Endodontics is a specialty branch of dentistry, recognized by the American Dental Association, which is focused on treating disease of the dental pulp (tissue within the tooth) and also the outside tissues surrounding the tooth.
First of all we need to know what a “normal” tooth looks like before understanding what can happen, leading up to needing endodontic therapy.
Since pictures can say a thousand words, here is a very informative link to the AAE (American Association of Endodontists) website for an excellent artists conceptualization for “What’s Inside a Tooth”: Simply scroll down this single page, and you will find an interactive tooth. This will offer you “normal anatomical” information.
An Endodontist is a dental specialist who has completed additional years of postgraduate training after dental school in order to develop the advanced skills for treating complicated endodontic cases. This includes challenging diagnostics, complicated non-surgical root canal therapy, and precision root tip microsurgery.
Because Dr. Smith and Dr. Chesler are specialists who have limited their practice to endodontics, they treat these types of problems every day. They use their special training and experience in treating difficult cases, such as teeth with narrow or blocked canals, or unusually complex internal anatomy.
The doctors employ state-of-the-art technology. This includes operating microscopes with intense lighting, electronic apex locators for precision measurement of canal lengths, ultrasonic devices to clear away obstructions, flexible endodontic rotary files for cleaning and shaping canals, specialized instruments to completely fill the canals and seal the root tips, and advanced digital imaging.
Let’s start with answering some basic, frequently asked questions
Use this AAE link for the following information:
Under the skilled care of an endodontist, approximately 95% of root canal therapy is successful in saving teeth.
What about the remaining 5 to 6 %? Significantly curved roots and calcified or complex canals are the culprit. These may lead to unreachable microscopic areas within the root canal space that allow inflamed or infected tissue debris to remain. Thus with specialty endodontic care, “loss of tooth” is not typically due to failure of the highly refined procedure.
Other causes of tooth loss can be:
Again, these have nothing to do with “root canal procedure failure”. So, you can appreciate that endodontics is a very successful treatment procedure that saves teeth.
Your treatment appointment will be for an hour and a quarter. Whereas in the past, multiple, long appointments were the norm, with few exceptions today your treatment is completed in a single, brief visit.
Digital Radiography: Diagnostic pre-op and post treatment images will be necessary for your endodontic therapy. An advanced, non-film, computerized system will be used. It is called digital radiography. This technology uses as little as 30 percent of the radiation of the already very low dose of conventional dental x-ray imaging. These digital images can be optimized, archived, printed, or e-mailed to other professionals and insurance companies.
Operating Microscopes: Dr. Smith and Dr. Chesler perform root canal therapy through an amazingly small hole in the tooth, not much larger than the size of a BB. High magnification and strong fiberoptic illumination are helpful in aiding the doctor to see very small, but important details inside your tooth. Also, in “microsurgical” cases, a tiny, high tech, digital camera built into the microscope can capture images of interest. This will further document the doctor's findings and treatment. This equipment has increased our success rate and also makes possible the management of difficult cases in just one appointment.
Electronic Apex Locators: High tech electronics in this instrument allow for extremely accurate measurements of the length of the canals. In this way the doctor knows exactly how far to advance into the canal with his precision instruments in order to ensure all tissue debris is removed.
Ultrasonics: Calcium buildup within the tooth is common, especially if the dental pulp is diseased. It can block the effort to reach extremely small root canal openings when endodontics is needed. With great accuracy, the positioning of these advanced ultrasonic instruments chips away at the obstruction, and enables the endodontist to successfully complete the procedure.
Highly engineered rotary instruments: These are used to gently open up the very small root canal spaces (many are no wider than the diameter of a hair) in order to remove tissue debris that is fueling inflammation and infections. Roots are commonly curved. These instruments / files are made from a remarkably flexible alloy: nickel titanium. This enables it to advance into a curved canal, and while inside, rotate in order to enlarge the canal. It takes extreme metal flexibility and strength to achieve this working motion without breaking.
It is the nature of this specialty that we treat emergency patients on a daily basis. We make every effort to see patients who are in severe pain on that same day. Accommodating those in distress occasionally means small delays for appointed patients. However, our flexible schedule minimizes this.
In general “most” patients do very well. They experience pain relief and feel minimal discomfort the next day, but it really depends on a few issues:
The number one reason for strong postoperative discomfort after well-done root canal therapy has little to do with the procedure itself. It is primarily due to clenching and grinding of teeth. Some of us do this. It forces the tooth into the socket resulting in powerful tissue fluid pressure. This encourages more inflammation around your tooth. It also delays your tooth’s return to a normal, comfortable status. If you don’t have a gap between your upper and lower teeth during waking hours, you ARE applying unnecessary pressure to your teeth.
Yes and No.
YES: If you tolerate ibuprofen (Advil, Motrin), naproxen sodium (Aleve), or aspirin, it does help reduce post-op inflammation when taken pre-operatively. If you decide to do this, we recommend (over the counter strength) 3 tablets of ibuprofen or 2 tabs of naproxen or aspirin an hour before endodontic therapy.
NO: It is very important to avoid pain / anti-inflammatory medication if you are having a consultation appointment. This will make it very difficult to do diagnostic testing.
No. It remains alive on the outside, nourished by the adjacent tissues of the gums and jawbone. After successful endodontic treatment, the tooth continues to perform and feel just like normal.
Postoperative infections are not common. However, if a problem does develop, we are available for you. Occasionally, “existing bacteria” may not fade as normally expected. In these cases an effective antibiotic may be prescribed, or sometimes additional treatment may be recommended.
When your root canal therapy has been completed, you will leave the office with a temporary filling in the treatment access hole in the tooth. A treatment report will be sent to your restorative dentist.
You should contact your referring dentist for a follow-up restoration to be done within a few weeks to a month of your visit with us. Your restorative dentist will decide on what type of restoration is necessary to protect your tooth.
NOTE: It is very important you have the tooth properly restored afterwards, since failing to do so in a timely manner may result in bacterial contamination and / or damage due to cracks. Cracks can jeopardize the existing, well-done endodontic treatment. If extensive enough, a crack can even result in tooth loss. If a definitive crown is planned, then caution should be used in not chewing with this tooth until at least the protective “temporary” crown is in place.
Antibiotics alone only slow down a building infection. They do not eliminate it. Therefore, once the dental pulp is diseased, the only alternative to root canal therapy is tooth extraction. After an extraction, replacing the tooth with a bridge, implant, or removable partial denture is generally more costly than root canal treatment and a crown. Our aim is to “save” your natural tooth.
We adhere to the most rigorous standards of infection control advocated by OSHA, the Centers for Disease Control, and the American and California Dental Associations. We utilize reliable autoclave instrument sterilization and barrier techniques to eliminate any risk of cross infection.
NOTE: In April 2007, the American Heart Association released an update to its guidelines for the prevention of infective endocarditis. The new guidelines indicate fewer dental patients need to receive antibiotic prophylaxis prior to treatment. If you have been taking antibiotics all along for your dental appointments, it may be time to ask your physician if you continue to need them.
As stated above, most patients with heart murmurs no longer need antibiotic coverage. Bona fide indications for prophylaxis are for patients with artificial heart valves, a history of infective endocarditis, or any underlying cardiac conditions associated with a high risk of postoperative cardiac infection. If you have any doubt, consult with your physician.
Many joint replacement patients have standing instructions from their physician for antibiotic coverage prior to all dental procedures. Since this directive differs from patient to patient, your orthopedic surgeon is the source for guidance here.
San Diego North Endodontics | 850 East Grand Avenue, Suite B | Escondido, CA 92025
Tel 760.741.1355 | Fax 760.741.1923
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