Dentalnews (en)

A placebo is a substance which a patient is told is medicine, but which actually contains no medicinal properties and thus has no real pharmacological effect!

Even surgical procedures can be placebos, for example ‘pretend’ operations.
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Researchers have discovered that the sensation of pain is blocked on the way from the skin to the spinal cord if the patient expects little or no pain.
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There are many different ways in which psychological factors can affect the way we perceive pain: drawing attention away from it, hypnosis and of course the placebo effect. But what neuro-biological mechanisms are involved in reducing the feeling of pain?
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Researchers have found that the placebo effect is associated with reduced nerve cell activity in the spinal cord.
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Neuro-scientist explain the placebo effect as follows: believing that pain medication will work leads to an rise in the level of endogenic opiates released in the brain – also known as endorphins. This is the case both in the frontal cerebral cortex, which is more highly developed in humans, and parts of the brain stem, which are older in evolutionary terms. The release of these endogenic opiates leads to reduced pain perception and thus a reduced response on the part of the nerve cells in the parts of the brain responsible for processing sensations of pain.

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How exactly this release of opiates and the reduction of nerve-cell activity responsible for pain perception are related used to be unclear. Earlier studies have shown that placebo effects – reduced pain perception despite physical stimulation – are accompanied by increased endorphin activity between the frontal areas of the cerebral cortex and the brain stem. The latest technical developments now enable the use of high-resolution magnetic resonance tomography pictures of the human spinal cord to show that during a placebo effect there is reduced nerve cell activity in the spinal cord, the gateway to  the central nervous system. This shows that the psychological factors affecting pain modulation are rooted deep in the brain.
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The fact that these factors can be measured in the human spinal cord is also important for clinical studies on testing new medicines, as it is possible to measure both their efficacy and examine the areas they affect.

Source:  Science Vol. 326. no. 5951, p. 404

Using toxins is bad!

But why is it done? The answer is simple: time!

You walk into the dentist’s office with a toohache, but without an appointment, since you cannot plan for a toothache. But getting rid of the pain for good requires thorough root treatment, for which there is just not enough time right then and there. So the tooth is opened up and a toxin injected in the hope that the tooth, and you as a patient, will not cause any more trouble before your next appointment. This process is known as „incomplete“ root canal treatment.
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This need not be a problem, sometimes a dental nerve just cannot be filled immediately, it is necessary to perform intermediate steps. But a toxin should not be administered, as it also ends up damaging healthy tissue, e.g. the bone around the root tip, eventually leading to a root tip resection. Instead of toxins, it is also possible to use medicines such as CaOH – Calcium hydroxide!
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Regular check-ups can help prevent both – toothaches and incomplete treatment!

Dental nerve pain is usually a very bad sign, as it means the tooth requires root treatment!

An initial sign of this kind of inflammation of the dental nerve (=pulpitis) is often a sensitivity towards cold and heat, eventually leading to a constant throbbing toothache.
The tooth is sensitive to the slightest touch. After a few days, these problems usually go away, and you no longer feel any pain! But this is actually a sure sign that the dental nerve should be removed and proper root canal treatment performed, since the nerve is now dead.
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The damaged tissue begins to decay – it rots and even years later it can cause an inflammation at the root tip in the bone, necessitating a root tip resection. During root canal treatment the dentist extracts the dental nerve and cleanses the dental canal in order to then seal it up tightly!
Earlier, it was common practice to open up the affected tooth and inject a toxin into the dental nerve canal in order to kill off the nerve. Tomorrow you will find out why this used to be done and why it is not done anymore!

Extract the dental nerve and then perform root canal treatment or kill the nerve using a toxin?

Generally: the longer a dental nerve is exposed or undernourished, the less rosy the future of the tooth!

Toxins should not be used, as they damage not only the dental nerve, but also the surrounding bone. But the tooth should not simply be left open – saliva contains hundreds of different bacteria, which are liable to invade an open tooth and are hard to remove after that.
The problem faced by doctor’s offices is timing. Toothaches appear without due warning, so toothache patients cannot just „make appointments“. This is when dentists resort to toxins, treatment of the „open tooth“, this does not take very long and is easy to squeeze into the ordinary daily schedule of the office! A separate appointment is then made for the actual root treatment.
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However long treatment takes, it is important to use a magnifier (magnifying glass, microscope) and coffer dam. This vastly improves the chances of saving your tooth!

How long should you bother keeping a tooth?

Get a tooth removed, or wait, but for how long? As long as you still have good reason to!

We are talking about severely damaged teeth, teeth that have undergone root treatment but are still causing problems. The picture shows you a tooth that there is no more reason to keep.
The patient underwent root treatment 4 years previously and is still experiencing pain in this area. Root tip resection was performed, but to no avail. During the root tip resection, the tooth received neither an orthograde nor a retrograde filling – more on this topic here

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The patient opted for another resection, but in the course of the operation it became evident that the tooth needed extraction.

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The mucous membrane has been flipped to the side, you can see a small window of bone (highlighted in white), and you can clearly see the tooth (highlighted in black) – the root tip has already been cut. The inside of the tooth is highlighted in blue, inside the pink dot you can see the filling compound. Around the compound, however, the tooth has started to rot  – the black area. There is no more point in keeping this tooth, as faulty root treatment has caused the tooth to rot from the inside. Another root tip resection may help to put off the problem for a while, but not eliminate it completely!