All dentists, including your general dentist, received training in endodontic treatment in dental school. General dentists can perform endodontic procedures along with other procedures but often they refer patients needing endodontic treatment to endodontists.
Endodontists are dentists with special training in endodontic procedures. To become specialists, they complete dental school and an additional two or more years of advanced training in endodontics. 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.


Endodontic treatment is necessary when the pulp tissue inside the tooth, consisting of nerve tissue, blood vessels, and connective tissue 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, it can cause pain or lead to an abscess. Signs of pulp damage include pain, prolonged sensitivity to heat or cold, discoloration of the tooth, and swelling and tenderness in the nearby gums. Sometimes, there are no symptoms.


The endodontist removes the inflamed or infected pulp, carefully cleans and shapes the inside of the tooth, then fills and seals the space. Afterwards, you will return to your dentist, who will place a crown or other restoration on the tooth to protect and restore it to full function. After restoration, the tooth continues to function like any other tooth. 


Many endodontic procedures are performed to relieve the pain of toothaches caused by pulp inflammation
or infection. With modern techniques and anesthetics, most patients report that they are comfortable during the procedure.
For the first few days after treatment, your tooth may feel sensitive, especially if there was pain or infection before the procedure. This discomfort can be relieved with over-the-counter or prescription medications. Follow your endodontists instructions carefully.


The unrestored tooth is susceptible to fracture, so you should see your dentist for a full restoration as soon as possible. Most endodontically treated teeth last as long as other natural teeth. In a few cases, a tooth that has undergone endodontic treatment fails to heal or the pain continues. Occasionally, the tooth may become painful or diseased months or even years after successful treatment. Often when that happens, another endodontic procedure can save the tooth.


New trauma, deep decay, or a loose, cracked or broken filling can cause new infection in your tooth.
In some cases, the endodontist may discover very narrow or curved canals that could not be treated during the initial procedure.



Most teeth can be treated. Occasionally, a tooth can't be saved because the root canals are not accessible, the root is severely fractured, the tooth doesn't have adequate bone support, or the tooth cannot be restored. However, advances in endodontics are making it possible to save teeth that even a few years ago would have been lost. And when endodontic treatment is not effective, endodontic surgery may be able to save the tooth.


The most common endodontic surgical procedure is called an apicoectomy or root-end resection. When the 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 root, and the infected tissue is removed. The very end of the root is removed and a small filling is placed at the root end 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 the tooth is damaged, the only alternative to endodontic treatment is extraction of the tooth. To restore chewing function and to prevent adjacent teeth from shifting, the extracted tooth must be replaced with an implant or a 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. No matter how effective modern tooth replacements are-and they can be very effective-nothing is as good as a natural tooth.

For more information
If you would like further information about endodontic treatment, your endodontist will be happy to talk with you, click on our link to the American Association of Endodontists webpage.

All pictures are ©American Association of Endodontists.

 












 
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