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Dr. Emily Tyler
Board Certified Endodontist
American Board of Endodontics
Dr. Bethany A. Douglas
Board Certified Endodontist
American Board of Endodontics
Endodontists are dentists who specialize in root canal treatment. Becoming a specialist requires at least two additional years of advanced specialty education and residency training. Although General Dentists can perform Endodontic treatment, patients are often referred to an Endodontist when the case is complicated to diagnose or more difficult to treat than usual. Because their practice is limited to endodontics, they treat these types of problems every day utilizing advanced technology, such as operating microscopes, ultrasonics, and digital imaging.
Endodontic, or root canal treatment is necessary when the pulp, the nerves and soft tissue inside the tooth, becomes inflamed or infected.
To better understand endodontic treatment, a review of tooth anatomy is helpful. Under the white, outer enamel of a tooth is a hard layer called dentin. Inside the tooth, under the enamel and 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 is contained in channels called “root canals” that 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 completely mature it can survive without the pulp, because the tooth continues to be nourished by the surrounding tissues.
Endodontic, or root canal treatment is necessary when the pulp, the nerves and soft tissue inside the tooth, becomes inflamed or infected.
There are several things that can cause a tooth to become infected: deep decay, repeated dental procedures on the tooth, trauma, or a crack or chip in the tooth. If pulp inflammation or infection is left untreated, it can cause pain or lead to an abscess. An abscess can lead to bone loss in the jaw and other more serious problems.
Some signs and symptoms of needing a root canal include tooth pain, prolonged sensitivity to hot or cold, tenderness to touch and chewing, discoloration of the tooth, swelling, drainage, and tenderness in nearby bone and gingival tissues. Sometimes, however, there are no symptoms.
The endodontist removes the inflamed or infected pulp, carefully cleans and shapes the inside of the root canals, 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.
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.
New trauma, deep decay, or a loose, cracked or broken filling can cause new infection in your tooth. In some cases, the endodontist may discover additional very narrow or curved canals that could not be treated during the initial procedure.
As with any dental or medical procedure, occasionally a tooth may not heal as anticipated after initial treatment. This may occur for a variety of reasons:
- Complicated root canal anatomy
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Accessory or additional canals undetected in the first procedure
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Narrow, curved, or calcified root canals that are inaccessible during initial treatment
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The placement of the crown or other restoration was delayed following the treatment, resulting in reinfection of the root canals
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An inadequate seal of the restoration (filling) allowed recontamination of the inside of the tooth.
First, the endodontist will discuss your treatment options. If you and your endodontist 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.
After removing the canal filling, the endodontist can clean the canals and carefully examine the inside of your tooth using magnification and illumination, searching for any additional canals or unusual anatomy that requires treatment.
In this procedure, the endodontist opens the gum tissue near the tooth to see the underlying bone and to remove any inflamed or infected tissue. The very end of the root is also removed.
A small filling may be placed in the root to seal the end of the root canal, and a few stitches or sutures are placed in the gingiva to help the tissue heal properly. Over a period of months, the bone heals around the end of the root.
The only other alternative is extraction of the tooth. The extracted tooth should then be replaced with an implant, bridge or removable partial denture to restore chewing function and to prevent adjacent teeth from shifting. Because these options require extensive 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.