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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

Root Canals: Everything You Ever Wanted to Know

Why are root canals done?

Root canal therapy is required when the nerve of the tooth becomes irreversibly damaged. This damage can occur from decay, trauma, or a crack in the tooth.

What is a common root canal symptom?

Pain, swelling, and sensitivity to hot or cold. Another indication of nerve damage is the tooth becoming darker in color. Sometimes, it can only be diagnosed with an x-ray or other tests by an endodontist.

What is done during a root canal procedure?

The purpose of root canal therapy is to clean out the infected tooth pulp tissue within the roots. After all the nerve has been removed, the canals are filled with a sealer.

How long will the procedure take?

Generally, root canals take one or two appointments for a front tooth (anterior), and two or three appointments for a back tooth (posterior). A tooth can have from one to four roots; all of the roots must be treated. Difficult cases may require even more visits.

Will the tooth need any more work after the treatment is finished?

Yes, the tooth will require a permanent restoration. This could range from a simple filling to a large build-up with posts and pins. The tooth is more brittle after a root canal treatment and therefore is more susceptible to fracture. If the filling is large, the tooth may need a crown as well. A crown protects the tooth from breaking.

Isn't it simpler to take out the tooth?

It may seem simpler to have the damaged tooth removed; however, it is really much healthier and more economical to save it. If the extracted tooth is not replaced, the teeth next to it can drift into the empty space. Replacing an extracted tooth involves either expensive bridgework or a partial denture.

Will the root canal procedure hurt?

During the actual treatment, your tooth will be numb as it would be for simply filling a cavity. The treatment is usually started because the tooth is sensitive; it may take a day or two for the tooth to get back to normal. Generally a mild painkiller is enough to keep you comfortable during this time. If something stronger is needed, your endodontist will prescribe it. If the tooth is badly infected, an antibiotic may be needed as well.

How much will it cost?

The cost of root canal treatment and therapy varies with the number of canals which need to be treated. There will be a separate charge for the restoration, depending on the extent of the procedure. Your dentist will be glad to discuss the charges with you for all the expected treatment.

+Jim Du Molin is a leading Internet search expert helping individuals and families connect with the right dentist in their area. Visit his author page.