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Dental Visits - The Endodontic Examination Appointment

On most occasions, the endodontic examination and the endodontic consultation take place at the same visit. Most dentists prefer this. This section will look at each process separately.

What Is the Purpose of the Endodontic Examination?

The purpose of the endodontic examination is to determine the state of health of the pulpal tissues of a tooth or group of teeth. The dentist hopes to collect specific information to assist in diagnosis and treatment planning. During the examination portion of the visit, the dentist will:

• Review the patient's medical history and evaluate the patient's current medical status and in order to determine how it might influence the dental diagnosis and/or treatment plan.
• Review the patient's dental history and, in particular, its relationship to the specific reason for the visit, also called the "chief complaint."
• Perform a thorough clinical examination.
• Perform certain endodontic tooth tests to help establish an accurate diagnosis of the condition of the pulpal tissue.
• Perform a radiographic examination. Two or three different radiographic angles of the same area are often required to adequately visualize the various teeth, the root canal spaces within each tooth, and the surrounding bone and structures. Since a single radiograph is a two-dimensional picture of a three-dimensional object, two or more radiographs with different angulations can provide important additional information. Radiographs reveal many things that the dentist is unable to see with the clinical examination alone.

What Is the Purpose of the Endodontic Consultation?

The purpose of the endodontic consultation is to present a root canal treatment plan to the patient. Once the dentist has collected and evaluated all of the diagnostic information, the goals of the consultation visit are to:

• Share the examination findings and the resultant diagnosis with the patient.
• Discuss the prognosis.
• Discuss the treatment recommendations and any perceived complications.
• Discuss the treatment alternatives and their respective ramifications.
• Discuss the number and length of appointments necessary to complete the recommended treatment.
• Review the cost of the recommended treatment and the various treatment options.
• Answer questions that the patient may have regarding the diagnosis and various treatment options.

On occasion, the dentist may need to consult with other professionals or obtain additional information before all of the goals listed above can be accomplished.

By Clifford J. Ruddle, DDS, in collaboration with Philip M. Smith, DDS

Causes And Treatment Of Root Canal Disease

Why Does My Tooth Need Root Canal Treatment?

A tooth generally needs a root canal procedure because the pulpal tissue inside the tooth has become irreversibly injured because of root canal disease. The tooth pulp is composed of elements similar to any other tissue in the body and is susceptible to injury from bacterial decay, repeated or extensive dental procedures, traumatic accidents, or advanced periodontal disease. Pulpal disease occurs in an anatomically complex space termed the root canal system. When appropriate, root canal treatment is directed towards removing inflamed or abscessed tissue, disinfecting, and preparing this space to receive a biocompatible filling material. Once the root canal system has been sealed and a protective crown placed by an endodontist, the tooth can be retained as a healthy and functional member of the dental arch.

What Are the Usual Events That Trigger Root Canal Disease?

Events that may trigger root canal disease include:

• Decay: Dental decay contains bacteria that can infect the tooth pulp. Decay can progress through the outer enamel surface of the tooth into the underlying dentin, which is a hard, yet porous, structure. Ultimately, decay can invade the dental pulp and cause pulpal injury, which leads to an inflammatory condition that can potentially become an abscess. As dental decay and its associated bacteria invade the pulpal tissue, a patient may experience no discomfort or, in other instances, the pain may be acute.
• Traumatic events: The tooth pulp is vulnerable to trauma. A blow to the mouth may lead to a variety of dental injuries. A traumatized tooth may appear whole but exhibit root canal disease at a later date. A tooth may be only slightly chipped or it may be fractured to the extent that its clinical crown is broken off and the pulpal tissue is exposed. In severe situations, the root can be fractured within the bone or the tooth completely knocked out of the mouth, which is called an "avulsion." Frequently, these traumatic events will irreversibly damage the tooth pulp by causing bacterial contamination or by interfering with the tooth's blood supply and its ability to repair. Some teeth are traumatized to the extent that they are not treatable and must be removed.
• Repetitive or extensive dental procedures: The tooth pulp is also vulnerable to injury from repetitive or extensive dental procedures. Subjecting a previously injured pulp to the additional trauma of even the best planned and performed dental surgery may be enough to cause the pulpal tissue to become irreversibly inflamed and the tooth to require root canal treatment. The dentist may or may not be able to predict this outcome in advance. At times, based on the examination and treatment plan, the dentist may recommend the removal of the dental pulp before performing other planned dental procedures. In these situations, the tooth pulp is removed so that it will not become problematic at a later date under a new, and possibly complex, restoration. At times, initiating a root canal procedure through an existing restoration may compromise its integrity.
• Periodontal disease: Infection in the gum and bone around the tooth is referred to as periodontal or gum disease. Advanced periodontal disease may compromise the blood supply to the dental pulp and ultimately, bacteria may enter and infect the pulpal tissue in the root canal space.

By Clifford J. Ruddle, DDS, in collaboration with Philip M. Smith, DDS

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