Are Root Canals Safe and What the IAOMT Review Means for Patients

Clinically reviewed by:
Eugene Sambataro, DDS, a holistic and biological dentist with more than four decades of clinical experience.

Root canal treatment is commonly recommended to preserve a damaged or infected tooth. However, a 2026 scientific review from the International Academy of Oral Medicine and Toxicology raises important concerns about what may remain after treatment, including persistent microbes and chronic inflammation around a root canal-treated tooth.

The review does not conclude that root canal-treated teeth directly cause systemic disease. At The Julian Center for Comprehensive Dentistry, our clinical position goes further: we do not promote root canal therapy because we believe a chronically infected, nonvital tooth can contribute to systemic health concerns. We recommend evaluating root canal-treated teeth individually with a clinical examination, appropriate imaging, and microbial testing rather than assuming that the absence of pain means the tooth is healthy.

What Did the IAOMT Review Examine?

Released in April 2026, the IAOMT State of the Science on Root Canal Treated Teeth draws on more than 560 scientific references published over several decades. The review examines:

• Persistent infection and inflammation following root canal treatment
• Chronic apical periodontitis around root canal-treated teeth
• The limitations of conventional two-dimensional dental X-rays
• Possible associations between oral infection and systemic health
• Patient and procedural factors that may affect treatment outcomes
• Emerging diagnostic and treatment technologies
• Alternatives to root canal treatment
• How dentists and patients can decide whether to retain or remove a treated tooth

A central concern is that a root canal-treated tooth can appear symptom-free while infection or inflammation remains near the tip of its root or within parts of the root system that are difficult to disinfect completely.

What Is Apical Periodontitis?

Apical periodontitis is inflammation around the end of a tooth’s root. It is generally associated with bacteria or their byproducts entering the tissues surrounding the tooth.

The condition may cause discomfort, swelling, tenderness, drainage, or changes visible on dental imaging. In other cases, it may remain asymptomatic. A patient may therefore feel that the tooth is fine even when inflammation is still present.

The IAOMT review reports that post-treatment apical periodontitis is frequently identified in root canal-treated teeth and notes that conventional two-dimensional X-rays may not reveal every area of concern. Symptoms and a standard X-ray alone may therefore provide an incomplete picture.

The Julian Center’s Position on Root Canal Treatment

The Julian Center does not promote root canal therapy. Root canal treatment removes the living pulp from inside a tooth and attempts to clean, disinfect, and seal a complex microscopic canal system. In our view, the procedure cannot reliably eliminate every pathological microbe from all dentinal tubules, accessory canals, and other difficult-to-reach spaces.

For that reason, we do not describe a root canal-treated tooth as healthy. The tooth is nonvital, and its clinical impact may depend in part on the patient’s immune function, inflammatory burden, overall health, and biological resiliency. Some patients may remain free of noticeable symptoms for years, while others may develop local or broader health concerns. A lack of symptoms should not be treated as proof that the tooth is free of pathological microbes.

This is The Julian Center’s clinical perspective. The IAOMT review discusses associations between chronic apical periodontitis and systemic disease but stops short of concluding that root canal-treated teeth directly cause systemic illness.

Do Root Canals Cause Systemic Health Problems?

Current research does not prove that root canal-treated teeth directly cause heart disease, diabetes, autoimmune disorders, neurological conditions, or pregnancy complications. The IAOMT review does, however, identify associations between chronic apical periodontitis and several systemic conditions. An association means that two conditions have been observed together more frequently; it does not by itself establish that one caused the other.

Researchers have proposed several ways chronic oral infection may affect the rest of the body. Bacteria, bacterial byproducts, and inflammatory signals may enter circulation and add to the body’s inflammatory burden. The strength and clinical significance of these relationships continue to be studied.

At The Julian Center, we believe these findings should not be dismissed simply because direct causation has not yet been established. When a nonvital tooth may be chronically infected, we consider it appropriate to evaluate the tooth in the context of the patient’s total health rather than viewing it as an isolated dental issue.

Why Does The Julian Center Recommend Microbial DNA Testing?

The IAOMT review discusses diagnostic limitations but does not recommend microbial testing for every root canal-treated tooth. The Julian Center believes this leaves an important gap in the evaluation.

We recommend microbial DNA testing when evaluating root canal-treated teeth to help identify pathological microbes that may be present. This information can add another layer of evidence beyond symptoms and imaging. Test results should be interpreted together with the patient’s medical and dental history, clinical findings, imaging, immune status, and treatment goals. No single test should be used in isolation to diagnose a systemic condition or determine treatment.

Can a Root Canal Infection Exist Without Pain?

Yes. Infection or inflammation around a root canal-treated tooth may be present without pain. Patients should consider discussing an evaluation with a qualified dental professional if they have:

• A history of root canal treatment and new dental or health concerns
• Tenderness when chewing or touching the area
• Swelling, drainage, an unusual taste, or a pimple-like bump on the gum
• A tooth that feels different from the surrounding teeth
• An older root canal that has not been evaluated recently
• Concerns about the materials or procedures used during treatment
• Questions about alternatives to a proposed root canal

These signs do not establish that a root canal is causing a systemic problem. A comprehensive evaluation is needed to understand the condition of the tooth and the surrounding tissues.

How Are Root Canal-Treated Teeth Evaluated?

A biological evaluation looks beyond whether the tooth hurts. Depending on the patient’s needs, the assessment may include:

• A detailed dental and medical history
• Current symptoms, health concerns, and treatment priorities
• A clinical examination of the tooth and surrounding tissues
• Evaluation of the tooth’s structural condition and restorability
• Appropriate two-dimensional or three-dimensional imaging
• Microbial DNA testing for pathological microbes
• Review of materials used in previous dental treatment
• Discussion of the risks and benefits of monitoring, retreatment, or removal
• Biocompatible options for restoring or replacing the tooth

The purpose of this evaluation is to gather enough information to discuss the potential sources of inflammation and help the patient make an informed decision.

What Are the Alternatives to Root Canal Treatment?

When the inner tissue of a tooth is severely damaged or infected, conventional options may include root canal treatment or removal of the tooth. Because The Julian Center does not promote root canal therapy, we discuss extraction and the biological considerations involved when a tooth cannot be predictably restored without a root canal.

If extraction is selected, tooth-replacement options may include:

• A biocompatible ceramic dental implant
• A dental bridge
• A removable dental appliance
• In selected cases, leaving the space untreated

Extraction is an irreversible procedure and is not appropriate based on an online article alone. Each option has potential benefits, limitations, costs, and biological considerations. Patients should receive an individualized assessment before choosing treatment.

Should You Have an Existing Root Canal Evaluated?

The Julian Center recommends evaluating existing root canal-treated teeth, including teeth that are not painful. An evaluation may be especially important when a patient has unexplained health concerns, signs of local infection, an older root canal, or questions about whether a treated tooth may be contributing to inflammation.

Patients should not attempt to diagnose a root canal infection or systemic illness based on symptoms or online information alone. They should also not have a tooth removed without understanding the clinical findings, potential risks and benefits, and replacement options.

Root Canal Evaluations in Ellicott City, Maryland

At The Julian Center for Comprehensive Dentistry, Dr. Eugene Sambataro and Dr. Zachary Reicher take a biological, whole-body approach to dental care. Our team evaluates root canal-treated teeth within the context of each patient’s oral health, medical history, immune function, and individual concerns.

If you have a root canal-treated tooth, have been advised to undergo root canal treatment, or would like to discuss biological alternatives, we welcome your questions. Call The Julian Center for Comprehensive Dentistry at (410) 964-3118 or contact our Ellicott City office to schedule an appointment.

Key Takeaways

• A root canal-treated tooth may continue to harbor pathological microbes and chronic inflammation even when it does not hurt.
• The IAOMT review identifies associations between chronic apical periodontitis and systemic conditions but does not establish direct causation.
• The Julian Center does not promote root canal therapy and does not consider a root canal-treated tooth to be a healthy, vital tooth.
• A patient’s immune function, inflammatory burden, overall health, and resiliency may influence whether noticeable health problems develop.
• The Julian Center recommends microbial DNA testing as part of a comprehensive evaluation of root canal-treated teeth.
• Treatment decisions should be individualized and based on clinical findings, imaging, microbial testing, health history, and a clear discussion of risks, benefits, and alternatives.

Frequently Asked Questions

Does The Julian Center Recommend Root Canal Therapy?

No. The Julian Center does not promote root canal therapy. We believe a nonvital, root canal-treated tooth may remain a source of pathological microbes and chronic inflammation, and we discuss biological alternatives when treatment is needed.

Can a Root Canal-Treated Tooth Be Healthy?

The Julian Center does not consider a root canal-treated tooth to be a healthy, vital tooth. A patient may remain symptom-free because of individual immune function and resiliency, but the absence of symptoms does not confirm that the tooth is free of pathological microbes.

Can a Failed Root Canal Have No Symptoms?

Yes. Persistent infection or inflammation around a treated tooth may exist without pain or swelling. A clinical examination, appropriate imaging, and microbial testing can provide more information.

What Is Microbial DNA Testing?

Microbial DNA testing uses molecular methods to help identify microbes associated with oral infection. At The Julian Center, results are considered alongside the patient’s examination, imaging, health history, and other clinical findings rather than used as a stand-alone diagnosis.

Does Research Prove That Root Canals Cause Systemic Disease?

No. Research has found associations between chronic apical periodontitis and several systemic conditions, but association does not prove causation. The Julian Center believes the potential relationship is clinically important and should be considered during a whole-body evaluation.

What Should I Do if I Am Concerned About an Old Root Canal?

Schedule an examination with a qualified dental professional. Bring any previous records or images that are available and discuss your symptoms, medical history, concerns, and treatment preferences.

Where Can I Read the IAOMT Review?

The complete paper, including its methodology, conclusions, limitations, and references, is available from the International Academy of Oral Medicine and Toxicology.

Related Articles and Resources

• Tooth Extractions in Ellicott City, Maryland
• Zirconia Dental Implants in Ellicott City, Maryland
• Why Mercury Dental Fillings Still Exist — And Why It Matters

This article is intended for general educational purposes. It does not diagnose a dental or medical condition and is not a substitute for individualized dental or medical advice.