Endodontists are dentists who specialize in maintaining teeth through endodontic therapy -- procedures involving the soft inner tissue of the teeth, called the pulp. Although all dentists are trained in diagnosis and endodontic therapy,  some teeth can be especially difficult to diagnose and treat and require a referral 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.  They learn, through the use of advanced technology such as the dental operating microscope, to locate and clean the very small root canals and complexities within the tooth. For this reason, many dentists choose to refer their patients to endodontists.

In order to understand endodontic treatment, it helps to know something about the anatomy of a tooth.  Teeth have several layers.  The outside layer of the tooth is composed of a hard layer called enamel.  Enamel is supported 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 supply 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 tooth. The tooth continues to be nourished by the tissues surrounding it even after the pulp is removed.

The treatment consists of three or four basic steps and the number of visits will depend on the degree of infection/inflammation and degree of treatment difficulty.  Some treatments take 2 visits but many are just a single visit.  Occasionally, 3 appointments are needed.  We believe it is more important to emphasize the quality of care and attain a succesful outcome than to meet a specific time criteria.  

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

When a tooth becomes inflamed and hypersensitive to a point where it cannot recover or when the pulp dies and abscesses, a root canal in needed in order to retain the natural tooth and eliminate the pain and infection. The only other alternative to having root canal therapy would be to have the tooth removed (extracted/pulled).   Antibiotics are only a short term solution to temporarily control any swelling and pain from the infection.  As there is no blood flow into the abscess or into the root canals where the infection originates, the antibiotics cannot reach the source of the infection and will not "cure" it.  Delaying definitive treatment with either a root canal or extraction of the tooth is not a good option as it will only increase the risk of pain, swelling, loss of tooth structure and bone support. 

Oral pain, such as a toothache or a cracked/fractured tooth, can often be difficult to pinpoint.  Due to the vast network of nerves in the mouth, the pain of a damaged or diseased tooth may be felt in another tooth and/or in the head and neck region.  An Endodontist is a specialist trained in diagnosing and treating this type of pain.

A local anesthetic will be given for this treatment.  A rubber dam (latex or non-latex) will then be placed around the tooth to isolate it and keep it dry during the treatment.  A small access opening will be made through the biting surface of the tooth and the root canals will be located, cleaned with tiny files and flushed thoroughly with antibacterial rinses.  Once the canals are cleaned and dried, the root canal filling material and a temporary restoration will be placed.

Although very rare during endodontic treatment, there is the possibility of instrument separation within the root canals, perforations(extra openings), damage to bridges, existing fillings, crowns or porcelain veneers, canals which are too small to locate or clean entirely, loss of tooth structure in gaining access to canals, and fractures of the tooth or roots over time due to the loss of tooth structure and repeated use/stress on the tooth.  Curved roots and small "calcified" root canals may put you at higher risk for some of these complications.

There are, of course, no guarantees.  Root canal or endodontic therapy has a very high degree of success, up to 90%.   We will discuss with you the prognosis for success before any endodontic procedure is undertaken to help you make an informed decision.  If the endodontic therapy is unsuccessfull, there are other options available.

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.  Since an abscess may take 2 years to heal, it is important that a reevaluation be done.

Occasionally, a tooth that has undergone endodontic treatment fails to heal, or pain continues despite therapy. Although rare, a tooth that initially responds to root canal therapy may become painful or diseased months or years later. When either of these situations occur, the tooth often can be maintained with a second endodontic treatment.

Although rare, an infection can be resistant to healing after root canal therapy and may  require a surgical procedure to remove the inflamed and infected tissue at the tip of the roots.  Endodontists are the experts in this type of surgery, using the dental operating microscope, microinstruments and advanced materials to conservatively treat these teeth.  Although the surgery involves making an incision in the gums, it is different than "gum" surgery or periodontal surgery performed by periodontists to treat gum disease.

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. Procedures such as apexification or pulpal regeneration can be utilized in teeth with either incompletely developed roots or fully developed roots to save the tooth. An endodontist is specially trained in procedures for replanting teeth that have been avulsed (knocked out of their sockets).