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Root Canal Dentist, Tooth Pain and Endodontic Disease

What Are the Most Common Symptoms of Endodontic Disease?

Endodontic disease can manifest itself with a wide variety and combination of symptoms. Common symptoms of endodontic disease include:

• Lingering tooth sensitivity to cold liquids.
• Lingering tooth sensitivity to hot liquids.
• Tooth sensitivity to sweets.
• Tooth pain to biting pressure.
• Tooth pain that is referred from a tooth to another area, such as the neck, temple, or the ear.
• Spontaneous toothache, such as that experienced while reading a magazine, watching television, etc.
• Constant or intermittent tooth pain.
• Severe tooth pain.
• Throbbing tooth pain.
• Tooth pain that may occur in response to atmospheric pressure changes, such as when flying or scuba diving.
• Tooth pain that may occur in response to postural changes, such as when going from a standing to a reclining position.
• Tooth Swelling.

If you have any of these symptoms, it would be wise to see your dentist because you might have root canal disease or another dental problem.

Some of these endodontic disease symptoms may also be attributable to decay, defective fillings, periodontal diseases, cracked teeth, or other tooth or bite-related problems.

On other occasions, the symptoms may even be caused by disorders that are not related to the teeth.

Why May Endodontic Disease Cause Swelling?

When the pulpal tissue becomes severely diseased and necrotic, the resultant infection can spread from inside the tooth into the adjacent bone and soft tissues. As a result, swelling can occur in the tissues immediately surrounding the tooth.

If this situation is not treated and the endodontic disease process is not kept under control by the body's defenses, the infection can begin to spread into other tissue spaces, such as those around the eye or in the neck. In some situations, this can become a serious medical emergency.

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