What is Endodontics?
Endodontics is a specialty of dentistry that deals with disease deep inside the tooth. Mainly it involves a procedure referred to as "root canal treatment" or more commonly, a "root canal".
The specialty also involves root canal surgery and pain diagnosis. An Endodontist is a dentist who has undergone 2-3 years additional training in this area after dental school. While most dentists can and do perform root canals, they may choose to refer patients to an endodontist when the diagnosis or treatment is more complicated than usual.
In addition to providing treatment, it is also our role to provide information. It is important that you understand why you require treatment, what the treatment involves, and what you can do to ensure the best possible outcome.
It is equally important that you receive information about other options that may apply to your situation and the pros and cons of these options so that you can make an informed decision about your dental care.
Why Would I Need Root Canal Treatment?
In order to understand endodontic (root canal) 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 from vessels which enter the end of the root. Once tooth development is completed (during childhood) however, the pulp no longer serves a purpose.
Endodontic treatment is necessary when the pulp becomes irreversibly inflamed. The most common reasons for inflammation are deep cavities, repeated dental procedures, and fractures. Trauma can also cause inflammation and often shows up as discoloration of the tooth.
Irreversible pulp inflammation ultimately leads to necrosis (dying) of the pulp tissue. This necrotic (dead) tissue and the space it occupies within the root, then becomes a perfect breeding ground for bacteria. If left untreated, this infection within the root canal space spreads into the surrounding bone resulting in an abscess.
How do I know if I need root canal treatment? Signs and symptoms
The need for root canal treatment is determined by either symptoms or x-ray findings. The most common symptoms are heat or cold sensitivity, bite sensitivity, or a spontaneous dull ache or throbbing. The range of symptoms can vary from a simple awareness that something feels different to some of the most excruciating pain one is likely to experience.
In other cases there is no pain or symptoms at all and the problem is only detected by x-rays or direct examination. We will only make a recommendation for treatment with conclusive findings or test results and a definitive diagnosis.
What is involved with a "root canal" procedure?
Endodontic treatment involves the following steps:
1. A local anesthetic is administered to ensure pain-free treatment (many patients also elect to use oral sedation to relax). After the tooth is numb, a small protective sheet called a "dental dam" is placed over the area to isolate the tooth and keep it clean and free of saliva during the procedure.
2. A small opening is then made in the crown of the tooth. With the aid of a microscope, very small instruments are then used to clean the pulp from the pulp chamber and root canals. These instruments are also used to enlarge and shape the canal spaces for filling. A sterilizing solution is used througout the procedure to kill and dissolve bacteria and any pulp remnants.
3. After the space is cleaned and shaped, the tooth is either medicated with a disinfecting medication between visits or filled with a biocompatible material (usually a material called gutta percha) at the completion visit. The gutta-percha is placed with an adhesive cement to ensure complete sealing of the root canal. A permanent or temporary filling is then placed over the root canal filling depending on the situation and the need for further restorative treatment.
4. After the final visit with your endodontist, you may need to return to your dentist to have a crown placed. This may not be necessary for a front tooth or for a back tooth that is already crowned.
If the tooth lacks sufficient structure to hold the restoration in place, a post may be needed to build the tooth back up prior to crowning.
How many visits are required and how long is the procedure?
Some teeth only require one visit. Many teeth, however, require two or more visits - most often two. A tooth with a simple cavity into the pulp with no symptoms and no abscess present can be treated effectively in one visit. However, many teeth requiring treatment have other considerations (dead and infected pulp tissue, abscess, cracks, pain and swelling) that require treatment in two or more visits.
The first visit involves removing the inflamed or infected tissue and placing an antibiotic-like medicament in the tooth. The first visit in a two-visit situation will typically be one hour long. The second visit involves further enlarging and shaping of the canals followed by sealing of the canals and placing a restoration on the coronal portion of the tooth. The second visit is often considerably longer and ranges from 1 to 2 1/2 hours.
We will make every effor to provide treatment in the most efficient manner possible using the very latest in technology, but our primary goal is quality care and the highest level of treatment. While you want to be in the chair as little as possible and we want to be as efficient as possible, we won't sacrifice quality for expedience or productivity.