Endodontists are dentists who specialize in maintaining teeth through endodontic therapy -- procedures, involving the soft inner tissue of the teeth, called the pulp.  The word "endodontic" comes from "endo" meaning inside and "odont" meaning tooth.  Like many medical terms, it's Greek.  All dentists are trained in diagnosis and endodontic therapy, however, some teeth can be especially difficult to diagnose and treat.  That’s why you may have been referred to an endodontic specialist.

In addition to dental school, endodontists receive two or more years of advanced education in this kind of treatment. They study root canal techniques and procedures in greater depth, for diagnosis and treatment of more difficult cases. For this reason, many dentists choose to refer their patients to endodontists.

A local anesthetic will be given. We also offer anti-anxiety medications by prescription, and nitrous oxide is also available at an additional cost for patients requesting additional sedation. A sheet of latex called the "rubber dam" (we've got non-latex ones too) will be placed around the tooth to isolate it, keeping it clean and dry during treatment. The treatment consists of 3 or 4 basic steps, but the number of visits will depend on your particular case. Some treatments require 2 visits, but many are just a single visit. 

In any case, it depends on the degree of infection/inflammation and degree of treatment difficulty. To us, it's more important to do it the very best we can, rather than to meet a specific time criteria. Let's look at the basic steps for non-surgical endodontic therapy after the tooth is anesthetized:

1.  An opening is made in the top of the tooth to access the inside of the tooth. The endodontist uses very small instruments to remove the pulp from inside the tooth, as well as shaping and preparing the root canals for filling.

2.  Once the pulp is removed and the root canals are cleaned and shaped, the canals are filled with a rubber-like substance called gutta-percha and sealant to prevent bacteria from entering the canals and reinfecting the tooth. The endodontist typically places a temporary filling in the tooth at the conclusion of the visit, which will help protect the inside of the tooth while the patient waits for permanent restoration with their general dentist.

3.  The general dentist will remove the temporary filling, place a permanent filling in, and prepare for the tooth to receive a permanent crown or other restoration to protect the tooth and allow full function. 

There are, of course, no guarantees.  Root canal or endodontic therapy has a greater than 94% rate of success when performed by an endodontic specialist. Success can be lower depending on the amount of damage the tooth has sustained, such as a crack or a fracture. We will discuss with you the chances of success before any endodontic procedure to help you make an informed decision. Even if a root canal or endodontic therapy is unsuccessful or fails, you still have options.

Oral pain such as toothaches or cracked / fractured teeth can often be difficult to pinpoint.  Because of the vast network of nerves in the mouth, the pain of a damaged or diseased tooth often is felt in another tooth and/or in the head, neck, or ear. An endodontist is a specialist in diagnosing and treating this type of pain.

Pulp or tooth damage is sometimes caused by a blow to the mouth during an accident or a sports-related injury. This can include chipped or fractured teeth, teeth that are knocked-out, dislodged teeth, root fractures, and others. Endodontists have specialized training in treating these and other traumatic injuries. For example, a blow to a child's permanent tooth that is not fully developed can cause the root to stop growing. A procedure called apexification stimulates bone to be deposited at the end of the root which makes it possible to then save the tooth through a root canal procedure. 

If a tooth gets knocked out, handle it very carefully, avoid touching the root surface of the tooth, and call an endodontist or your general dentists immediately. The endodontist may be able to place the tooth back in its socket and secure it using an orthodontic splint to hold it in place while it heals. 

Injuries where the pulp is damaged or exposed often require root canal treatment. The type and success of treatment selected depends on the type and extend of damage to the tooth, as well as the length of time since the damage occured. Generally, the sooner that treatment takes place after an injury, the higher the likelihood of success. Your endodontist will discuss and help you decide what type of treatment will be most appropriate for your situation.

Resorption is when the body's immune system begins to eat away at the tooth structure, weakening it and eventually leading to rejection of the tooth. Resorption often occurs in correlation to a traumatic or sports-related injury to the tooth, but resorption can still happen even if injury does not occur. 

Occasionally a tooth that has undergone endodontic treatment fails to heal or pain continues despite therapy. Although rare, sometimes a tooth initially responds to root canal therapy but becomes painful or diseased months or years later. When either of these situations occur, the tooth often can be maintained with a second endodontic treatment. During a retreatment, the old filling material in the root canals is removed and the inside of the tooth is thoroughly cleaned again, looking for new infection or additional nerve canals that were not found previously. New filling material is then placed in the root canals. Success for this treatment can still be very good, but may be slightly less than initial root canal therapy.

If traditional root canal therapy does not treat the problem or is unable to be performed, then a procedure called an apicoectomy may be recommended. "Apical" means the end of the tooth's root, and "ectomy" means removal of. An apicoectomy is a procedure in which the endodontist surgically removes the end of the root. On rare occasion, the entire root has to be removed due to root fractures. This is called a root amputation. The tooth is filled using a special retrograde filling material. A bone graft is typically placed to help facilitate the growth of bone around the surgery site, and sutures are placed to help the gums heal. This type of treatment, performed by our highly skilled and trained endodontists, have rates of success above 90%. Your endodontist will work with you and help you decide which treatment will give you the best possible outcome for your situation. 

Images Courtesy of American Association of Endodontists