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What is Endodontics?
What is an Endodontist and what do they do?

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.

What Happens During Endodontic Treatment? or What is a Root Canal?

A local anesthetic will be given.  A sheet of latex called the "rubber dam" (we've got nonlatex ones too) will be placed around the tooth to isolate it, hence keeping it clean and dry during treatment.  The treatment consists of three or four basic steps, but the number of visits will depend on your particular case.  Some treatments take 2 visits but many are just a single visit.  Occasionally 3 appointments are needed.

In any case, it depends on the degree of infection/inflammation and degree of treatment difficulty.  To me, it's more important to do it the very best we can then to meet a specific time criteria.  

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 chances of success before any endodontic procedure to help you make an informed decision.  If a root canal or endodontic therapy is unsuccessful or fails you still have options.

Diagnoses and Treats Pain
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.
Treats Traumatic Injuries
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.
Retreatment

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.

Improper healing may be caused by:

~ Complicated canals went undetected during the initial treatment.

~ The crown or restoration was not placed within the approprate amount of time following the proceedure.

~ The crown or restoration did not prevent saliva from contaminating the inside of the tooth

In some cases, new problems can influence a tooth that was successfully treated:

~ New decay can expose a root canal filling material, causing infection.

~ A cracked or loose filling or crown can expose the tooth to new inection.

 

Once retreatment has been selected as a solution to your problem, the doctor will reopen your tooth to gain access to the root canal filling material.  This restorative material will be removed to enable access to the root canal.  The doctor will now clean your canals and carefully examine the inside of the problematic tooth. Once clean, the doctor will fill and seal the canals and place a temporary filling in the tooth.  

At this point, you will need to return to your dentist as soon as possible in order to have a new crown or restoration placed on the tooth to restore full functionality.  

Apicoectomy

Why would I need Endodontic surgery?

Generally, a root canal is all that is needed to save teeth with injured pulp from extraction.  Occassionally, this non-surgical proceedure will not be sufficient to heal the tooth and your endodontist will recommend surgery.  Endodontic surgery can be used to locate fractures or hidden canals that do not appear on x-rays but still manifest pain in the tooth.  Damaged root surfaces or the surrounding bone may also be treated with this proceedure.  The most common surgery used to save damaged teeth is an apicoectomy or root-end resection.

What is an Apicoectomy?

It is a simple proceedure where an incision is made in the gum tissue to expose the bone and surrounding inflamed tissue.  The damaged tissue is removed along with the end of the root tip.  A root-end filling is placed to prevent reinfection of the root and the gum is sutured.  The bone naturally heals around the root over a period of months restoring full function.

Following the proceedure, there may be some discomfort or slight swelling while the incision heals.  This is normal for any surgical proceedure.  To alleviate any discomfort, an appropriate pain medication will be recommended.  if you have pain that does not respond to medication, please call our office.

Before Endodontic Treatment

This procedure will be performed using local anesthesia. There are usually no restrictions after the procedure concerning driving or returning to work. A doctor is available for consultation at all times should a problem arise after your treatment.

Continue all medications for blood pressure, diabetes, thyroid problems and any other conditions as recommended by your physician. If there is a question, please call our office prior to your appointment.

Please eat a full breakfast or lunch as applicable.

If you have been advised by your physician or dentist to use antibiotic premedication because of mitral valve prolapse (MVP), heart murmur, hip, knee, cardiac or other prosthesis, or if you have rheumatic heart disease, please make sure you are on the appropriate antibiotic on the day of your appointment. If there is a question, please call our office prior to your appointment.

If you can take ibuprofen (Advil) or naproxen sodium (Aleve), it does help reduce inflammation when taken pre-operatively. We recommend 2 tablets of either medication 2-4 hours before endodontic therapy.

After Completion of Endodontic Treatment

Endodontic treatment has now been completed. The root canal system has been permanently sealed. However, the outer surface is sealed with a temporary restoration. A follow-up restoration must be placed to protect your tooth against fracture and decay. Please contact your restorative dentist for an appointment. A complete report of treatment will be sent to your restorative dentist. 

Your tooth is more prone to fracture immediately after endodontic treatment. You should chew on the other side until your restorative dentist has placed a core build-up and a protective restoration, usually a crown. If your tooth's strength is seriously compromised, your endodontist or restorative dentist may place a post and core build-up inside the tooth. Your restorative dentist and endodontist will determine the appropriate restoration to best protect your tooth.

Are There Any Potential Problems After Treatment?

~ Post-operative infections.  Post-operative infections occassionally occur.  This usually just requires an office visit and examination.  Many times placing you on an antibiotic for one week will take care of the infection.  Occassionally, other follow-up proceedures will be needed.

Home Care Instructions

Your tooth and surrounding gum tissue may be slightly tender for several days as a result of manipulation during treatment and previous condition of your tooth. This tenderness is normal and is no cause for alarm. Do not chew food on the affected side until your endodontic therapy is completed and your tooth is covered with a protective restoration provided by your restorative dentist. You may continue your regular dental hygiene regimen. Discomfort may be alleviated by taking ibuprofen (Advil), aspirin, or acetaminophen (Tylenol) as directed.

NOTE: Alcohol intake is not advised while taking any of these medications. Should you experience discomfort that cannot be controlled with the above listed medications, or should swelling develop, please contact this office immediately.

If you have any questions, please call our office at (573) 664-1455.