Who performs endodontic treatment?

All dentists, including your general dentist, received endodontic training in dental school. General dentists can perform endodontic procedures along with other dental procedures, but often they refer patients needing endodontic treatment to endodontists.

Endodontists are dentists with special training in endodontic procedures. They do only endodontics in their practices because they are specialists. To become specialists, they complete dental school and an additional two years of advanced training in endodontics. They may perform routine as well as difficult and very complex endodontic surgery. Endodontists are also experienced at finding the cause of oral and facial pain that has been difficult to diagnose.

What is endodontic treatment?

"Endo" is the Greek word for "inside" and "odont" is Greek for "tooth." Endodontic treatment treats the inside of the tooth.

To understand endodontic treatment, it helps to know something about the anatomy of the tooth. Inside the tooth, under the white enamel and a hard layer called the dentin, is a soft tissue called the pulp. The pulp contains blood vessels, nerves, and connective tissue and creates the surrounding hard tissues of the tooth during development.

The pulp extends from the crown of the tooth to the tip of the roots where it connects to the tissues surrounding the root. The pulp is important during a tooth's growth and development. However, once a tooth is fully mature it can survive without the pulp, because the tooth continues to be nourished by the tissues surrounding it.

Why would I need an endodontic procedure?

Endodontic treatment is necessary when the pulp becomes inflamed or infected. The inflammation or infection can have a variety of causes: deep decay, repeated dental procedures on the tooth, or a crack or chip in the tooth. In addition, a blow to a tooth may cause pulp damage even if the tooth has no visible chips or cracks. If pulp inflammation or infection is left untreated, it can cause pain or lead to an abcess.

Signs of pulp damage include pain, prolonged sensitivity to heat or cold, discoloration of the tooth, swelling and tenderness in the nearby gums. Sometimes, there are no symptoms.

How does endodontic treatment save the tooth?

The endodontist removes the inflamed or infected pulp, carefully cleans and shapes the inside of the tooth, then fills and seals the space. Afterwards, you will return to your dentist, who will place a crown or other restoration on the tooth to protect and restore it to full function. After restoration, the tooth continues to function like any other tooth.

Will I feel pain during or after the procedure?

Many endodontic procedures are performed to relieve the pain of toothaches caused by pulp inflammation or infection. With modern techniques and anesthetics, most patients report that they are comfortable during the procedure.

For the first few days after treatment, your tooth may feel sensitive, especially if there was pain or infection before the procedure. This discomfort can be relieved with over-the-counter or prescription medications. Follow your endodontist's instructions carefully.

Your tooth may continue to feel slightly different from your other teeth for some time after your endodontic treatments is completed. However, if you have severe pain or pressure or pain that lasts more than a few days, call your endodontist.

Endodontic Procedure:

Endodontic treatment can often be performed in one or two visits and involves the following steps:

The endodontist examines and x-rays the tooth, then administers local anesthetic. After the tooth is numb, the endodontist places a small protective sheet called a "dental dam" over the area to isolate the tooth and keep it clean and free of saliva during the procedure.

The endodontist makes an opening in the crown of the tooth. Very small instruments are used to clean the pulp from the pulp chamber and root canals and to shape the space for filling.

After the space is cleaned and shaped, the endodontist fills the root canals with a biocompatible material, usually a rubber-like material called "gutta-percha." The gutta-percha is placed with an adhesive cement to ensure complete sealing of the root canals. In most cases, a temporary filling is placed to close the opening. The temporary filling will be removed by your dentist before the tooth is restored.

After the final visit with your endodontist, you must return to your dentist to have a crown or other restoration placed on the tooth to protect and restore it to full function.

If the tooth lacks sufficient structure to hold the restoration in place, your dentist or endodontist may place a post inside the tooth. Ask your endodontist for more details about the specific restoration planned for your tooth.

Will the tooth need any special care or additional treatment?

You should not chew or bite on the treated tooth until you have had it restored by your dentist. The unrestored tooth is susceptible to fracture, so you should see your dentist for a full restoration as soon as possible. Otherwise, you need only practice good oral hygiene, including brushing, flossing, and regular checkups and cleanings.

Most endodontically treated teeth last as long as other natural teeth. In a few cases, a tooth that has undergone endodontic treatment fails to heal or the pain continues. Occasionally, the tooth may become painful or diseased months or even years after successful treatment. Often when this happens, another endodontic procedure can save the tooth.

A second chance to save your tooth

With proper care, most teeth that have had endodontic (root canal) treatment can last as long as other natural teeth.

In some cases, however, a tooth that has received endodontic treatment fails to heal or the pain continues. Occasionally, the tooth becomes painful or diseased months or even years after successful treatment.

If your tooth has failed to heal or has developed new problems, you have a second chance. Another endodontic procedure may be able to save your tooth.

Why do I need another endodontic procedure?

As occasionally happens with any dental or medical procedure, a tooth may not heal as expected after initial treatment for a variety of reasons:

• Narrow or curved canals were not treated during the initial procedure
• Complicated canal anatomy went undetected in the first procedure
• The crown or other restoration was not placed soon enough after the procedure
• The restoration did not prevent saliva from contaminating the inside of the tooth

In other cases, a new problem can jeopardize a tooth that was successfully treated. For example:

• 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

What will happen during retreatment?

1) First, the endodontist will discuss your treatment options. If you and your family dentist choose retreatment, the endodontist will reopen your tooth to gain access to the root canal filling material. In many cases, complex restorative materials - crown, post, and core material - must be disassembled and removed to permit access to the root canals.

2) After removing the canal filling, the endodontist can clean the canals and carefully examine the inside of your tooth, searching for any additional canals or unusual anatomy that requires treatment.

3) After cleaning the canal(s), the endodontist will fill and seal the canal(s) and place a temporary filling in the tooth. Post space may also be prepared at this time.

4) After the final visit with your endodontist, you will need to return to your dentist as soon as possible to have a new crown or other restoration placed on the tooth to protect and restore it to full function.

Is retreatment the best choice for me?

Retreated teeth can function well for years, even for a lifetime. It's always best to save the tooth if your endodontist believes retreatment is the best option for you.

Advances in technology are constantly changing the way root canal treatment is performed, so your endodontist may even be able to use a new technique that was not available when you had your first procedure. If your tooth has unusual anatomy that was not cleaned and sealed during the first procedure, your endodontist may be able to resolve this problem with a second treatment.

Of course, there are no guarantees with any dental or medical procedure. Your endodontist will discuss your options and the chances of success before beginning retreatment.

What are the alternatives to treatment?

For some patients considering retreatment, endodontic surgery is also an option. This surgery involves making an incision near the end of the root to allow the tip of the root to be sealed. Endodontic surgery may be recommended in conjunction with retreatment or as an alternative. Your endodontist will discuss your options and recommend appropriate treatment.

The only other alternative is extraction of the tooth. The extracted tooth must then be replaced with an implant, bridge, or removable partial denture to restore chewing function and to prevent adjacent teeth from shifting. Because these alternatives require surgery or dental procedures on adjacent healthy teeth, they can be far more costly and time consuming than retreatment and restoration of the natural tooth.

No matter how effective modern tooth replacements are - and they can be very effective - nothing is as good as a natural tooth. You've already made an investment in saving your tooth. The pay-off for choosing endodontic surgery could be a healthy, functioning natural tooth for many years to come.

Once endodontic therapy is completed your tooth should be examined periodically, usually every 6 - 12 months.  This allows us to make sure the tooth has healed or is healing properly.  We will be happy to schedule you for your recall appointment at the time your treatment is completed or we can put you on a call list to notify you when it is time for your check up.  This is a no charge check up to you.

To understand endodontic surgery, it helps first to know something about the nonsurgical endodontic procedure, or "root canal." A root canal is necessary when the soft inner tissue, or "pulp" of the tooth becomes inflamed or infected. This may happen as a result of deep decay, repeated dental procedures on the tooth, or a blow to the tooth. Endodontic treatment removes the damaged pulp. Then the tooth's canals are cleaned and filled to help preserve the tooth.

In a few cases, however, nonsurgical endodontic treatment alone cannot save the tooth. In such a case, your dentist or endodontist may recommend surgery.

Why would I need endodontic surgery?

Surgery can help save your tooth in a variety of situations:

Surgery may be used in diagnosis. If you have persistent symptoms but no problems appear on your x-ray, your tooth may have a tiny fracture or canal that could not be detected during nonsurgical treatment.

Sometimes calcium deposits make a canal too narrow for the cleaning and shaping instruments used in nonsurgical root canal treatment to reach the end of your root. If your tooth has this "calcification," endodontic surgery may be able to clean and seal the remainder of the canal.

Usually, a tooth that has undergone a root canal can last the rest of your life and never need further endodontic treatment. However, in a few cases, a tooth may fail to heal. The tooth may become painful or diseased months or even years after successful treatment. If this is true for you, surgery may help save your tooth.

Surgery may also be performed to treat damaged root surfaces or surrounding bone. Although there are many surgical procedures that can be performed to save a tooth, the most common is called apicoectomy or root-end resection. When inflammation or infection persists in the bony area around the end of your tooth after a root canal procedure, your endodontist or oral surgeon may have to perform an apicoectomy.

What is an apicoectomy?

1. In this procedure, the gum tissue near the tooth is opened to see the underlying bone and to remove any inflamed or infected tissue. The very end of the root is also removed.

2. A small filling may be placed to seal the end of the root canal, and a few stitches or sutures are placed in the gum to help the tissue heal properly.

3. Over a period of months, the bone heals around the end of the root.

Will the procedure hurt?

Local anesthetics make the procedure comfortable. Of course, you may feel some discomfort or experience slight swelling while the incision heals. This is normal for any surgical procedure. Appropriate pain medication will be prescribed to alleviate your discomfort.

Who will perform your surgery?

An oral surgeon may be recommended by your endodontist to perform the necessary endodontic surgery. Their experience and surgical suites offers additional options for sedation during the procedure.

How will I know that the surgery will be successful?

Your dentist and endodontist, as a team, are suggesting endodontic surgery because they believe it is the best option for you. Of course, there are no guarantees with any surgical procedure. We will discuss your chances for success so that you can make an informed decision.

What are the alternatives to endodontic surgery?

Often, the only alternative to surgery is extraction of the tooth. The extracted tooth must then be replaced with an implant, bridge, or removable partial denture to restore chewing function and to prevent adjacent teeth from shifting. Because these alternatives require surgery or dental procedures on adjacent healthy teeth, endodontic surgery is usually the most cost-effective option for maintaining your oral health.

No matter how effective modern tooth replacements are - and they can be very effective - nothing is as good as a natural tooth. You've already made an investment in saving your tooth. The pay-off for choosing endodontic surgery could be a healthy, functioning natural tooth for the rest of your life.

Most traumatic dental injuries occur in children, but people of all ages can be affected. Whether the injury is a result of an automobile accident, a sports mishap, an altercation or a bad fall, the severity and type of injury will determine the treatment necessary.

There are a number of common injuries that occur to teeth. Many of them affect the inner soft tissues of the tooth, known as the dental pulp. When the pulp becomes injured or inflamed, root canal treatment may be needed.

Types of Injuries:

Chipped teeth account for the majority of all dental trauma. The remaining represent more serious problems, including dislodged and knocked-out teeth. Treatment depends on the type, location and severity of each injury. When any dental injury occurs, the most important thing is to see your dentist or endodontist immediately. The outcome, or prognosis, for your specific injury often depends on how quickly you see your dentist.

Other Injuries:

An immature permanent tooth that has been dislodged may require minimal or no treatment other than follow-up until it has matured. If the tooth is severely dislodged, orthodontic or surgical repositioning and stabilization may be necessary.

If an immature permanent tooth has been out of the mouth for less than one hour, the tooth should be placed back in its socket, stabilized and watched closely by your dentist or endodontist for three to four weeks. During this time, your dentist will look for changes in tooth colour, pain, swelling or loosening of the tooth. If any of these problems arise, an apexification procedure followed by a permanent root canal filling may be needed.

If the immature permanent tooth has been out of the mouth and dry for more than one hour, the tooth may be put back in the socket, filled with a medication and re-evaluated in six to eight weeks. The long-term health of this tooth is generally poor, so your dentist or endodontist may discuss other treatment options with you.

Will the tooth need any special care or additiona treatment?

The nature of the injury, the length of time from injury to treatment, how your tooth was cared for after the injury and your body's response all affect the long-term health of the tooth. Timely treatment is particularly important with the dislodged or avulsed tooth to prevent resorption. Resorption occurs when your body, through its own defense mechanisms, begins to reject your own hard tooth structure in response to traumatic injury. You should return to your dentist or endodontist to have the tooth examined at regular intervals following the injury to ensure that resorption is not occurring and that surrounding tissues contin

With their more sophisticated procedures, dentists are helping people keep their teeth longer. Because people are living longer and more stressful lives, they are exposing their teeth to many more years of crack-inducing habits, such as clenching, grinding, and chewing on hard objects. These habits make our teeth more susceptible to cracks.

How do I know if my tooth is cracked?

Cracked teeth show a variety of symptoms, including erratic pain when chewing, possibly with release of biting pressure, or pain when your tooth is exposed to temperature extremes. In many cases, the pain may come and go, and your dentist may have difficulty locating which tooth is causing the discomfort.

Why does a cracked tooth hurt?

To understand why a cracked tooth hurts, it helps to know something about the anatomy of the tooth. Inside the tooth, under the white enamel and a hard layer called the dentin, is the inner soft tissue called the pulp. The loose pulp is a connective tissue that contains cells, blood vessels and nerves.

When the outer hard tissues of the tooth are cracked, chewing can cause movement of the pieces, and the pulp can become irritated. When biting pressure is released, the crack can close quickly, resulting in a momentary, sharp pain. Irritation of the dental pulp can be repeated many times by chewing. Eventually, the pulp will become damaged to the point that it can no longer heal itself. The tooth will not only hurt when chewing but may also become sensitive to temperature extremes. In time, a cracked tooth may begin to hurt all by itself. Extensive cracks can lead to infection of the pulp tissue, which can spread to the bone and gum tissue surrounding the tooth.

How will my cracked tooth be treated?

There are many different types of cracked teeth. The treatment and outcome for your tooth depends on the type, location, and extent of the crack.

Craze Lines:

Craze lines are tiny cracks that affect only the outer enamel. These cracks are extremely common in adult teeth. Craze lines are very shallow, cause no pain, and are of no concern beyond appearances.

Fractured Cusp:

When a cusp (the pointed part of the chewing surface) becomes weakened, a fracture sometimes results. The weakened cusp may break off by itself or may have to be removed by the dentist. When this happens, the pain will usually be relieved. A fractured cusp rarely damages the pulp, so root canal treatment is seldom needed. Your tooth will usually be restored with a full crown by your dentist.

Cracked Tooth:

This crack extends from the chewing surface of the tooth vertically towards the root. A cracked tooth is not completely separated into two distinct segments. Because of the position of the crack, damage to the pulp is common. Root canal treatment is frequently needed to treat the injured pulp. Your dentist will then restore your tooth with a crown to hold the pieces together and protect the cracked tooth. At times, the crack may extend below the gingival tissue line, requiring extraction. A nontreatable tooth is shown in the graphic above.

Early diagnosis is important. Even with high magnification and special lighting, it is sometimes difficult to determine the extent of a crack. A cracked tooth that is not treated will progressively worsen, eventually resulting in the loss of the tooth. Early diagnosis and treatment are essential in saving these teeth.

Split Tooth:

A split tooth is often the result of the long term progression of a cracked tooth. The split tooth is identified by a crack with distinct segments that can be separated. A split tooth cannot be saved intact. The position and extent of the crack, however, will determine whether any portion of the tooth can be saved. In rare instances, endodontic treatment and a crown or other restoration by your dentist may be used to save a portion of the tooth.

Vertical Root Fracture:

Vertical root fractures are cracks that begin in the root of the tooth and extend toward the chewing surface. They often show minimal signs and symptoms and may therefore go unnoticed for some time. Vertical root fractures are often discovered when the surrounding bone and gum become infected. Treatment may involve extraction of the tooth. However, endodontic surgery is sometimes appropriate if a portion of the tooth can be saved by removal of the fractured root.

After treatment for a cracked tooth, will my tooth completely heal?

Unlike a broken bone, the fracture in a cracked tooth will not heal. In spite of treatment, some cracks may continue to progress and separate, resulting in loss of the tooth. Placement of a crown on a cracked tooth provides maximum protection but does not guarantee success in all cases.

The treatment you receive for your cracked tooth is important because it will relieve pain and reduce the likelihood that the crack will worsen. Once treated, most cracked teeth continue to function and provide years of comfortable chewing. Talk to your endodontist about your particular diagnosis and treatment recommendations. They will advise you on how to keep your natural teeth and achieve optimum dental health.

What can I do to prevent my teeth from cracking?

While cracked teeth are not completely preventable, you can take some steps to make your teeth less susceptible to cracks.

Don't chew on hard objects such as ice, unpopped popcorn kernels or pens:

• Don't clench or grind your teeth
• If you clench or grind your teeth while you sleep, talk to your dentist about getting a retainer or other mouthguard to protect your teeth
• Wear a mouthguard or protective mask when playing contact sports

   

Most chipped teeth can be repaired with a simple filling. Sometimes a chip will expose the pulp of the tooth. Some exposures can be treated by placing a filling over the injured area. Other exposures, however, may require root canal treatment.

Injuries in the back teeth often include fractured cusps, cracked teeth and the more serious split teeth. Cracks may or may not extend into the root. If the crack does not extend into the root, the tooth can usually be restored by your dentist with a full crown. If the crack does extend into the root and affects the pulp, root canal treatment is usually necessary in an attempt to save all or a portion of your tooth.

During an injury, a tooth may be pushed into its socket. This can be one of the more serious injuries. Your endodontist or general dentist may reposition and stabilize your tooth. Root canal treatment is usually started within a few weeks of the injury, and a medication, such as calcium hydroxide, may be put inside the tooth. A permanent root canal filling will be placed at a later date. You should continue to have the tooth monitored periodically by your dentist to assure proper healing.

Sometimes a tooth is pushed partially out of the socket. Repositioning and stabilization of the tooth are usually necessary. If the pulp remains healthy, no additional treatment may be needed. If the pulp is injured, your dentist or endodontist may need to start root canal treatment. Medication, such as calcium hydroxide, may be placed inside the tooth and should be followed by a permanent root canal filling at a later date.

If a tooth is completely knocked out of your mouth, time is of the essence. If this type of injury happens to you, pick up your tooth by the crown, or chewing portion. Try not to touch the root. If the tooth is dirty, gently rinse it in water. Do not use soap or any other cleaning agent. If possible, place the tooth back into its socket. Go to the dentist immediately.

If you cannot put the tooth back in its socket, be sure to keep it moist. The less time the tooth spends drying out, the better the chance of saving the tooth. Solutions to keep your tooth moist are available at local drug stores. You can also put the tooth in milk or a glass of water with only a pinch of salt, or you can simply put it in your mouth between your gum and cheek. Bring your tooth to the dentist immediately.

If the tooth has been put back in its socket, your dentist may stabilize the tooth with a splint and check for any other facial injuries. If the tooth has not been put back into its socket, your dentist will examine the tooth to determine if it is still intact and check for other facial injuries. Your dentist will clean the tooth carefully and place it gently back into the socket. Your tooth may need to be stabilized with a splint for a period of time. Depending on the stage of root development, your dentist or endodontist may start root canal treatment. A medication may be placed in the tooth followed by a permanent root canal filling at a later date. The length of time the tooth was out of the mouth and the way the tooth was stored before reaching the dentist may influence the type of treatment you receive. You should contact your physician to see if a tetanus booster is necessary.

A traumatic injury to the tooth may also result in a horizontal root fracture. The location of the fracture determines the long-term health of the tooth. If the fracture is close to the root tip, the chances for success are better. If the fracture does not result in the two pieces of the root being separated, there is also a better chance for success. However, the nearer the fracture is to the chewing surface of the tooth, the poorer the long-term success rate, regardless of whether the pieces are separated.

Sometimes stabilization with a splint is required for a period of time. If the tissue inside the tooth is damaged, root canal treatment may be needed. A medication may be placed in the canal to prepare the fracture site for the eventual root canal filling.