Laboratory diagnosis before root canal treatment
If the purpose of the diagnosis is to check whether the root canal-treated tooth is 'sowing' bacteria on the body and may be causing chronic inflammation, then not all the tests on the list are necessary. The focus should be on those that will best assess:
1. Is there chronic inflammation in the body?
2. is there activation of the immune system in response to bacterial toxins?
3. is there evidence of an infection that may originate from the tooth?
Key studies to assess the impact of the tooth on the body:
1. Perox (Lipid peroxidase, LPO - Lipid peroxidation test)
Assesses oxidative stress and cell membrane damage caused by chronic inflammation.
2. CRP (C-reactive protein) and hs-CRP (high-sensitivity CRP)
It shows whether there is inflammation in the body - elevated levels may suggest that the body is responding to a chronic infection (e.g. originating from a tooth).
3. ESR (passerine reaction)
A general marker of chronic inflammation - elevated may suggest that there is an ongoing inflammatory process in the body.
4 Interleukin 6 (IL-6)
A key marker of chronic inflammation - elevated levels may indicate infection, autoimmune disease or inflammation related to the tooth.
5. TNF-α (tumour necrosis factor alpha)
Marker of systemic inflammation - if elevated, may indicate that the tooth is the source of a chronic immune response.
6. LPS (lipopolysaccharides - bacterial endotoxin test)
Key test - if the tooth is a source of infection, bacterial endotoxins may appear in the blood, suggesting an active infection originating from the root canals.
7. sCD14 (soluble CD14 - endotoxin response marker)
If levels are high, it may mean that the body is fighting bacterial toxins from a chronic source of infection (such as a tooth).
8. leucocyte scintigraphy (examination of labelled leucocytes)
The most advanced imaging test for detecting active inflammatory foci - if a tooth is 'seeding', it should be visible as an active inflammatory site.
Additional tests (if the result of the above is questionable):
9. blood count with smear
Elevated monocytes and neutrophils may suggest a chronic infection, such as a bacterial infection.
10. D-dimers
If chronic inflammation affects the coagulation system, D-dimers may be elevated.
11. Procalcitonin (PCT)
If an active bacterial infection in the body is suspected, elevated levels can confirm the infection.
Which studies are absolutely key?
If only a few tests need to be done to determine whether a root canal treated tooth is 'sowing', I would recommend it:
- Perox - shows damage to cell membranes by chronic inflammation.
- hs-CRP + ESR - general inflammation.
- IL-6 + TNF-α - key pro-inflammatory cytokines.
- LPS + sCD14 - detection of bacterial toxins from a potential source of infection.
Leucocyte scintigraphy - if you want to see precisely whether a tooth is the source of inflammation.
If the results of these tests come out elevated, the diagnosis can be extended to include blood count, D-dimers and procalcitonin.
Summary:
Not every root canal treatment sows bacteria on the body, but if the patient has chronic complaints and it is suspected that the tooth may be the source, the above tests will assess this.
The most important tests are inflammatory (CRP, IL-6, TNF-α) and endotoxin detection (LPS, sCD14).
Leucocyte scintigraphy is the most accurate imaging study for the detection of inflammatory foci.
This diagnosis gives certainty as to whether the tooth should be saved or whether it is better to remove it.
