Wisdom Teeth Extractions Northville, MI

A Root Canal Abscess

What Causes an Endodontic Abscess?

An endodontic abscess is caused by infected pulpal tissue. This acute disease process then spreads to the outside of the root and enters the bone and soft tissues around the tooth. An endodontic abscess is oftentimes accompanied by a cascade of symptoms. These symptoms may include:

• Pain to hot liquids, touch, or biting pressure.
• Pressure that partially pushes the tooth out of the socket, causing it to contact the opposing tooth first upon biting.
• A loose tooth resulting from infection and subsequent pressure that builds around the outside of the tooth.
• Swelling localized to the tissue around the tooth.
• Swelling that spreads from the gums around the tooth into the cheek, lips, or neck areas. These tissues can become swollen resulting in an exaggerated asymmetry of the face.

In cases of extreme dental infection, the eye can become swollen shut or breathing can become difficult as pressure builds against vital structures. In these instances of severe infection, hospitalization may become necessary.

What Is Involved in the Emergency Management of an Abscessed Tooth?

An endodontic abscess can be extremely painful and emergency treatment is directed towards promptly relieving the patient's pain and, if present, reducing the swelling as quickly as possible. Emergency management would usually include getting the area profoundly numb and then creating a small window through the biting surface of the tooth and into the pulpal space. By opening the tooth in this manner, the dentist can relieve the pressure that has built up inside the tooth and allow the infected area to drain. Usually, the only procedures that are performed at the emergency visit are the ones that are necessary to eliminate acute pain and control the infection. Subsequent care an endodontic abscess will be necessary when the patient is more comfortable and relaxed in order to properly complete root canal treatment. At the conclusion of the emergency visit, the patient may require medications for pain and/or infection control and these will be prescribed by the doctor if they are necessary.

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

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The Endodontist, the General Dentist and Root Canals

All dental school graduates have basic education and training in the diagnosis and treatment of diseases of the tooth pulp and are licensed to perform a routine root canal procedure.

What Is an Endodontist?

An endodontist is a dentist who has completed an additional two to three-year course of study in an accredited endodontics postdoctoral residency program. In addition to performing routine root canal treatment and tooth pulp treatments, the endodontist has extensive training and experience in the diagnosis and treatment of a wide variety of conditions, such as:

• The differential diagnosis of painful oral and facial conditions in which the origin of the pain is uncertain. In these cases, the root canal dentist is part of a team, which may include other specialists in dentistry as well as medical colleagues, when appropriate.
• Endodontics treatment of teeth involved in cases of oral-facial trauma.
• Endodontic treatment for patients who are medically compromised.
• Endodontics treatment of complex root canal cases, such as teeth that exhibit calcified canals, curved canals, or very long roots.
• Non-surgical re-treatment of teeth that have had previous root canals.
• Surgical treatment of endodontic disease that can be treated in no other way.

There are ethical guidelines that determine what an endodontist can and cannot do. As an example, an endodontics specialist would not place crowns, dentures, or perform orthodontic procedures.

Following the completion of a root canal procedure, a patient is usually referred back to the general dentist. At times, however, in a complex situation it may be necessary for the endodontist to refer a patient to another specialist before the patient returns to their general dentist.

Why Are Patients Referred From a General Dentist to an Endodontist?

Patients are referred from a general dentist to specialist because a dental problem may be so complex that its successful diagnosis and treatment require considering a multitude of complex factors.

A "multidisciplinary" approach allows the patient to have expert opinions from different generalists and specialists so that the best of science, art, and technology can be utilized in a particular set of circumstances.

Oftentimes, an individual dentist is more interested and experienced in some areas of dentistry than in others. A general dentist may choose not to do certain procedures because:

• They do not have the equipment, instruments, or training necessary to do the procedures.
• The time involved to do the procedure well is more than they wish to spend.
• Particular teeth may exhibit complex treatment challenges.
• The patient may have medical or other complicating factors.

In short, the primary consideration for referral is that the patient has the opportunity to have the best diagnosis and the best care available. A patient may be referred from a general dentist to specialist to make certain that this goal is attained.

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