The Root of the Matter

Unveiling the Future of Root Canal Therapy: Biologic Dentistry and Innovative Techniques with Dr. Sonia Chopra

• Dr. Rachaele Carver, D.M.D. Board-Certified, Biologic, Naturopathic Dentist • Season 3 • Episode 3

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Discover the transformative world of biologic dentistry with Dr. Sonia Chopra, a board-certified endodontist whose personal journey from misdiagnosis to advocacy provides a powerful perspective on holistic dental care. We unravel the prevalent misconceptions surrounding root canals, emphasizing their role as a viable option for tooth pain management while stressing the importance of preserving natural teeth. This episode illuminates the significance of accurate diagnosis and informed consent, providing clarity for patients seeking to make informed decisions that align with their personal health values.

Explore the cutting-edge advancements revolutionizing root canal treatments today. With Dr. Chopra's expertise, we dive into the technologies reshaping the field, such as the GentleWave system and laser therapy, which enhance treatment precision and efficacy. These tools, combined with innovative imaging techniques, help address even the most complex cases, leading to faster healing and improved patient outcomes. We highlight the necessity of understanding each "tooth story" and selecting providers who are equipped with the latest technological capabilities to transform your dental experience.

We conclude with a deeper look into biological endodontics and the broader health implications of proper root canal diagnosis. Dr. Chopra shares real-life case studies that underscore the body's incredible resilience and healing capacity. By integrating advanced techniques and natural remedies, we aim to align dental practices with the body's natural healing processes. This episode encourages both patients and professionals to continuously seek knowledge and stay informed about the latest developments in endodontics, emphasizing a thoughtful and comprehensive approach to dental care. Join us for an enlightening conversation that promises to shift your perspective on root canal therapy.

Check out Dr. Chopra's website here: https://drsoniachopra.com/

Follow her on Instagram: https://www.instagram.com/drsoniachopra/

Check out her course: https://drsoniachopra.com/endodontic-patient-course/

To learn more about holistic dentistry, check out Dr. Carver's website:

http://carverfamilydentistry.com

To contact Dr. Carver directly, email her at drcarver@carverfamilydentistry.com

Want to talk with someone at Dr. Carver's office?  Call her practice: 413-663-7372

Reverse Gum Disease In 6 Weeks! With Dr. Rachaele Carver Online Course!

Learn more about here: https://reversegumdiseaseinsixweeks.info/optinpage




Disclaimer: This podcast is for educational purposes only. Information discussed is not intended for diagnosis, curing, or prevention of any disease and is not intended to replace advice given by a licensed healthcare practitioner. Before using any products mentioned or attempting methods discussed, please speak with a licensed healthcare provider. This podcast disclaims responsibility from any possible adverse reactions associated with products or methods discussed. Opinions from guests are their own, and this podcast does not condone or endorse opinions made by guests. We do not provide guarantees about the guests' qualifications or credibility. This podcast and its guests may have direct or indirect financial interests associated with products mentioned.

Dr. Carver :

Hello everybody, welcome back to another episode of the Root of the Matter. I am your host, dr Rachel Carver, and I'm very excited to have the conversation today with Dr Sonia Chopra, who is a board-certified endodontist. So you know many of you are listening to this podcast because you're interested in biologic dentistry, how it connects to the rest of the body, and there is a subset of biologic or holistic dentists who think root canals are all bad and there's no place in the body for them. And if you've been listening to the podcast, you know that I have a different take on that and I really believe in the bio-individuality of each person, and so it's really important when we're considering treatment that we look at all different avenues and that patients are given a choice. So I don't ever want my thoughts or ideas to persuade somebody to do something that maybe isn't fit with their values.

Dr. Carver :

So we always, you know, talk about all the different options, and Dr Schroeper is here to explain a little bit more about canal kind of, why they maybe have a bad rap and what a properly done root canal with the right technology can really do. So a little bit more about Sonia she has been not just an author and an entrepreneur. Her website is fabulous with so many resources. So she is a woman after my own heart and I love it and I'm excited for this conversation. So thank you for being today and welcome, thank you so much for having me.

Dr. Chopra:

This is truly an honor to be able to connect with the biological dentist who actually still sees that there's space for the root canal at the tables. I feel like you are just my favorite person right now. Thank you.

Dr. Carver :

So it's really kind of fabulous. So maybe just give us a little bit about your story, how you got to become an endodontist and yeah, again, my mom was so adamant about me having a full complement of teeth going to college.

Dr. Chopra:

That the summer after I graduated high school, she was like all right, I'm going to close up all these gaps in my mouth. And soon after a lot of that dental work, I started to develop a toothache. And because I just had dental work done, everyone assumed that the toothache was related to that dental work. And so this is what kind of started this kind of path to a misdiagnosis. I had this toothache, nobody could diagnose it and in fact, now that I look back, I'm like they didn't really know how to diagnose. Now that I am where I am in my career, I look back and like whoa, they didn't do any of this stuff and they decided to extract a tooth on me and I still. They extracted the tooth, I still had my toothache. They extracted the wrong tooth because their diagnosis was wrong and now I'm without nine teeth.

Dr. Chopra:

So I have had everything done in my mouth. I've had an extraction now. I've had root canals, I've had braces, I've had gingival grafts, I have crowns, bridges, like you name it, and implants. I have four implants now because of this kind of debacle and it was so incredibly impactful on me because it was like a nine month journey of pain and so tooth pain to me. I've had three children too. Now I have three children and I've had a massive toothache, and the toothache wins the battle of the worst pain I've ever experienced in my entire life, and so I have this compassion for people who are experiencing it, and I think that event in my life is what catapulted me to become an endodontist or a tooth saver, tooth healer and somebody who really gets people out of pain quickly when it comes to their mouth and safely. Yeah, yeah, it's great.

Dr. Carver :

And it's. You know. It's amazing, your story, to think about all that because in listening to your I don't know if it was in the TEDx talk I was listening to or something else where even the oral surgeon, before he took out that tooth, he said he kind of had, and I was hoping, while you were telling this story that you were going to say he said nope, you know what? This, it's not this tooth and I'm not going to do it. You know, but unfortunately he did, and you know that's that's the issue. Like, sometimes, when you have tooth pain, you have two options. Now, right, have the root canal, have the tooth extracted. But once a tooth, that's it, it's gone forever. Right, that is an irreversible problem, right? Whereas a root canal, we can save the tooth right and maybe down the line it has to be extracted. But in the meantime, again, let's look at that person, look at their, their life, let's look at their overall, let's see, you know, is this going to be a good, viable option for this patient? Like you know, it's the patient's decision. We, you know, I'm giving them informed consent. You know, here's what it is. I mean, the extraction is pretty, you know it.

Dr. Carver :

Most of us know that the tooth is not just this mechanical, you know body part that is supposed to chew food. It's a living organ and it's connected to, you know, the jawbone. It is connected to our stomach. You know there is all sorts of things that the reason why we need teeth. So, again, just pulling it out, we lose a lot of that connection to the nervous system and proprioception and a bunch of the posture right. We know a lot of that connection to the nervous system and proprioception and a bunch of the posture right. We know a lot of the way our teeth come together effect. You know it can be a relatively simple procedure, but what are the consequences? And that's I really wanted to have this conversation today. Patients can really understand you know these different options and you know what it means because I love what you said in all in on your website right that the body has an amazing ability to heal itself. If we can remove those tucks and the infections, the body can regenerate and that's what people, a lot of times people don't appreciate.

Dr. Chopra:

We are regenerative beings. We can heal from a cut right. If you knock out a tooth, your body can re-accept it and regenerate it back. When we have a tooth infection and we see bone loss around the tooth, we can regenerate that because there's already these systems in our body that are there, ready to protect us. And so that's why I love endodontics, because when you see what can heal, what can work, what can regenerate, it is so powerful and that's really the missing piece. I love what you said. Like I am the same way, like I practice, when a patient comes to me even though they were already prescribed, like a root canal, I give them that option Again, like you can do the root canal and you can extract it. And I think there's so much value that we should really remember about our teeth. Our teeth should not be meant to be disposable. They are given to us for a reason they give us nourishment, they give us hydration, they give us breath, they give us confidence, they give us attraction.

Dr. Carver :

They give us so much and I think the more we start to value our teeth, the better we're going to be Absolutely so. Maybe for those of us who don't really understand what a root canal is, what is? Every tooth has a root canal system, right, but when you have a procedure that we typically call a root canal, what are we doing? Why?

Dr. Chopra:

do we do a root canal treatment. So typically what's happening is there's a bacterial infection. So I would say the most common scenario is somebody gets a cavity. That cavity has the opportunity to get deep and then the bacteria finds its way into the nerve or the pulp and starts creating either pain and infection. Sometimes that infection is painless, it doesn't even have to be painful. So that's one of the reasons why I'm a proponent of imaging digital imaging that keeps the radiation low so that we can identify these areas of infection.

Dr. Chopra:

But once that happens, that pulp is irreversibly damaged. And that's when you have two options either the root canal or an extraction. And then it becomes a personal choice Do you want to save this tooth or do you want to take it out? And if something is savable, I would always try to just show people why it's worth saving. Because when you take out a tooth, there are repercussions Other teeth start to shift, you get super eruption, you get like your tongue starts to spread out. There's just a lot of things that can happen as a result of taking out one tooth. Your whole neuromuscular junction here can be affected and again, like you said, your posture. It all shifts. It's all connected. So what we do in root canal therapy, you have to follow two cardinal rules, and this is another problem, because many root canals are done violating these rules. You've got to find all the canals in a tooth and you've got to get to the very end of these roots and these canals, otherwise you're simply leaving bacteria inside the teeth.

Dr. Chopra:

And when you think about how we're taught how to do a root canal in dental school, we have four years of education. I personally only had a two-week crash course on how to do a root canal and I only had to perform four of them in order to graduate and be able to just do it freely on people. I didn't really feel that good about that. So I went ahead and did a specialty because I knew it's what I enjoyed, because it's what got me out of pain and what saved my life. But I knew that I wasn't good enough after I graduated dental school, and nowadays the requirements are actually like two or sometimes it's four canals, and sometimes you can find four canals in one tooth. So the requirements to graduate are very low, and so that is what creates this problem of we need to really be clear on the difference between a good root canal and a bad root canal.

Dr. Chopra:

And it's not that I think that these dentists are ill intentioned. They're not trying to hurt anybody. They just don't know what they don't know and they're doing their best with the resources that they were given. So when we do root canal, you've got to clean out all those canals and get to the end of every canal, and so you disinfect the tooth and nowadays there's so much fun technology that helps us do our job even better and get better patient outcomes and then, once that's all cleaned out, you seal it up outcomes. And then, once that's all cleaned out, you seal it up and then you can see and watch the regeneration of what is going to happen. And I have some imaging that I can show you so you can actually see what happens in these patients.

Dr. Carver :

Yeah, and again, this is important, judgene, I had the exact same situation. I graduated 21 years ago. We had to do, you know, one anterior tooth, I think, and one posterior molar, with multiple canals, right. So one single canal tooth and one end. You know that this is a very there's a reason why we have specialists who just do root canals, because sometimes maybe in a front tooth, the canal is nice and big, it's very easy to see.

Dr. Carver :

But oftentimes those posterior, those back teeth molars have curvature of the roots or all sorts of funky anatomy. And again, why imaging is so crucial and you leave just one little bit of bacteria behind and you know can potentially cause persistent infection. And this is what we see and why a lot of biological people say you know, root canal is just so bad If it's not cleaned out properly. You'd lose that. And that's the part, like if you aren't doing these all day, every day and you don't really understand how. And that's what we see oftentimes on x-rays, like the fill material is short, so you've let the last couple millimeters of the root where the bacteria you know didn't get fully clean, and you know this is where problems with the lab right and they find all sorts of weird bugs and bacteria. Maybe talk to us a little bit about the technology.

Dr. Chopra:

So, yeah, let's talk about a properly done root canal. I think that's key. I love to talk in tooth stories, okay, because I believe every tooth has a story and you need to figure out what's happening in that particular tooth. So here is a tooth and it's had a previous root canal. You can see that this white material inside the tooth is the evidence that there's been a root canal. Now, again, we want to follow all the cardinal rules when we're doing root canal therapy. So I can see already that this root canal end adherometer counts in our world. Okay. So if you're a patient and you're trying to figure out what's happening in my tooth story, this is how you can evaluate it. Okay, now we are using 3D cone beam technology to really understand the internal anatomy of our teeth. Actually, I take this before I even start treatment now, because it's helped me so much in being able to understand the tooth in front of me and understand that tooth story.

Dr. Chopra:

So you can see that there's root canal filling material in three of these canals, but there's a fourth canal that wasn't even treated. So both of the cardinal rules have been violated in this root canal. It's not that root canals don't work, it's that this root canal is not going to work. And it's not even like by individual. This root canal wouldn't work in any individual. Does that make sense? So you can see, here's the canal. And if this root canal is 10 years old, that tells me this infection is 10 years old because there's still original bacteria from 10 years ago that was never treated. And when bacteria has time to fester in these teeth it has impact. So you can see the border of the sinus here has been eroded. You can see the sinus mucous membrane is completely inflamed. So this patient was even complaining about having breathing problems, sinus problems. And again, you can appreciate, here the border of the sinus is completely eroded by this tooth infection.

Dr. Chopra:

I redid the root canal. I made sure that I got to the very end. This little, what we call a sealer puff is totally fine, and so then it's important to follow up. Now, one of the secrets about how we heal is that bone and healing after root canal actually takes a lot of time, and I find that some dentists don't even understand this, and so they jump the gun. They take an x-ray maybe a month later and they're like that's not healing.

Dr. Chopra:

It takes time, and so I do a one-year follow-up because bone is so slow to regenerate, and look at what happened one year later. Do you see that there was no bone here for the sinus floor at the original time and that all that inflammation in the sinus? Look at how beautifully, one year later, that floor of the sinus has restored itself. The bone regenerated. Now this is only one year, so we still have some bone that needs to regenerate. That is fine. But look at this that sinus mucous membrane has now fully decreased its inflammation and this patient is not only saving their tooth, regenerating their bone, but they're also breathing better. That's incredible. Yeah, it's very dramatic for any of those not only saving their tooth regenerating their bone, but they're also breathing better.

Dr. Carver :

That's incredible, yeah, that's, it's very dramatic for any of those listening. The massive amount of inflammation in the sinus is gone, and so that's and we talk about that all the time. In my opinion, a lot of disease is from toxins and infections, and if you can remove those, the body will heal. And that sometimes is the challenge. Where is the infection? What is the toxin? And so again in the root canal.

Dr. Chopra:

Why root canals get the bad rap is because they're not properly disinfected and so you can see here that that other canal, that fourth canal, was treated. Here you can really see that bone reconstituted and that inflammation gone. And then again here you could really see that bone reconstituted and that inflammation gone. And then again here one, two, three canals that were treated originally. But there was one, two, three, four canals actually in this tooth. So if you're a patient, you've been told that you have a root canal that's gone bad.

Dr. Chopra:

Do you understand your whole tooth story and has it really been done with proper methods? So I will say that I did this one with the gentle wave, and the gentle wave looks. You don't just what it does is, it doesn't just go linearly, it also gets these connections. So this is where again, where people used to pick on us that oh, root canals still harbor bacteria, because we couldn't get these connections and these little fins. But now we can because the gentle wave allows us to irrigate and disinfect better. It uses sound waves to actually move the disinfection solution through the tooth in these anastomoses and these connection points, and that's really changing the game for the patients and their outcomes and it's allowing them to have decreased postoperative pain after their procedure and actually heal a lot faster. So we're seeing better outcomes, but even faster than before.

Dr. Carver :

Yeah, and this is what I'm often talking to my patients about. One of the complications is because there are the main canals, which are obvious, right, but then there's all the channels, right, and then again, like you see how sometimes the canals come together and you know, in previous, when we were just using hand files, there was really no way to get into all those little aspects and even with our syringe and trying to flush it with bleach, they weren't necessarily getting into all of them. So the gentle wave is kind of like an ultrasonic type of machine where it's amazing, when you just put that in water you can really see how it's just flushing and getting through all of those little canals and you're able to get your disinfectant into those last little areas Right.

Dr. Chopra:

So if you really want the ideal root canal, you will utilize somebody you will pick your provider based on. Like their technology. For example, those canals can be really hard to see, so I'm always using a 3D micro not a 3D, but a microscope to really elevate my magnification inside the tooth. It allows me to keep my opening into the tooth really small and be very conservative, but still be able to visualize all those canals. So I need my microscope, I need my 3D comb beam so I can understand the tooth story before I go in, and then I need my gentle wave to really clean and so that 3D imaging is my GPS, essentially through the tooth. I utilize it through my whole procedure and then it allows me to understand how to utilize my gentle wave, because I'm going to use that differently on every case. And then I'm also now using a laser during my treatment so that, like for me, this is what I call the modern day root canal and we're seeing this type of bone regeneration over and over again.

Dr. Carver :

I was going to ask about the laser. Just a couple episodes ago we had a periodontist on who. She's regenerating crazy with the laser. Like this, light technology and laser therapy is amazingly healing for the body. In the last root canal I did, I said the last one I'm going to do, I had my laser. So I was like you know, I was like I've got, I've got. You know, he didn't want to go to the specialist. All right, you know. Hey, you know, and it's worked out well. Um, yeah, laser is phenomenal that way.

Dr. Carver :

You know, in and of itself it can be antimicrobial, but the healing part, I think of late is really, you know, it's funny. We have a local endodontist who's fabulous and she makes the tiniest access holes and I think, same thing. She has all the technology and I think how on earth can be seen and it's almost. I was like I think I have to write her an email. I love and appreciate how small, because the smaller the access, the stronger their tooth is. Right. A lot of endodontists were like get the biggest hole possible so you can see everything, but that compromises tooth structure. Um, but you know, I love how small the access is, but, man, I have the hardest time trying to get that little tape out when I want to seal that. It's amazing. So tell us what is your thingy on the laser? How does that async work in a root canal system?

Dr. Chopra:

I mean, I love it. I do think the gentle wave and the laser are two different animals, but I do think there is a synergy between the two. But I do think there is a synergy between the two. So what I love to do in the beginning, before I even start moving things around in the tooth because every time you take an instrument down you are pushing things a little closer to the exit I like to run my laser right away and already when I do that, I call it the laser sandwich technique. It's Dr Chopra's laser sandwich technique. I run my laser first, before I start moving anything around. Why? Because what is that doing? From the beginning of the appointment? It is reducing the bacteria in there from the get go. So before I start moving anything, before I start cleaning, pushing things against walls, beyond walls, whatever, I'm already reducing that bacterial load, I'm already supporting the immune system of that person and then I'm going to start cleaning things, opening things up to allow my gentle wave to work, and that gentle wave is going to get in there and it's going to make the connections.

Dr. Chopra:

When we do a traditional root canal, we're just using a hand syringe, but what happens with that hand syringe is that bubbles are formed and when those bubbles go in the tooth they actually prevent the irrigation solution, the disinfection solution, from going deep in the tooth. So the first thing that the gentle wave does, that the laser can't okay, is it degasses the solution. It's actually a closed system. You create this platform around the tooth and there's a special handpiece that goes on and works in this closed system. So the first thing it does is it pulls out all the air, so all those bubbles that are preventing that penetration of the disinfection solution. It goes away and then the sound waves start to work and it pumps the solution through the tooth and you get that connection and you even get a penetration of the dentinal tubules, which is what many biological dentists have criticized us, that we can't clean that. So now we can, and so I'll do the gentle wave in the middle and then I probably have a little bit more cleaning to do, like sometimes I don't. If I can just do the gentlewave and then be done, that would be great, and then I will always end with the laser. But as I'm doing my instrumentation, I'm using my laser to activate my solution to pull things out of the tooth, so I do an immediate decrease of the bacterial load to pull things out of the tooth. So I do an immediate decrease of the bacterial load, I get clean, I use my laser throughout the procedure, I do the gentle wave at the end, get that really good flush through the tooth and then I'll give it one final little laser. So I'll sandwich it all that in between my laser and my patients are loving it. I no longer have to give like hefty pain meds. I rarely have to give antibiotics, so I'm already like preventing gut disruption, which is incredible.

Dr. Chopra:

Okay, you're going to need a little Advil Tylenol, because the reality is I'm working on you. You're going to have a little inflammation, a little soreness. If I were to dig under your fingernail for an hour and a half it would be sore. So that makes sense. So your body's just going through wound healing. Wound healing is just bringing in those immune cells to heal it. That influx of cells makes soreness. So you are going to have a period of time where you're sore. But the gentle wave decreases that. I even think the laser decreases that. We even use the laser for photomodulation after. So we're using red light therapy to heal the periapical tissues afterwards.

Dr. Chopra:

So it's a process, but I only lean on over-the-counter medications. Now Maybe if somebody has a hard time healing, I have to give them a steroid. But I don't give narcotics anymore and I try to keep my antibiotic usage to a minimum Because, if you think about it, the root canal is the antibiotic and everything that comes after that is inflammatory pain. So that's why Advil will work better than Tylenol, because it's an anti-inflammatory, and that's why, if they do need more support, a steroid is going to be really helpful and you don't have to think that it's an infected pain. It's an inflammatory pain and you just have to get through it, just like you would if you got in an accident and you're sore from that Same thing Again, like you said right, we're digging that bacteria deeper down into those pockets.

Dr. Carver :

Right, we're decontaminating. And now all of my hygienists have been trained with the laser, so they're going around doing that decontamination. You know, there's all these in the in the medical world. Like you can't have a cleaning so many months after heart or after this or that, and I'm thinking but now we're letting up. That person is a periodontal patient and we're letting that build up. And you know, yes, maybe a traditional dentist, that's not great, but those of us who are using these antimicrobial like I think that's more important because we know oral bacteria contributes to heart disease and on and on. So I think that's me.

Dr. Carver :

Like you, you know I do a lot of extractions and between the laser and the ozone I use PRF. There's I don't remember the last time I gave an opiate either or had somebody come back for you know, you know dry socket or anything like that. And actually I give Arnica right after, before the numbness where it's. Often I have them take home some Arnica to use for five days and that even reduces the need for sometimes the ibuprofen. And so we tell them hey, that's, you know, use that. I found the little Arnica pellet been amazing for for post-op and it was funny I saw a patient after an extraction and she was.

Dr. Carver :

She was like, oh, there's like a sharp thing. And I was like, oh, maybe there's a bone fragment, cause sometimes that happens, and I was looking in that and both my assistant heal as well, and then she was like, oh no, no, that wasn't done by you and by you know somebody else. I was like, aha, it's like you know so that, like with all the kind of natural stuff and stuff that we're giving to enhance the body's, you know, ability to heal itself, so, like you just see the difference. Um, yeah, you know, when we're doing these kind of things to support the body's healing right, that photobiomodulation is so key to just stimulating, um, you know, the body's ability to heal yeah, I feel is it fair to say that I'm a biological endodontist, like I would say.

Dr. Carver :

I feel like I am.

Dr. Chopra:

Yeah, even though the biological community might come after me for saying that, but like I really do feel, like I understand the biology, like I understand the time it takes to heal, to see the evidence, just like really thinking about things in a strategic way that's going to support the patient and their recovery.

Dr. Carver :

Well, you know, I teach at the biological dental college, the American College for Integrative Medicine and Dentistry, just same as you. Right, you guys have the same technology and do the stuff, and we teach our biologic students about a properly done root canal, so that there is such a thing.

Dr. Chopra:

Yeah, oh, I would love to be a part of that. What fun, that would be great.

Dr. Carver :

Yeah, it's exciting. I'm really excited that we're doing this episode because, again, I do want people to understand that it's not all bad. But unfortunately, like you said, we can do two root canals and then we can go into practice and start doing them. I did them for a long time until I was like you know what? I don't feel like I have the right expertise. I don't want to contribute to a lot of poorly done root canals. Again will abscess and will create systemic effects and I'm like I'm going to stick to my lane.

Dr. Chopra:

They really are technique sensitive and I think patients need to understand that, because I do think patients feel like their dentist should do everything. And there's really a zone of genius, like I was telling you earlier. If you asked me to do your front four veneers, you wouldn't look pretty. I would not make, even though I'm a dentist, those veneers would not look very pretty because my zone of genius is really the root canal. I do root canals for the past 16 years eight to 10 times a day and even my first three years in practice I didn't really know it. It took me those three years after a residency of doing 250 root canals beyond the two four that I did in dental school right, and then the 250 and then three years of eight times a day. I finally learned the nuances that I understand now and I think that's what patients need to understand.

Dr. Chopra:

And even I would say not all endodontists are created equal. There's some endodontists that I know that don't use a microscope, that don't have cone beam 3D technology in their practice. They would never invest in a gentle wave. So I think, as a lay person, understanding what's available and making your choice based on that. On the flip side, there are some general dentists who actually do really good root canals especially. I have a lot of dentists that I train. I can honestly say I would let them do my root canal because they just get it. They understand the whole concept. I think understanding which provider you choose is also just as important.

Dr. Carver :

And what do you say to? So I often tell me I'll take a 3D x-ray and a look at the tip of a tooth right and let's say the root canal was done maybe a decade ago and you still see like a little shadow, maybe a little radial lucency. How would you determine like, is that an active problem, does it need to be redone or is it just scar tissue? Is there any way to really know? I think if it's.

Dr. Chopra:

I think scars are small and I think some things that dentists actually watch and wait are actually active infections. So I I it's funny because this year I have seen a few of my patients from like pre 2018 come back to me. And I say pre 2018 because that's the year that I got my gentle wave and I didn't have the resources, I didn't have the technology. The technology simply didn't exist for me to use it. And they came. I did. I followed the rules. I followed that cardinal rule of root canal therapy of finding every canal, getting to the end of every canal. It was actually a redo of a root canal that didn't follow the rules. I followed them like, oh, it should work, and then it came back to me. It was a 2015 root canal. It came back to me in 2023.

Dr. Chopra:

And even though the patient wasn't in pain, that dark shadow was still there. That dark shadow should have resolved itself in a year or two. And so to me, that tells me okay, my root canal didn't work, but can I redo this now that I have new resources? And so understanding the timeframe or how that root canal was done originally is important. So anything of mine that doesn't work and it was done pre-general wave era. I'm going to offer an opportunity before extraction that if you want me to do this again with new resources, new technology, I'm happy to do it.

Dr. Chopra:

I also respect the decision of I don't want to do this treatment again and if you want to extract it, that's okay. But I'm seeing the ones that I'm redoing are healing now. I've only had three or four this year and over, like the last 16 years, and so, like even traditional root canals, they still work. But I want people to start thinking like okay, just because the first one didn't work, we can redo it and it doesn't have to be something. That's a symptomatic thing. I think scar tissue is really small and if there's a sleepy lesion, a sleepy infection, and it's tiny, I may not necessarily hunt after it, but I feel like if it's of a good size and it's sleepy, it's not making noise I'm going to consider that still active infection.

Dr. Carver :

Yeah, and that's good to know Because as a general dentist, when I'm looking at these things I'm like I don't really have symptoms but I want it to look better. And then as a biologist, I'm always thinking what part of the body is that connected to? Are they having any, maybe symptoms? Do you? You know, what is your interpretation of how kind of are connected to the rest of the body and the gut health? Do you ever see situations where, like an infected, a lot of, like the infected first molar and people and you know breast health issues, because supposedly that's on that same meridian? Have you seen any connections with systemic health and infected teeth?

Dr. Chopra:

I haven't from a breast perspective, but I mean I've definitely seen it with more adjacent tissues like sinuses, headaches, people just feeling like malaise, like just because they have this thing in the background. I actually just had a patient who I did a redo of her root canal and I could see there was some sinus connection. But she was like I'm so planned for this surgery over here. I'm like whoa, hold on, give this a month to heal before you go for that surgery, because you may be okay. So she's coming back to see me in a month to see how her symptoms are doing and if she really needs surgery or if it was just this tooth having an impact.

Dr. Chopra:

Now I will say that I don't see root canal infections jumping from tooth to tooth, and so I do feel like there is a protective mechanism. The way our bodies create almost assist is a protective mechanism because it's encapsulating that infection so it doesn't spread anywhere else. I feel like there is some confusion between periodontitis and endodontic infections. Does that make sense? Yeah, and so I think there needs to be some clarity there. I think what we're seeing in the research is that it's more perio connection than endodontic infection, connection than endodontic infection. And I you know people say they see connections all the time between root canal infections and breast cancer, but I haven't been able to find that article.

Dr. Carver :

The way I'd explain it to my patients is if there is, if the immune system has a bunch of energy trying to deal with the infection in the tooth right, there's less energy along that pathway to clean up the other cancer cells that are being made right. So, again, it's not a necessary cause, it's the fact that the resources are being used up. So when we do a well done root canal, we get rid of the infection right. Then the energy persists in the rest of the body. And to your point about saying imaging is so important right because, as you stated there. To your point about saying imaging is so important, right Because, as you stated there, sometimes are abscessed teeth and patients have no pills, nothing.

Dr. Carver :

I'm like whoa, like this is. It's so close to the and we know there's so much research coming out with oral infections and dementia and I just we've got to have.

Dr. Chopra:

I want to show you another tooth story That'll blow your mind. It'll blow your mind.

Dr. Carver :

I really geek out about it and I can't help it.

Dr. Chopra:

Yeah, that's what we're here for. Love it. Here we have a few teeth and this giant dark shadow. So a dark shadow is what people, dentists, find, and that's a sign that your body is giving us that there's infection, okay, and it's huge, like in 3D those of you are listening.

Dr. Carver :

Yeah, In the regular x-ray it looks like it's three teeth are in this big.

Dr. Chopra:

And this is the 3D image. So you can see the difference between 2D and 3D and the clarity that you get with 3D. It's like a no brainer. But look at it. In this section, this entire right part of the maxilla has been eaten away. This dark shadow is all bone loss.

Dr. Chopra:

Okay, look, a lot of dentists would get nervous that there's a loss of cortical plate here, and I'm here to say it doesn't have to be so nerve wracking. So I did the root canal because I did proper testing and I found that only this tooth was the issue, even though it looked like three teeth were the issue, because, again, you can't just treat the radiograph, you have to do the testing and marry the two. And this was the only tooth that didn't respond to cold, so it was actually a dead nerve. So bacteria got into this tooth at some point and I did the root canal and I got the bacteria out, and then I have to start following up. Now.

Dr. Chopra:

This was a massive infection like almost the whole maxilla on the right side, and the patient didn't have any pain. That's crazy, okay, and so it was hard for them to even believe that they needed treatment. They were like refusing treatment. But you can see a year later that they needed treatment. They were like refusing treatment. But you can see, a year later, this bone is coming back. You can see it's coming back. That buckle plate has regenerated. Obviously, it's not going to be done healing in a year, it's going to take time, but you can see that regeneration of that bone happening and I think that's wild.

Dr. Carver :

Yeah, that's significant.

Dr. Chopra:

You can have an infection this big and not even know it.

Dr. Carver :

I know, I see it all the time and it just is amazing to me, because the body is just an amazing thing. It's always trying to help us and heal us, but sometimes it needs a little help For sure. Tell me a little bit. You know you talked about cold testing. What is your? You know a tooth. You know how do you know that it needs a root canal?

Dr. Chopra:

Yeah. So I will say it's a common thing I do is I listen, because I'm listening to too few. There's like six or seven descriptions of a story that a patient will tell me and I will know it to be of a root canal issue, Because sometimes I get sent somebody and it's not a root canal issue. Maybe it's a bite issue, Maybe it's actually perio, or maybe they just had some recent dental work, or maybe it is truly sinus and they just got through a sickness. So it's very important that I'm listening. So listening is number one.

Dr. Chopra:

Number two is I start with imaging and I start to see, I start to match what they're telling me to their imaging and then I do testing. I do, I'll make sure I probe them, I'll make sure I understand their percussion. So I'll tap on their teeth, because teeth that are upset have three main symptoms pain to hot, pain to cold, pain to biting. It's either one, two or all three of these at the same time. Of that diagnostic testing I'll marry it with my imaging and also with my listening to their tooth story and then from there I come up with a proper diagnosis.

Dr. Chopra:

And because of my past I'm a little sensitive to this and I am very keen on a proper diagnosis. I will not prescribe a root canal just to anyone who walks through my door. Okay, I will understand them as an individual. Like maybe they have a high carries rate right and they're like keep getting decay in this one spot, Maybe it is better that they transition into an implant. So I am actually always looking at the patient holistically and seeing, okay for this patient, what is the right treatment plan. But it's always based on the diagnosis, and getting that diagnosis for me is the most important thing.

Dr. Carver :

Absolutely it is, and so I find sometimes when with the cold testing that's what I have, and sometimes I always try to start with what I assume to be a normal tooth maybe you know a front tooth A lot of people don't do that and we say, okay, this is what it should feel like. Right, you should feel cold. As soon as I remove it it should dissipate. But sometimes you have the patient maybe you know an older patient who the nerves have retreated a little, who never feel and you've done the percussion and you know, but Old doesn't really, you know, as a general dentist. That's why I get you know, I get to be like well, we're going to have a specialist. And something interesting some people when they have reversible colitis, they generally are like it's here, right, and they're like describing an area when that tooth has abscess or irreversible. They can pinpoint the tooth specifically. So it's when you're in that reversible phase where sometimes the diagnosis is a little tricky.

Dr. Chopra:

So I teach dentists how to do better root canals, but a huge part of what I teach is diagnosis and what I've learned is that people don't really do their testing. But the key, the beautiful outcome of doing the testing almost every single time you meet a new patient is that you understand better what's within normal and maybe has the opportunity to heal with just time because they had a recent crown done and what's not normal and what's root canal worthy and what's not root canal worthy. Like you start to see those nuances. And again, that is a muscle that I've had to exercise and I've had to work out and now I can be like I'm going to pause Instead of treating this person. I'm going to pause and maybe there's an opportunity for it to heal on its own. Or maybe there's an opportunity for that pain localization that you talk about, because tooth pain will 100% of the time, localize Okay, and what that means is the patient can put their finger on it and say, doc, that's the only tooth that hurts and then you start treatment on the right tooth, which is what I wish my doctors did First.

Dr. Chopra:

I wish they did the testing. Nobody did the cold testing and they sprayed air with a syringe, but that went on multiple teeth and so they didn't do the testing. Nobody did the cold testing and they sprayed air with a syringe, but that went on multiple teeth and so they didn't do localized testing, they just sprayed air and asked me first of all it wasn't cold enough, and then it was too generalized that you didn't know where it came from. So when my cold test doesn't work for me, I'm looking at other things like percussion, or I'm even looking at my comb beam to see is there an incipient radiolucency? That's starting to begin, because you start to see what other tests are going to support you when your traditional tests don't, and I do think that takes time and exercise.

Dr. Carver :

And, let's say, you have that kind of in that, that murky, reversible, irreversible state. Are there any modalities? I, for one, love to use ozone, because when I'm thinking of pain in my thoughts it's always okay. The energy is not flowing for some reason right. Is it an infection? Is it a scar? Like? How do we get more energy to the tooth so it can maybe heal itself? Are there any modalities that you energy to the tooth so it can maybe heal itself? Are there any modalities that you're aware of or that you maybe use to see if you can help? I?

Dr. Chopra:

use time, because I think by the time somebody's referred to me they're past that point, right? Yes, and it's my job to be the gatekeeper of root canal land. Okay, like I have said no to so many people and they've come back and said I feel better, right, so I do what I call the two week check. If I cannot figure it out in that first appointment with a patient, I bring them back in two weeks. And the reason why is because most of the time the patient doesn't understand their own true story and so they can't describe it to me. So that listing piece is off for me. Because what are they doing? They're avoiding, they're not using that side, so they don't actually know what hurts. What hurts Hot, cold or biting, I don't know. I've been avoiding it All. Right, I'm going to send you home and I have an idea of where I think this may be coming from, or if it's even a root canal problem. And because, again, the diagnosis for me is number one before I start throwing treatment at it. And because I don't know, is that treatment needs to be ozone? I actually don't use ozone in my practice. Everything that you've seen from a healing perspective has not had ozone on it. So I know when it comes to a root canal you don't necessarily need that, but you do general. So you probably do need that and I think that there's so much stuff that can happen at the general level, the general dentist level, before the referral is made. That's where I think we could be a team right.

Dr. Chopra:

But once they get to my chair and I still don't know what the problem is, their symptoms haven't really localized too much. It could have just been like cracked tooth syndrome and they just need a crown. So I will do all my testing. It doesn't add up, I'll pause, I won't treat, I'll say let's. I'm going to send you home for two weeks.

Dr. Chopra:

I want you to pay attention, I want you to actually chew things hard things, crunchy things, soft things, hot things, cold things and see what sets it up. And I want you to take record. And then I want you to come back and I want to retest. I would say eight times out of 10, the patient's pain goes away because maybe they were clenching or grinding or maybe they did have a cold and it was somehow impacting their teeth Like. Two weeks is a good enough time for things to just go away naturally, to recover from some dentistry to do a lot of things, and so I love that. Time can be a beautiful medicine, and so that's typically my approach and I don't charge the patient again for that second show, like I want to make sure that's inclusive of that one consultation. My goal is that we just get the answer that we need.

Dr. Carver :

I think that's so valuable, right? Because in your own experience it was like oh, it's painful, it's this too, let's just dive right in, right. But I think you're right, the generalist. That's why I have that same approach. Okay, I can't exactly tell where it is, so I throw all sorts of fun things at them, busy like all of us.

Dr. Chopra:

We're pretty sure it needs a root and I think just throwing out antibiotics is the wrong move. I actually don't want to give antibiotics because I want, if there is a problem, I want it to surface. I don't want the patient to take pain meds on the day of testing, because all of this stuff can mask the problem. And so, again, I think some of our treatments are palliative and supportive. That would work. But I also think that trying to be drug-free is also important, because then it allows me to really make an accurate diagnosis, so much of that stuff can mask.

Dr. Carver :

Absolutely yeah, and that's a really important point too. So what about cracks? So sometimes a cracked tooth can cause you talked about decay being one reason we need root canals but other times it's a crack that hits the nerve and that causes death of the nerve too. But I know sometimes a crack is too much. So how do you know if a crack is too deep and the root canal is not going to work and it has to have extraction?

Dr. Chopra:

You actually have to go inside the tooth and visualize it with the microscope. I never diagnose a cracked tooth. Let's align on our vocabulary because for me cracked tooth is something that is within the crown, versus a vertical root fracture which extends to the root and that's not restorable. I think there are many cracked teeth out there that can be saved and once you do the root canal and the crown now some of them don't even need the root canal, they just need the crown and they'll get better because it's a true reversible pulpitis. But I even see some cracks extending down into the root that are not completely cracked. That I think we can save.

Dr. Chopra:

And maybe it's not a lifelong save, but maybe it's four or five years and then implant technology has advanced for another four or five years and the implant you get in the future is better than the implant you get today. So I will always have that conversation with the patient about what they want to do. Some patients are like, nope, just take it out, and I can respect that. I will. If I'm really weary about a tooth that doesn't have any life in it, I will remove it. But I will not make that decision until I've actually visualized it with my microscope and gone inside, Because you will make so many assumptions if you just do it on imaging alone.

Dr. Carver :

And a lot of times you're not imaging, doesn't?

Dr. Chopra:

show us cracks.

Dr. Carver :

Even on 3Ds, you can't. There's some techniques, but it's more challenging. You really have to go by. Like you said, a microscope is really the goal if you want to see a crack there. So yeah, that's awesome. Anything else you think that's important for us to know about a properly done root canal and why it is a viable option.

Dr. Chopra:

They're safe, they're effective, they give beautiful outcomes, they're incredibly regenerative and there is purpose to our teeth. So give teeth a chance is all I'm going to say.

Dr. Carver :

And again I so value you coming on because this is an important topic that comes up a lot and there are a lot of myths surrounding it and not every root canal is the same, and you've elucidated for us. The amount of education that we get really varies. No one is really getting enough in dental school and so I know the first couple of years out of school all of my CE was about endo and trying to understand how to, how to do it better. You know I I got some of the newer technology like immediately, um. But then it got to the point where I was like you know, my expertise is avenues. I'm going to let the real specialists cause, you know, if I'm doing, you know, two a month, you know that's not, you know, versus somebody who's doing two in an hour. I mean that's a big difference and this is so important If we are striving to maintain teeth and maintain health.

Dr. Carver :

We want it done in the most, you know, beneficial, you know, appropriate way. So, and again, I'm so fortunate to have Dr Sarah Martinelli in our area who uses all these grapes, and she does such a wonderful job for me. So just a shout out to her. But thank you, I know you're in Charlotte, if somebody wanted to get some more information about your website. It's amazing. There's so many resources, especially for dentists too. There's so much training, and all this talks. How do we connect with you if we have any questions?

Dr. Chopra:

Yeah, my website is a great place to start. That's drsoniatropracom. That's Sonia with an I. I know I trained a lot of dentists, but I will say a lot of patients have found me and so now there's a lot of new patient resources out there. I just launched an online course for patients called Tooth Wisdom. A little play on words there, but it's really a great guide to understanding your own oral health and being a great patient advocate. And I would say, hang out on Instagram the most, and that's at Dr Sonia Chopra as well.

Dr. Carver :

And we will link to that in the show notes. So, thank you so much for your time on this Friday to chat with us and educate all of us. And yes, thank you. I really appreciate all your time and I wish you the best in all your endeavors. I love that you're educating because, like me, we're just trying to spread this awareness, make everyone aware of the options. Right, it's really important that you choose the best option for you.

Dr. Chopra:

I appreciate you. Thanks everybody. I appreciate you so much for having an open mind.

Dr. Carver :

Thank you, oh of course, I think science is constantly evolving and if we can't have an open mind, we're not really helping our patients, we're not really helping ourselves, we're not helping our patients. Things that I knew and thought were true five years ago now is more evidence. Some of them. We change and I think that's really important and some of the reason why I think healthcare is really stuck where it is now it's become more disease care Like we really. We might still think the earth was flat right If we didn't challenge these ideas, and that, to me, is the definition of science. And, as health practitioners, I think it's so valuable. There's so much information coming out all the time that it's important to keep learning and keep understanding, keep having these conversations, trying to have community with all of us, because we're not, no one can do everything alone. It's important that we talk to our specialists, we meet with them, and it's okay to have disagreements, you know, but again, if we ultimately are trying to do the best for the, you know, that's where we have common ground and I think that's really valuable for all of us. So awesome. Thanks again for listening everybody. Hope you enjoyed this episode. Please check out Dr Sun'si's website and we'll see you on the next episode. Everyone, have a great day.

Dr. Carver :

Hello, I'm Dr Rachel Carver, a board-certified naturopathic biologic dentist and a certified health coach. Did you know that over 80% of the US population has some form of gum disease? Many of us don't even know that we have this source of chronic infection and inflammation in our mouth that's been linked to serious consequences like heart disease, diabetes, stroke, dementia, colon cancer, kidney disease, even pregnancy complications. Would you like to learn how to reverse and prevent these chronic, debilitating conditions without spending a lot of time and money at the dentist? Join me for my six-week course where I will teach you the root cause of disease. You'll learn how to be your own best doctor. Are you ready to get started? Let's go.