Endodontic Services Overview

Endodontics is the branch of dentistry that deals with treating the inside of the tooth. Endodontic is a term derived from two Greek words, endo and odont. ‘Endo’ means inside, while ‘odont’ means tooth.

Inside the tooth, underneath the enamel and dentin, lies a soft tissue known as pulp. The pulp contains nerves, connective tissue, and blood vessels. It generates the adjacent hard tooth tissues during development. It stretches from the dental crown to the tip of the roots, at which point it connects to the tissues adjacent to the root. The pulp is vital during tooth growth and development. However, once the tooth is completely mature, it can survive without the pulp since the tissues around it continue to nourish it.

Endodontic treatment involves, among other procedures, the root canal procedure, which entails treating the soft tissue pulp in the interior part of the tooth. The dentist specializing in endodontic treatment is an endodontist.

Endodontists graduate to become specialists after completing at least two additional years of more advanced training in endodontics after dental school. They conduct all kinds of endodontic treatment, from routine, hard to very intricate ones, including endodontic surgery, root canal therapy, and special treatment procedures to salvage teeth after dental injuries.

By concentrating their specialty on specific treatment procedures like root canal therapy, trauma, and surgery, endodontists are experienced in managing a broad array of intricate endodontic issues effectively. They are also experts in diagnosing and treating the origin of facial or oral pain and treating dislodged, cracked, and abscessed teeth. The specialized techniques and advanced technologies these professionals use give them highly accurate views of the interior part of the tooth and enable them to conduct the tooth faster and more comfortably.

Once the pulp in the tooth is damaged or infected, treatment is required to salvage the tooth. An endodontist aims to extract infected or inflamed pulp. They then disinfect the interior part of the tooth before shaping, filling, and sealing it. This procedure is conducted under a microscope that offers very high magnification and illumination of the root canal system.

After your endodontist reviews whether your tooth has healed properly, they often recommend a dental crown for the rear teeth to restore their full strength. After that, you will go back to your dentist to place a dental restoration on the tooth to restore its normal function and protect it.

When they save your tooth, endodontists help you keep a natural, beautiful smile so you can keep eating your favorite foods and maintaining your general health. Nothing feels, functions, or looks like your original teeth.

The Root Canal Therapy

The root canal procedure is commonly conducted to salvage a tooth that might otherwise need extraction. In other words, this procedure is necessary where the tooth nerve or pulp is infected or inflamed. The most prevalent reasons the pulp (inside of the tooth) can become infected or inflamed include trauma, cracks, chips, fractures, deep decay, large fillings, or repeated or multiple dental procedures. Signs and symptoms linked to pulp infection or inflammation include:

• Prolonged or abnormal tooth sensitivity to hot or cold substances
• Tenderness in the deep part of the bone
• Sensitivity when biting or chewing or experiencing pain
• Tooth discoloration
• Sudden throbbing pain
• Painful or swollen gums
• Pimples on gums
• Cracked or chipped teeth
• Darkened gums or deep decay

Sometimes you will experience no signs. Infection or inflammation results are viewed on diagnostic X-rays. If left untreated, pulp infection or inflammation can cause abscess, pain, and eventually tooth loss. Should you have these signs, your general dentist may recommend tooth candle therapy to contain the infection.

During root canal therapy, the endodontist removes the tooth pulp and nerve and cleans and seals the inside of the tooth. Root canal therapy is conducted under local anesthesia. The procedure is viewed as painful. However, it is not more painful than a dental filling placement procedure. The procedure is generally completed in a single dental visit, although the total number of dental visits varies based on the individual case. A patient might need another dental visit for a root canal procedure because of significant infection or inflammation, calcified roots, complex root anatomy, or substantial root curvatures. On occasion, three or more appointments are required.

The success rate of root canal therapy is 90 percent. Factors impacting this success rate include the quantity of original tooth structure left after the decay extraction, cracks spreading into the tooth root, trauma, chronic infections, the gingival tissues and supporting bone health, and swift restoration of the treated tooth or teeth by your restorative dental professional.

If your endodontist thinks you are not a candidate for the root canal procedure or the chances of success are unfavorable, they will inform you during your consultation visit or when complications become apparent after or during treatment.

Root Canal Treatment Procedure

The root canal procedure follows these stages:

• Your endodontist will take x-ray images to visualize the root canal’s shape and determine whether you have any infection symptoms in the surrounding bone. They will numb the region surrounding the tooth with local anesthesia. You might not require anesthesia because the nerves are dead, although most dental professionals still administer anesthesia to help the patient feel more comfortable and relaxed.
• The dentist will then place a dental dam around the tooth to maintain dryness at the site and keep it saliva-free during treatment. The dam also isolates the tooth undergoing treatment by covering the other teeth.
• The next stage is for the endodontist to drill an access hole through the tooth. They will then remove the pulp, decayed nerve tissues, and bacteria from the affected tooth and clean the area with a root canal file. Once done, they will spray sodium hypochlorite or water in the region to flush the debris away and use an antiseptic and antibacterial solution to clean and disinfect the canals. This removes the bacteria and clears infection in root canals.
• Once the endodontist has thoroughly cleaned the tooth, they will seal it. Some endodontists may wait a week before sealing. For example, if you have a tooth infection, your endodontist may place medicine in the tooth to alleviate it. Others might opt to seal the tooth the same day they clean it. If the endodontist does not conduct root canal therapy the same day, they will temporarily fill the outer hole in the tooth to block food and saliva between appointments.
• The endodontist will place a rubber compound known as gutta-percha and a sealer paste into the canal during the subsequent and last appointment. They will then put in dental filling material to close the access hole drilled at the start of the procedure.

You might need additional tooth restoration once the root canal procedure is complete. Your endodontist will tell you if you need more dental work. Usually, a tooth that must undergo the root canal procedure has extensive decay, large fillings, or another weakness. Consequently, your endodontist might recommend a dental implant, crown, or any other dental restoration to safeguard it, prevent breakage, and restore its full function.

Also, based on the remaining tooth structure, your endodontist might recommend fixing a full dental crown on all treated rear teeth, like premolars or molars, and sometimes, on the front teeth. You can visit your restorative dental professional for a permanent dental restoration within weeks of the process. Your restorative dental professional will determine the ideal dental restoration for safeguarding your newly treated tooth.

Recovering of the Root Canal Procedure

After root canal therapy, your mouth becomes numb for several hours. Many people can return to their activities, like school, work, et cetera. You may have to wait for the numbness to disappear before eating.

The tooth might feel sensitive for the initial days after the treatment because of tissue inflammation, particularly if you had an infection or felt pain before the treatment. You can often alleviate this with over-the-counter pain relievers like naproxen or ibuprofen.

Until the tooth canal is completed and a permanent dental filling is in place, avoid chewing on the side of the affected tooth. This assists in keeping the place clean and prevents a fragile tooth from breaking before it can be completely restored.

Use an antiseptic mouthwash, floss, and brush as you routinely would. Visit your dentist regularly.

Endodontic Retreatment

If you practice proper dental care, you will keep the tooth subjected to root canal therapy for a long time. However, these teeth may sometimes fail to heal properly, becoming diseased or painful. On rare occasions, a tooth may respond to treatment initially but become infected or painful years or months later. When this happens, the infection or pain can usually be managed by subsequent endodontic treatment. A second procedure might diminish dental discomfort or pain and enhance recovery. If you think a tooth previously treated with root canal therapy needs retreatment, see your endodontist for an assessment.

Like any medical or dental procedure, your tooth may not heal as anticipated after the first treatment for various reasons, including:

• The restoration did not avert salivary contamination of the interior part of the tooth.
• Insertion of dental restoration like a crown was delayed after root canal treatment.
• The complicated anatomy of the root canal went unnoticed during the initial procedure
• Curved or narrow canals were left untreated in the first procedure

A new issue can also compromise a successfully treated tooth. For example:

• A cracked, broken, or loose filling or crown can make the tooth vulnerable to new infection
• New decay may expose the canal filling to bacteria, leading to a new tooth infection
• A tooth can sustain a fracture

The root canal retreatment procedure is generally conducted in two office appointments. However, the frequency of visits varies based on the individual case. Retreating teeth that have already undergone endodontic treatment is often more challenging than the initial treatment. The endodontist must reopen the tooth and extract the filling material put in the canals during your first procedure, and the material they put in the root canals to provide support, like posts.

The endodontist will then carefully examine the tooth, searching for new infections or additional canals. Then, they will remove the infection, clean and shape the root canals, and place new dental filling materials. They will then seal the opening using a temporary dental filling material. After the tooth recovers, the endodontist will place a new dental crown or any other restoration to protect it.

Teeth previously subjected to root canal therapy may have obstructions the endodontist might have to overcome to clean the canal system. The obstructions include calcifications, ledges, difficult-to-extract filling materials, or separated instruments. Conducting the retreatment in two or more appointments gives the endodontist more time to treat the tooth properly while ensuring the patient remains comfortable.

Also critical, at the initial appointment, the endodontist may have put a medicated paste in the canal to actively disinfect the inflammation or infection associated with a tooth.

Endodontic Surgery (Apicoectomy)

The nonsurgical root canal therapy may not be sufficient to salvage your tooth. In this case, your endodontist can recommend a surgical procedure. Endodontic surgery may be conducted to locate hidden canals or minor fractures previously undetected by X-rays in the first treatment. Surgery could also be necessary to extract calcium deposits in the canals or treat the surrounding tooth bone or damaged root surfaces.

You do not have to be worried about endodontic surgery should your endodontist recommend it. Advanced technologies such as operating microscopes and digital imaging allow this surgical procedure to be conducted quickly, successfully, and comfortably.

Several surgeries can be conducted to save an infected or damaged tooth, the most prevalent being apicoectomy. Apicoectomy might be necessary when infection or inflammation lingers in the bony region around the tip of the tooth after root canal treatment.

Your endodontist will conduct this surgery by first administering local anesthesia to make you comfortable. Then, they will incise the gum tissues close to the affected tooth to view the underlying bone.

They will then create a tiny opening in the underlying bone over the tip of the tooth root to access the infected area. They will then extract any infected or inflamed tissue and clean and seal the root tip. The endodontist may place a tiny filling to seal the root tip and do several sutures or stitches to assist the tissue in healing.

After some months, the bone heals around the root tip. Most patients resume their usual activities the following day. Post-surgical discomfort is usually mild.

Apicoectomy is usually performed in one office appointment. A subsequent appointment, generally a week after the procedure, is required to remove the sutures present and check how gum tissue healing is progressing. The bone will heal naturally around the root over a few months. You should experience no symptoms during this period.

Traumatic Injury Treatment

Traumatic dental-related injuries usually occur due to a sports injury or an accident. Most injuries are less serious, like chipped teeth. Having your tooth knocked entirely out or dislodged is less prevalent, but these are the more severe injuries. Treatment is based on location, severity and type of injury. Irrespective of the severity of the injuries, your tooth needs immediate checking by an endodontist or dentist. Sometimes, your surrounding teeth suffer further undetected injuries that could only be noticed through a comprehensive dental examination.

Endodontists have specialized in addressing traumatic dental-related injuries. Since they have advanced techniques, technologies, and skills, they can usually save an injured tooth. If your tooth is injured or cracked, go to an endodontist near you immediately. Most endodontists are extremely flexible in handling emergencies. You will be relieved of pain and salvage your tooth, but only if you act as fast as you can.

How will the endodontist conduct the treatment?

Knocked-Out Teeth

If your tooth is entirely knocked out of your mouth, visit a dentist or endodontist immediately. If you undergo treatment within thirty minutes, chances are high that your tooth will be saved.

Handle the knocked-out tooth carefully by not touching its root surface. Taking a few critical steps will increase the chances of saving the tooth. Your dentist or endodontist will examine the tooth, reinsert it in its socket, and check you for any other facial or dental injury. They will place a stabilizing splint for the following weeks. Based on the root development stage, your endodontist may begin root canal therapy one or two weeks later.

You might have to discuss other dental treatment options with your endodontist or dentist based on the period during which your tooth was out of its socket and how it was restored before treatment.

Root Fractures

A traumatic tooth injury can also cause a horizontal root fracture. The fracture’s location determines your tooth’s long-term health. The closer the fracture is to the tooth tip, the higher the odds of success and long-term tooth health. Fractures that are closer to the gum line are more debilitating for the tooth. Stabilizing the tooth with a splint is sometimes necessary while it heals.

Fractured or Chipped Teeth

If you have a fractured or chipped tooth, it could be repaired by using a dental filling or reattaching the broken piece. If a large part of the crown is chipped off, your dentist may recommend an artificial one.

If the tooth pulp is damaged or exposed after the fracturing of the crown, root canal therapy may be necessary. These injuries require exceptional attention. If you experience pain when drinking cold drinks or breathing through the mouth, bite on a clean, moist cloth or gauze to relieve the symptoms until you reach your dentist’s clinic. Do not use topical pain ointments or drugs like Anbesol or put aspirin in the affected area to alleviate pain symptoms.

An injury to the rear teeth, like cracked teeth or fractured cusps, needs root canal therapy and crown placement to restore tooth function if the crack goes up to the root. More severely injured and split teeth might need extraction.

Dislodged Teeth

An injury may result in a tooth being pushed sideways, into or out of its socket. Your general dentist or endodontist can reposition and stabilize the tooth. The root canal procedure is often necessary for dislodged permanent teeth and must be conducted several days after the injury. The endodontist may put medication inside the affected tooth during root canal therapy. After the treatment is over and successful, the dentist will place a permanent crown or dental filling in the root canal later.

Children aged 12 and below might not require tooth canal therapy as their teeth are still growing and developing. Research shows that the stem cells in children’s tooth pulp can be stimulated to heal the pulp and complete root growth after an infection or injury. When a minor’s tooth sustains an injury, a dentist or endodontist will monitor its healing carefully and take immediate action should any negative changes occur. Several follow-up dental appointments will likely be required.