard enough from a patient behavior or a patient opening standpoint. And that would be another reason to refer.
Dr. Weitz: And root canal saved the patient some money as well, right?
Dr. Chopra: Yeah, I mean it’s typically very well covered by insurance, whereas implants still to this day may not get covered at all. So root canals are typically more covered by insurance.
Dr. Weitz: I have never had insurance that covered anything.
Dr. Chopra: I know, that’s a whole nother podcast episode. But I would say a root canal probably, typically cost about depending on where you live. So I feel like in New York City, LA it’s probably going to be 2200, whereas where I am in Charlotte, North Carolina, it’s closer to 1500. So it depends.
Dr. Weitz: Yeah. I think in LA I paid 1800, and then I had to pay another what, eight, 900 for the crown.
Dr. Chopra: Right. And then if you look at an implant, in Charlotte it’s about $5,000.
Dr. Weitz: I think in LA it’s closer to 10.
Dr. Chopra: So it depends where you live. So now I have a feeling a lot of people are going to fly to Charlotte.
Dr. Weitz: All right, great. Any other things we want to talk about?
Dr. Chopra: I think we did great, but I want people to know that if you’re feeling something, like trust your body and learn about things. I love to educate my patients to really empower them. So take it upon yourself to learn a little bit more. And for those of you who have had a root canal and you’re like, “Well what is another root canal going to do for me?” Know that there are ways to revise it. It’s just like some people get a knee replacement and it didn’t take and then they have to go back and get a revision and then all of a sudden they feel better.
Really trust that there’s a way to save your tooth even if you feel like you’ve already gone in and done the procedure. I hate to say it, but like 50% of my practice are revisions and by the time people have met me, and this is one of the main reasons on this mission to get my voice out there, is because by the time people meet me, they’ve already spent several thousand dollars on one tooth and now they have to reinvest in that same tooth.
So how do I get the information out to people so that they can save their time, their money and their energy and their teeth. That’s so important. I’d rather them take that extra money and go on a bucket list vacation. That’s more important to have that self-care. There’s so many ways to do the self-care, but really take a minute, and root canals are not a sexy topic at all. I get it. And it let me tell you, it is hard to get your voice on a podcast, but take a minute to really learn about your teeth because this is the gateway of our body. It’s a really important place and these tiny little white temples are so important to so many parts of ourselves. And that’s it.
Dr. Weitz: Well, we talk about stool testing and lots of topics that aren’t so sexy. If patients wanted to seek you out for care, how would they get ahold of you? And you said you’re where? You’re in Charlotte?
Dr. Chopra: I’m in Charlotte, North Carolina. I do have a website that’s full of education that’s at soniachopradds.com. That’s Sonia with an I. But my practice is BallantyneEndodontics.com, so that’s Ballantyne with a B as in boy, B-A-L-L-A-N-T-Y-N-E endodontics.com or endo. Ballantyneendo.com. And so yeah, we’re happy to see you there. I also even have my trusted resources page on my website. That’s soniachopradds.com. So if you can’t travel, I’m trying to add more and more endodontists that I really believe in their work. They are also [inaudible 00:37:30] users and you know, can find somebody hopefully close to you and not have to come and see me.
Dr. Weitz: So they can go to your website to find an endodontist. And what if there’s not somebody on your website close to where they are? What questions or things should they ask? I know you said make sure that they’re doing a lot of root canals.
Dr. Chopra: Yeah. And ask what kind of technology that they’re using. Sometimes even though they have a 3D machine, sometimes they don’t know how to use it. So really ask good questions, have them show you. I love to use my cone beam and show the patient, they can see me navigating through it and I point and I show them this part of your tooth, that part of your tooth. This is what this means. So when somebody can utilize their tech and actually educate you through their tech, that’s a great sign.
Dr. Weitz: And then you have programs to educate dentists on how to do root canals?
Dr. Chopra: Yeah. I created a program called E-School Everyday Endo Made Easy to really compliment the busy lives of dentists. So that’s an online program for them. There’s several parts, but it’s an online program where they actually get the nitty-gritty. I kind of take away all the BS that they didn’t really need to learn and just focus them on the stuff that they really need to learn. The important little details. You can really simplify Endo for them. And then once they get that online education, I actually have a live patient hands-on program because that’s really how we learn. So they can come to my practice. I do it about four times a year. It’s a give back program to my community so patients can actually come get their root canal for $100 and the dentist will do the root canal with their hands under my supervision. And that’s where they really learn. And they’re doing more root canals in that program than they did in dental school, which is kind of scary.
Dr. Weitz: Great. Thank you so much, Sonia.
Dr. Chopra: Yeah, thank you. Thank you for listening. I love getting excited about root canal, so I really appreciate it.
Dr. Weitz: The teeth are super important part of our overall health, so that’s what we’re focused on.
Dr. Chopra: Awesome. Thank you so much.
Dr. Weitz: Thank you. Thank you for making it all the way through this episode of the Rational Wellness Podcast. For those of you who enjoy listening to the Rational Wellness Podcast, I would certainly appreciate it if you could go to Apple Podcasts or Spotify and give us a five star ratings and review, that way more people will discover the Rational Wellness Podcast. And I wanted to let everybody know that I do have some openings for new patients so I can see you for a functional medicine consultation for specific health issues like gut problems, autoimmune diseases, cardio metabolic conditions, or for an executive health screen and to help you promote longevity and take a deeper dive into some of those factors that can lead to chronic diseases along the way. And that usually means we’re going to do some more detailed lab work, stool testing, sometimes urine testing, and we’re going to look at a lot more details to get a better picture of your overall health from a preventative functional medicine perspective. So if you’re interested, please call my Santa Monica Weitz Sports Chiropractic and Nutrition office at (310) 395-3111 and we can set you up for a new consultation for functional medicine. I’ll talk to everybody next week.
