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What Is An Endodontist?

An Endodontist is a dentist who has undergone a minimum of 2 years postgraduate training after completion of dental school. Specialist training allows an Endodontist to deal with diseases of the dental pulp and supporting structures.

Your general dentist sometimes refers patients for consultation when the diagnosis is complicated or when treatment is more difficult than normal.

What Is Endodontics?

Endodontics is a specialty of Dentistry that deals with diseases of the dental pulp and its supporting structure. Endodontists are Dentists with special post-graduate training in this field.

Endodontist are also experienced at finding the cause of oral and facial pain that has been difficult to diagnose.

Although General Dentists can perform endodontic treatment, patients are often referred to an Endodontist when the case is complicated or more difficult than usual. In order to understand Endodontic treatment, it helps to know something about the anatomy of a tooth. 

The outside layer of the tooth is composed of a hard layer called enamel. Enamel is upported by an inner layer called dentin, which has at its center a soft tissue known as the pulp.

The pulp contains blood vessels, nerves and connective tissue that are responsible for forming the surrounding Dentin and Enamel during tooth development. The pulp receives its nourishment from vessels which enter the end of the root.

Although the pulp is important during development of the tooth, it is not necessary for function of the adult tooth.The tooth continues to be nourished by the tissues surrounding it even after the pulp is removed.


Why Would I Need Endodontic Treatment?

Endodontic treatment is necessary when the pulp becomes inflamed and/or infected. The most common reasons for inflammation or infection are caries (decay), repeated dental procedures or cracks or chips. Trauma can also cause inflammaton and often shows up as discoloration of the tooth. If pulp inflammation or infection is left untreated, it can cause pain and/or lead to an abscess.

Our Treatment Options

Our doctors will meet with you to discuss your individual case. We will evaluate all options and discuss a course of treatment that we hope will provide the best possible outcome for you. We explain some of our treatment options below. 

Root Canal Treatment

Root canal treatment is an often straightforward procedure to relieve dental pain and save your teeth. Patients typically need a root canal when there is inflammation or infection in the roots of a tooth. During root canal treatment, an endodontist who specializes in such treatment carefully removes the pulp inside the tooth, cleans, disinfects and shapes the root canals, and places a filling to seal the space.

Text courtesy of the American Association of Endodontists

Endodontic Retreatment

With proper care, you’ll keep teeth that have had root canal treatment for a lifetime but it’s possible for those teeth to heal improperly, becoming painful or diseased months or even years after treatment. If this happens to your treated teeth you have a second chance to save the tooth with retreatment. An additional procedure may be able to diminish dental pain or discomfort and promote healing. If you suspect a tooth that had a prior root canal requires retreatment, visit your dentist or endodontist for evaluation.

As with any dental or medical procedure, it’s possible your tooth won’t heal as expected after initial treatment for a variety of reasons, including:

  • Narrow or curved canals were not treated during the initial procedure.
  • Complicated canal anatomy went undetected in the first procedure.
  • The placement of the crown or other restoration was delayed following the endodontic treatment.
  • The restoration did not prevent salivary contamination to the inside of the tooth.

A new problem can also jeopardize a tooth that was successfully treated, such as:

  • New decay can expose the root canal filling material to bacteria, causing a new infection in the tooth.
  • A loose, cracked or broken crown or filling can expose the tooth to new infection.
  • A tooth sustains a fracture. During retreatment, the endodontist will reopen your tooth and remove the filling materials that were placed in the root canals during the first procedure. The endodontist then carefully examines the tooth, looking for additional canals or new infection. The endodontist then removes any infection, cleans and shapes the canals, and places new filling materials. The opening is then sealed with a temporary filling. Once the tooth heals, a new crown or other restoration is placed on the tooth to protect it.

Text courtesy of the American Association of Endodontists

Apicoectomy (Endodontic Surgery)

It’s possible that a nonsurgical root canal procedure won’t be enough to save your tooth and that your endodontist will recommend surgery. Endodontic surgery can be used to locate small fractures or hidden canals previously undetected on X-rays during the initial treatment. Surgery may also be needed to remove calcium deposits in root canals, or to treat damaged root surfaces or the surrounding bone of the tooth.

There’s no need to worry about surgery if your endodontist prescribes this additional measure. Advanced technologies like digital imaging and operating microscopes allow these procedures to be performed quickly, comfortably and successfully.

There are many surgical procedures that can be performed to save a tooth. The most common is called an apicoectomy, or root-end resection, which may be needed when inflammation or infection persists in the bony area around the end of your tooth after a root canal procedure.

Your endodontist performs this micro surgical procedure first making you comfortable by applying local anesthesia before opening the gum tissue near the tooth to see the underlying bone and to remove any inflamed or infected tissue. The very end of the root is also removed. A small filling may be placed to seal the end of the root canal and a few stitches or sutures are placed to help the tissue heal. In the next few months, the bone will heal around the end of the root. Most patients return to their normal activities the next day. Post-surgical discomfort is generally mild.

Text courtesy of the American Association of Endodontists

Signs And Symptoms

Indications for treatment include prolonged sensitivity to heat or cold, discoloration of the tooth, swelling or tenderness of the tooth or adjacent gums. Sometimes there are no symptoms and the area of infection is noted by radiographic (x-ray) examination.

How Can Endodontic Treatment Help Me?

The Endodontist removes the inflammed or infected pulp, carefully cleans and shapes the canal system and then seals the prepared space in the roots. Often treatment can be performed in a single appointment ranging from 1-2 hours.  Depending on the tooth, two-visits may be necessary to medicate the space for an extended period of time before sealing the roots. Once root canal treatment is completed, you may be instructed to return to your dentist for a permanent restoration (crown or bonded filling) of the top of the tooth. The restoration of the tooth is an important part of treatment because it seals the root canal filling from the oral environment, protects the tooth from fracture and restores it to function.

Will I Feel Pain During Or After The Procedure?

Toothache pain is the main reason for patients seeking treatment. Fortunately,modern anesthetics can make the procedure pain-free in most cases. Seeking treatment early makes the procedure more comfortable, so don't wait. When caught early, treatment should feel no different than having a regular filling. For the first few days after treatment, there may be some sensitivity to biting pressure, especially if there was pain or infection before the procedure. If there are no contra-indications, Extra Strength Tylenol and /or Ibuprofen 400-600 mg every four to six hours is recommended for 24 to 48 hours after the procedure. The typical inflammatory response peaks at 48 hours then subsides. Do not be alarmed if you feel your tooth a little more two days later. Your endodontist can prescribe other medications but they are rarely required.