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.

While there are many jokes about how painful the procedure is, the alluded-to pain is usually the symptoms that brought one to the dentist or endodontist in the first place. The actual root canal procedure is no more painful than having a “filling” or restoration, and, often, although your dental professional will numb up the area with local anesthetic before working, there is little or no sensation because the nerve can be damaged/destroyed by the infective process.

First, the tooth is x-rayed, so that the precise layout of the root canals can be seen (these are the “feet” of the teeth that extend down into the bone below the gum line. Usually your endodontist will place a waterproof piece of plastic or non-latex material around the tooth to keep it dry and prevent saliva (containing bacteria) from contaminating the area. Depending on the level of decay or damage to the enamel or dentin, a small hole is made through which progressively larger diameter cleaning tools are passed to scrape out the infected pulp canal. The holes made are rinsed out with water or sodium hypochlorite (dilute bleach) to make sure that all evidence of infection is removed.

Once the canal is thoroughly cleaned out, a rubber-like material, called gutta percha, is used to fill the space and then the tooth sealed with a filling. If the tooth is so badly damaged from decay that much of the structure has been destroyed, the dentist/endodontist may place small metal posts within the canal, around which s/he will build up the natural form of the tooth. A temporary crown will be placed. In cases like this, a permanent crown will be required, which can be placed at a second appointment.  Until the permanent crown is placed you will usually be advised to stay away from chewing on that tooth to prevent that temporary crown from breaking and allowing the pulp to be re-infected.

A few people do have complications, but they are rare. The most common complication is further infection, either because some area was missed during the cleanout, or new cracks or fissures develop in the tooth, leading to the re-introduction of bacteria. The sealing materials may degrade or breakdown over time, also allowing new infection in. This usually does not happen immediately, and can often be successfully treated with a second procedure. If the anatomy of the root canal is such that the files cannot be easily passed into them, a root-end resection, or apicoectomy might need to be performed. In this procedure, the endodontist goes through the gums to get to the base of the root, which is removed, along with the infected material.

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 damage is sometimes caused by a blow to the mouth, and the endodontist specializes in treating these 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. An endodontist is specially trained in procedures for replanting teeth that have been knocked out of their sockets.

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.  You will be sent a notice in the mail when we feel it is appropriate to reevaluate the area.  Since an abscess may take 2 years to heal, our office will reevaluate the tooth for at least 2 years.

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.