Oksana Oturgan

Root canals are structures less than a millimetre wide, curved, and surprisingly variable from person to person. The same tooth can hold more canals than the textbook says; canals can merge and separate; their openings can be sealed off by calcification. Working with the naked eye, some of these details can only be guessed at through touch and experience; the microscope makes them directly visible.

In my own practice the biggest returns come in two areas. The first is the search for extra canals: a missed canal can explain why even a technically flawless treatment has not silenced the complaint. The second is retreatment, the renewal of an old root canal: when I am removing old filling material, looking for a fractured instrument fragment or opening a sealed canal orifice, magnification and strong light let me work under control.

Let me also say this honestly: a microscope does not do good treatment on its own. It is an eye; the decisions are still the clinician's. But give a good endodontist a good microscope and the territory we leave to chance because we cannot see it shrinks dramatically. That is how I prefer to work: leaving as little as possible to chance.

When trouble returns in a root-treated tooth, many patients read it as the tooth's final loss. Yet endodontics has a whole field for exactly this: retreatment, the removal and renewal of the existing root canal work. The old root filling is taken out, the source of the complaint is sought, and the canals are cleaned, shaped and filled again.

What matters is not to stop at saying the treatment failed, but to find out why it failed. A missed canal, an old filling that leaks, new decay that developed over time; each has a different solution. Under the microscope a large share of these causes becomes visible.

Of course not every tooth is suited to retreatment; in some situations extraction really is the right decision. My objection is not to extraction, but to an extraction decided without assessment. If a root-treated tooth of yours has started to ache again, have it seen by an endodontist before it is pulled.

A patient from abroad walked into the clinic almost pre-programmed: X-rays in hand, translated reports, a translation app ready on the phone. They began listing the procedures before even sitting down. When I said in Russian that we could talk in our own language if they wished, they stopped for a moment; then I saw the shoulders loosen.

What they told me at that moment were things they had never typed into the translation app: that they were very afraid of root canal treatment, that they had been through a bad experience years before, and that what tensed them more than the pain was the possibility of not being able to explain themselves. We went through every step of the treatment in their own language; I explained what they might feel and when, and that raising a hand would be enough at any point. Through the treatment our communication ran on single-word signals.

The experience showed me again that a language barrier blocks more than the flow of information; it blocks trust. A patient who thinks they will not be able to explain themselves tries to control everything; a patient who feels understood can hand control to their clinician. Being able to say 'I am afraid' in your own language is sometimes the first relief, before the local anaesthetic.