General Information

An Endodontist is a dentist with specialized training in endodontic procedures requiring a minimum of 2 years advanced training They perform routine as well as difficult and very complex endodontic procedures, including endodontic surgery. Endodontists are also experienced at finding the cause of oral and facial pain that has been difficult to diagnose.

Endodontics is the area of dentistry concerned with the prevention, diagnosis, and treatment of disorders of the dental pulp (the tooth’s soft core). Endodontic treatment, also known as a root canal, is a safe and effective means of saving teeth.

What is dental pulp?

The soft tissue located inside a tooth is called the pulp. The pulp contains blood vessels, nerves, and connective tissue. The pulp extends from the crown of the tooth to the tip of the roots where it connects to the tissues surrounding the root.

Why would I need an endodontic procedure?

Endodontic treatment is necessary when the pulp becomes inflamed or infected. The inflammation or infection can have a variety of causes: deep decay, repeated dental procedures on the tooth, or a crack or chip in the tooth.

In addition, a blow to a tooth may cause pulp damage even if the tooth has no visible chips or cracks. If pulp inflammation or infection is left untreated, the tooth and surrounding tissues become infected and it can cause pain and swelling or lead to an abscess. Even in the absence of pain, certain by-products of a diseased pulp can injure the bone that anchors your tooth in the jaw. Without endodontic treatment, your tooth will eventually have to be removed.

Signs of pulp damage include:

• Pain
• Prolonged sensitivity to heat or cold
• Discoloration of the tooth
• Swelling and tenderness in the nearby gums

Sometimes, there are no symptoms.

Root canal therapy is much like having a filling place and is usually a relatively painless procedure. Endodontic treatment can often be performed in one or two visits and involves the following steps:

1. The endodontist examines and x-rays the tooth, then administers local anesthetic (similar having a cavity filled). After the tooth is numb, the endodontist places a small protective sheet called a "dental dam" over the area to isolate the tooth and keep it clean and free of saliva during the procedure.

2. The endodontist makes an opening in the crown of the tooth. Very small instruments are used to clean the pulp from the pulp chamber and root canals and to shape the space for filling.

3. After the space is cleaned and shaped, the endodontist fills the root canals with a biocompatible material, usually a rubber-like material called "gutta-percha". The gutta-percha is placed with an adhesive cement to ensure complete sealing of the root canals. In most cases, a temporary filling is placed to close the opening. The temporary filling will be removed by your dentist before the tooth is restored.

4. After the final visit with your endodontist, you must return to your dentist to have a crown or other restoration placed on the tooth to protect and restore it to full function.

5. If the tooth lacks sufficient structure to hold the restoration in place, your dentist or endodontist may place a post inside the tooth. Ask your dentist or endodontist for more details about the specific restoration planned for your tooth.

The unrestored tooth is susceptible to fracture, so you should see your dentist for a full restoration within 30 days of endodontic treatment.

With proper care, most teeth which have had endodontic (root canal) treatment can last as long as other natural teeth.

However, in a few cases, a tooth that has received endodontic treatment fails to heal completely. And occasionally, a tooth becomes painful or diseased months or even years after previously successful endodontic treatment.

If your tooth has failed to heal or has developed new problems, you have a second chance. Another endodontic procedure, called retreatment, may be able to save your tooth.

Retreated teeth can function well for years, even for a lifetime. It’s always best to save the tooth if your endodontist believes retreatment is the best option for you.

Advances in technology are constantly changing the way root canal treatment is performed, so your endodontist may even be able to use a new technique that was not available when you had your first procedure.

Of course, there are no guarantees with any dental or medical procedure. Your endodontist will discuss your options and the chances of success before beginning retreatment.

The most common endodontic surgical procedure is called an apicoectomy or root-end resection.

When inflammation or infection persists in the bony area around the end of your tooth after endodontic treatment, your endodontist may perform an apicoectomy. In this procedure, the endodontist opens the gum tissue near the tooth to expose the underlying bone, and the infected tissue is removed. The very end of the root is also removed, and a small filling may be placed to seal the root canal. Local anesthetics make the procedure comfortable, and most patients return to their normal activities the next day.

When the pulp of a tooth is damaged, the only alternative to endodontic treatment is extraction.

To restore chewing function and to prevent adjacent teeth from shifting, the extracted tooth must be replaced with an implant or bridge.

This requires surgery or dental procedures on adjacent healthy teeth and can be far more costly and time consuming than endodontic treatment and restoration of the natural tooth.

What are the disadvantages of losing a tooth?

When a tooth is removed and not replaced, the teeth next to the empty space begin to shift from their normal position. This may cause teeth to become crooked or crowded, which decreases chewing and biting efficiency. Crowded or crooked teeth may be more prone to dental disease because they are harder to keep clean than properly aligned teeth As a result, other teeth may be lost if the missing tooth is not replaced. A replacement tooth (an implant or a bridge) is usually more expensive than endodontic treatment and involves more extensive dental procedures on adjacent teeth. Endodontic treatment can safely and comfortably save a tooth that otherwise would have to be removed. In fact, root canal therapy is successful approximately 95% of the time. Remember, a healthy restored tooth is always better than an artificial one.

Root Canal - After care

Most people have a "dull" soreness or mild pain on chewing in the treated area which usually resolves with 48 hours.  Take an anti-inflammatory medication like Naproxen (Aleve) or Ibuprofen (Advil/Mortin) for 48 hours following treatment since these medications work by PREVENTING inflammation before it happens.

Avoid the following:

1. Brushing directly on the temporary filling.

2. Eating or chewing on the treated tooth for 3-5 days after treatment.

3. Hard, chewy, tacky, sticky or crunchy foods

The success of your endodontic treatment depends upon the promptness of your final restoration. Ensure a PERMANENT restoration initiated and/or completed within 15 to 30 days after treatment. Charges may occur if additional treatment is required due to delays with final restorations.

Complications, should you experience any item listed below, call our office immediately:

1. The temporary filling comes out before your general dentist for final restoration. The temporary filling does feel different and may wear away some leaving a minor depression feeling like it is missing.

2. Discomfort does not improve within 48 hours.

3. Discomfort returns after 48 hours.

4. Discomfort becomes pain.

5. A fever develops within the next week.

6. A sore, swelling, drainage or a knot (hard spot) develops around the treatment area, jaw or cheek.

Medications

1. Women prescribed antibiotics should use birth control methods other than ‘the pill’ for at least one month. Antibiotics can interfere with the effectiveness of birth control medications.

2. Alcohol and caffeine should be avoided while taking ANY medications, including anti-inflammatory (ibuprofen, naproxen, aspirin, etc.)

Surgical (Apicoectomy) After-care:

Activities involving changes in altitude are strongly discouraged until endodontic treatment is completed.

1. DO NOT pull or lift and to examine the surgical area this will delay (or damage) healing.

2. A slight swelling and skin discoloration is normal. To reduce swelling, apply an ice pack over the surgical area with gentle pressure, 20 minutes on and 10 minutes off for three to four hours, not to exceed six hours.

3. Adequate food and fluid is important following microsurgery. Soft foods are best. Hard, crunchy food, and carbonated beverages should be avoided. If eating is difficult, a food supplement is recommended (Ensure, Sego, Slender, Nutrament, etc.).

4. Tooth brushing: do not brush in the surgical area for three days. After three days, a soft tooth brush may be used carefully in the surgical area. Brush gently only in the direction from the gum to the tooth, brushing in and out of the mouth may damage the surgical area.  Do not floss in the surgical area for a minimum of three weeks.

5. Do not rinse for 48 hours. After 48 hours, rinse with warm salt water or Listerine after each meal and before bedtime until your checkup visit with our office. Do not use alcohol mouthwashes (scope, etc.), they may cause significant pain. Do not ‘puff’ your cheek with fluid or run your finger over the surgical area as this will pull out stitches.

6. Sleeping with your head slightly elevated will greatly help reduce nighttime swelling and/or discomfort.

7. Although a slight oozing or bleeding is normal during the first 24 hours, many unusual symptoms such as excessive bleeding, swelling, or elevated temperature should be reported immediately.

8. If gauze has been applied, (surgery or extraction) gently discard 20 minutes after leaving the office. Gauze is meant only to keep you from swallowing blood, it is not meant to stop bleeding.

9. Most people have a ‘dull’ soreness or mild pain on chewing in the area of the treated tooth lasting approximately 48 hours. Inflammation/swelling is usually the cause of the discomfort. Take an anti-inflammatory (ibuprofen, naproxen, etc.) medication for 48 hours following treatment since these medications work by PREVENTING inflammation before it happens, even if there is no discomfort. Tylenol does NOT reduce inflammation and is used only with those patients who cannot take ibuprofen/naproxen. If you’re unsure if these medications are compatible with your current medical condition or medications, please check with your physician.

Medications

1. Women prescribed antibiotics should use birth control methods other than ‘the pill’ for at least one month. Antibiotics can interfere with the effectiveness of birth control medications.

2. Alcohol and caffeine should be avoided while taking ANY medications, including anti-inflammatory (ibuprofen, naproxen, aspirin, etc.)

A call to our office the morning after surgery to report your progress is appreciated.