In this episode, I discuss the need to distinguish between individuals with good oral health and minimal dental work, and those with extensive dental treatments, which may contribute to systemic health issues. Not all dental care is created equal, and there are significant gaps in diagnostic techniques within the field. Many patients may be unaware of chronic inflammation in their mouths, which can go undetected for years due to these gaps and a lack of standardized diagnostic tools in dentistry.

It's crucial to shift our perspective on the oral biome and the connection between oral health and overall health. Educating the public is essential; people with healthy teeth and minimal dental work generally face lower health risks. However, those with poor dental health and extensive treatments may need a comprehensive diagnostic overhaul, utilizing advanced techniques like 3D CBCT scans.

For this reason, we developed an artificial intelligence tool that scans panoramic x-rays to detect hidden inflammation (see more at https://www.missinglink.ai/). This innovation aims to identify issues that, once confirmed by CBCT scans, can lead to the necessary medical interventions.

It's important to note that chronic oral inflammation is directly linked to over 22 noncommunicable diseases that can severely affect our lives. Awareness and education about these connections are vital to improving health outcomes.

Root canals have been round for hundreds of years, and are incredibly effective way to remove pain and to salvage the tooth structure. However,  when poorly executed, can lead to some complications. The definition of poorly executed can vary a lot, but its not always possible to get the treatment 100% and this can lead to many health issues in the long run. One of the basic and many times overlooked and very important steps, is setting up a dental or rubber dam to isolate the tooth against saliva contamination. If this was not done, then the likelihood that things can go wrong is very high. Also, the use of sterilised instruments and making sure that all canals even the hidden ones have been properly treated  and cleaned, for if not, the possibility of inflammation and even the formation of a cyst around the tooth in the long run is quite high. This is not good for systemic heath.
  The use of CBCT to make sure there is no ongoing inflammation is imperative and we must remember that no treatment last forever. If you have systemic illness, you might want to look into alternatives however, I believe that went well performed by a trained Endodontist using state of the art protocols and instruments, it can be a very effective treatment to help patients with tooth ache as opposed to extraction, but must always be done under optimal conditions. 
So, no! Not all root canals are bad, just the poorly executed ones. Always make informed decisions about your health. 

Based on the search results, the average life expectancy or longevity of a root canal treatment can be summarized as follows:

## Average Lifespan of a Root Canal

- Generally, a successful root canal treatment can last anywhere from 5 to 15 years on average, with proper care and regular dental check-ups. [1][2][3][9]

- However, many root canal treated teeth can potentially last a lifetime if optimal conditions are met. [1][7][8][11]

- Studies show that around 98% of root canals last at least 1 year, 92% last 5 years, and 86% last 10 years or more. [4][10]

- The mean or median estimated survival time of a tooth after root canal treatment ranges from around 11-12 years according to some large studies analyzing dental records. [6][14]

- Around 26% of root canal treated teeth showed a survival rate beyond 20 years in one study. [6]

So in summary, while there is some variation, most research indicates that the average expected lifespan of a root canal treatment falls in the range of 10-15 years, with the potential for much longer if all conditions are ideal. Proper care and maintenance are critical for maximizing longevity.

## Key Factors Affecting Root Canal Longevity

The search results highlighted several key factors that can impact how long a root canal lasts, including:

- Quality of the root canal procedure itself [1][3][10][12]
- Timely restoration with a crown or filling after treatment [4][6][10]
- Extent of initial tooth decay/infection [8][12]
- Location of the tooth (molars are more complex) [4][8][12] 
- Patient's oral hygiene practices [2][6][12]
- Presence of periodontal disease or bone loss [3][13]
- Patient's age and overall health [4][12]
- Avoiding fractures by using nightguards if recommended [3]

So in essence, getting a high-quality root canal from an experienced dentist/endodontist, followed by proper restorative treatment and maintenance, gives a tooth the best chance for long-term survival after root canal therapy. [1][3][4][6][10][12]

Sources
[1] How Long Does A Root Canal Last? There Are 2 Answers | Fab Dental https://fab.dental/blog/how-long-does-a-root-canal-last/
[2] How Long Does a Root Canal Last? What To Expect? - Najmi Dental https://najmidental.com.au/blog/how-long-do-root-canals-last/
[3] Find Out How Long You Can Expect a Root Canal to Last https://www.winstonhillsdental.com.au/fin

I have been following the evolution of Artificial intelligence in dentistry for quite some time, and I think that there are a lot of amazing companies out there doing incredible things. The foundation of all of these developments is to ensure better diagnostics, treatment planning and to help Dentists and dental teams around the world improve the quality of care. Or is it? Could it be that some companies will try and utilise artificial intelligence to enhance volume of sales and not quality of care? We have seen some examples in the industry where companies are incredibly focused on sales alone and not quality of care. As such, I think we need to ensure that different artificial intelligence organisations within healthcare do different things, and there should most certainly be organisations that focus on ethics and quality of care alone, ensuring that patients get exactly what they are paying for and what is sold to them. 
 I think with augmented reality and wearable cameras, it's going to be a very interesting time moving forward , is there will be a lot more information to monitor and control, and I trust that we can all work together ensuring that at the end of the day we can create healthy ecosystems where diagnostics are improved dramatically, treatment planning is the best possible, execution is gold standard and everyone can win and be profitable at the end of the day.
Ive been saying in my lectures for quite some time, "it's a very good time to start practising ethical gold standard dentistry"

For the past 20 years an incredible technology called cone beam computed tomography (CBCT) has been around in the world of Dentistry that uses x-ray technology but create a 3-D scan of the mouth and skull. Modern versions can actually do a reconstruction of the data allowing surgeons in Dentists to see intimate details that you simply cannot see in a two-dimensional film x-ray. Unfortunately this technology is still not mainstream and not available in the larger portion of dental clinics around the globe, and with the growing number of people suffering from chronic diseases looking for more answers about their health and trying to connect more dots, they are looking to the dentist to see if it could be coming from failed dental treatments. The only non invasive way to diagnose this is with the 3-D CBCT. Dr Stanley talks briefly on why this technology needs to be more mainstream why patients should demand this simple diagnostic test prior to engaging in any complicated surgery, implant treatment or orthodontic movement. There is much that can be overlooked in a simple two dimensional film x-ray, a technology that is almost 100 years old. In all other areas of medicine, diagnostic technologies have evolved immensely, why is it acceptable to still have 2-D x-ray as the primary tool of diagnostics? Time for a change! 

In this episode of Biting into Healthcare, Dr Miguel Stanley interviews his colleague, Dr Dirk Duddek from Germany, who founded the clean implant foundation. This nonprofit organisation tests dental implants for impurities on the surface that were left over during the manufacturing and packaging process. Sometimes his findings are startling and worrying! We are led to believe that our dental implants that have FDA and or CE approval are sterilised and as such are clean. Using electronic scanning microscope and a very highly regulated testing system that is unbiased, the Clean Implant Foundation has found some shocking results as well as some very good ones. In this discussion we ask some interesting questions such as, "could the surface contaminants be responsible for the spike in autoimmune diseases around the world  ?"
Would you be surprised if some companies learn that they have "dirty"  implants , meaning leftover particles from the manufacturing and cleaning process such as plastic, cobalt, and other metals, and do nothing about it? 
I really enjoyed this discussion with a doctor/scientist  who really wants to do a lot of good and answer questions not  every dental implant company is interested in answering. 
Find out more at www.cleanimplant.org

The link between healthcare and your mouth is more complex than most people realise. There is mounting evidence that poorly executed dental treatments and natural occurring cysts  can lead to serious health issues. We can link the inflammation in the jawbone caused by these problems to a large array of systemic illnesses: Fibromyalgia, Breast Cancer (link), Depression, Chronic Fatigue , Rheumatoid Arthritis and many more. 
The way dentistry is being practiced in many clinics around the world has not evolved to be able to properly diagnose these issues, and 2D film Xray and clinical observation during check ups, that sometimes take 15 minutes,  is still the norm.
  We need to disrupt this method of clinical evaluation in 2022 and ensure that dentists, or at least those that really care about connecting dots between oral issues and systemic issues, start asking more questions and using better technology to diagnose, such as 3D-CBCT (Cone Beam Computer Tomography) and also blood tests looking for RANTES\CCL5 cytokines produced when there is inflammation present in the jawbone. 
We can objectively trace the source of the inflammation back to the origin during oral surgery through biopsies and with a proper clinical protocol dramatically reduce the inflammation with immediate health benefits to the patients.  
We can no longer sit back and look at teeth as simple mechanical structures separate from our immune system and neurological network. Getting this right can save lives if not seriously improve them for millions of sick people desperate for answers but not getting them, as their dentists are telling them, "all is good", based on outdated diagnostic tools. 
This is the foundation on Biological , Functional and Integrative Dentistry .  I like to call it Immune Dentistry .

According to the Centre for Disease Control -CDC, in the USA,  and the World Health Organisation, more than 8 million people a year die from tobacco related diseases. According to the same sources Covid has killed 4.2 million since the beginning of the pandemic. These numbers need to be looked at and we need to be fair about this discussion. Smoking kills more than Covid yet no one is doing anything to stop it. 
 I think it's very important that everybody does the best they can to stop the transmission of the virus, and to help our healthcare services. We all accept this. We have been ordered to stay home, to wear masks and to vaccinate all in order to protect our hospitals and the weak, and its understandable, yet no one is talking about banning smoking during these challenging times. Why?
 The WHO clearly states that there is a 50% increase in mortality in smokers after contracting COVID-19. Why is it still okay to smoke during this pandemic? Smoking is not something that should be so overly protected. If civil liberties are being taken away to improve public safety and public health, then smoking is no longer a civil liberty that doesn't impact all of us. The same rational goes  for heavy drinking ( 3 million deaths a year according to WHO). 
Smoking directly contributes to the mortality rates and the comorbidity rates of COVID. 
 For decades smokers have overburdened our hospitals, created massive healthcare issues and no one talks about this. We all acknowledge it, yet nothing is done. Should we not take this opportunity to have this discussion?
People get nervous if you don't wear a mask outdoors, but have no problem seeing parents smoke next to their infants. We need to have a serious discussion around smoking and the challenges that smokers present to our healthcare systems, to themselves and to this battle we are all fighting on a global scale. 
As a surgeon that operates patients every day for over 20 years, Dr Miguel Stanley has recently begun refusing treatment to moderate and heavy smokers, and works closely with them to help them find ways to quit and dramatically improve their systemic health in order to have a more healthier life and a longer lifespan. 
Should governments not be thinking the same?

After more than one year of  pandemic and lockdowns , political turmoil around the globe, civil unrest, mistrust in the financial sector, concerns about vaccination, education and even in our religious leaders, it is evident that there is a lot more stress going on in people around the world, so is this a really scary time to be a doctor? 
 Trust is the foundation of any relationship between the patient and their physician or dentist. If we do not have it, the fabric of the relationship is corroded and will not work. We are living in a world where trust is becoming much harder to attain, and more importantly maintain. Everybody is very opinionated, and the access to an overwhelming amount of information and online data, some of it fake, some of it real, with so many "healthcare" specialists giving their opinions that are not based on science, are leading to a growing population that is willing to argue with their doctors on so many points as if they know better. In some cases, they actually might be right, but let's face it, doctors went to medical school and are highly trained to take care of you. 
 It's one thing is to ask for a second opinion or alternative treatment options, it's a completely different thing is to question why a doctor is going to do things the way that he was trained to do. In the private healthcare sector, doctors should not be confused with restaurant owners that might go out of their way to accommodate multiple alterations to their signature dish to keep you happy. A surgeon however, most definitely cannot accommodate these sorts of changes without scientific evidence and should not change his or hers protocols for no one if that might affect the outcome. For example a patient that refuses to take antibiotics because they're fearful it might cause them some harm, which is obviously true, but there is a greater risk of having a bone infection after a surgery. Them not taking that antibiotic could most definitely lead to severe complications that could affect the doctors livelihood and stress to manage the problem.
 And so, here we are in this new normal where there is a growing part of the population that despite needing care from their healthcare providers, have no problem in voicing their mistrust to treatment options, pharmacological prescriptions based on their recently gained online knowledge. 
 It's very difficult for us doctors to challenge core beliefs, and I personally don't think that is our job, and so we need to be very careful about how trustworthy our relationships are and sometimes it is simply best to not pursue care with patients that don't trust you. It has been this way since Hippocrates over 5000 years ago.

In the short episode Dr Stanley discusses some of the differences and challenges facing private practitioners in dentistry vs doctors that work in a hospital environment. 
 A few insights into what goes on behind the scenes and why potentially when you are paying for a dental treatment it's not just the treatment you're paying for but the entire set up of the practice. Much like in a restaurant, you're not paying just for your steak, but the service and everything that goes into getting that steak safely and deliciously to your table.  Unlike your GP that practices in a hospital that most probably they did not set up, do not manage and are not legally responsible for, dentists have to think of everything from the rent to the staff and the entire setup and the costs of all this need to be spread across-the-board into your treatments. So we should think about cost Vs value, private Vs public and so much more when analysing the healthcare market. Certainly an interesting topic. 

Have you ever stopped to think about why dentists can be  so stressed? Do you ever think why things cost what they do at the dentist? Are you one to think that it's so much better that your dentist does things fast and cheap? Are you a dentist that is seeing more than 20 patients a day? Do you even know what a dental dam is and why it is so important? Then this podcast is for you. 
 Dr Stanley is a founder of the Slow Dentistry Global Network, that is a non-profit foundation based in Switzerland focused on improving safety in dentistry around the world. It is a growing movement that is now in over 50 countries and growing daily , with like-minded dentists that believe that taking the appropriate amount of time to properly disinfect and prepare  patients for treatment is of critical importance in overall healthcare.
 Patients have rights, they have a right to a clean, fair and ethically driven appointment at the next trip to the dentist. Make sure your dentist is going slow where it matters the most.