Endodontists: Root Canal & Dental Pulp Experts

What is an Endodontist?

Endodontists deal with oral health issues related to the dental pulp and periradicular tissues, which are the blood vessels, tissues, and nerves surrounding a tooth’s root. They are commonly referred to as “root canal specialists” because root canal therapy is the most common treatment they provide. Endodontists are experts in understanding the anatomy of tooth roots, root morphology, dental pulp, and the internal anatomy of teeth.

tooth pulp

Dental Pulp Experts

Dental pulp is a living tissue in teeth that contains sensory nerves and blood vessels. Since it is living tissue, pulp irritation is common and results in inflammation and, in more serious cases, tissue damage. As caries (dental cavities) grow, they get closer to the pulp, which may lead to an infection or a serious pulpal disease. Small caries and trauma-related dental issues are even capable of releasing toxins to the dental pulp.

Types of Pulpal Diseases

The need for root canal therapy, or similar endodontic treatment, depends on the classification of the pulpal disease at hand. Endodontists examine a patient’s mouth using radiographic images and pulp testing to assess the infection and determine its classification. There are four common types of pulpal conditions, including:

  • Normal Pulp — when a tooth responds positively to tests, such as electrical stimuli and cold stimuli, it is unlikely that the patient has a pulp infection. If the tooth doesn’t respond to cold stimuli, the tooth is likely “dead,” and therefore requires treatment.
  • Reversible Pulpitis — this pulpal condition is minor and doesn’t require a tooth extraction or root canal. Teeth with reversible pulpitis have caries or exposed dentin, which causes a response from the pulp. Although, removing the cavity and covering the tooth with a filling typically protects the tooth from infection. Reversible pulpitis is also very common following dental treatments. It resolves itself.
  • Symptomatic Irreversible Pulpitis — this condition results when caries gets very close to or inside the pulp chamber. Traumatic injuries may also cause irreversible pulpitis if the pulp becomes exposed. Teeth will test positive to cold stimuli. Although, the pain lingers, which means endodontic treatment is necessary.
  • Asymptomatic Irreversible Pulpitis — when teeth have deep caries, the patient has no symptoms, and they respond positively to cold tests. Although, in a radiograph, caries appear to reach the pulp chamber.
  • Pulpal Necrosis — another term for this condition is “dead tooth” or “non-vital tooth.” When the tooth dies, the pulpal tissues are replaced with debris, inflammatory cells, and bacteria. The tooth will not respond to cold tests and may result in bone loss.

Treatments and Procedures

Endodontists spend most of their time diagnosing and treating root canals. Although, they also specialize in endodontic retreatment, endodontic surgery, and trauma-related dental injuries:

Endodontists specialize in root canals, also known as endodontic treatment. Instead of extracting a tooth, an endodontist removes the infected dental pulp. Patients get root canals for a variety of reasons, including:

  • Severe Tooth Decay — when a tooth becomes decayed from an untreated cavity.
  • Gum Inflammation — when the gums become inflamed, it is more likely that the bacteria will travel to a tooth’s root.
  • Tooth Chips and Cracks — typically caused by teeth grinding (bruxism).
  • Injury or Trauma — after a permanent tooth is dislodged due to a traumatic injury, root canals may be necessary to protect it from further damage or infection.
  • Large Cavity Fillings — teeth with large cavities and fillings are more prone to pulp infections.

On average, endodontists complete 25 root canals per week, while general dentists perform about two per week.

When a tooth dies, decays, or is unsavable, extraction is typically necessary. After the tooth extraction, a dental implant replaces the permanent tooth. A dental implant (artificial tooth root) mirrors the shape of a screw. An endodontist surgically inserts the implant into the patient’s jawbone, which bonds with the natural bone.

A dental crown sits on top of the implant and becomes the only visible part of the artificial tooth. Common reasons patients get implants include:

  • Tooth Decay — if a tooth with extreme decay is left untreated, it commonly results in tooth loss.
  • Periodontal Disease — a severe gum disease that causes inflammation, tooth infections, and eventually bone loss.
  • Old Age and Medications — after age 55, tooth loss is more common. Older people who take medications for heart disease, high cholesterol, or high blood pressure are even more susceptible.
  • Trauma or Injury — damaged teeth caused by an injury, car accident, or fall can lead to complete tooth loss, partial tooth loss, or small chips.

Endodontic Retreatment

Root canals are successful most of the time and can last a lifetime with proper care. Although, sometimes the restorations fail, which results in the need for “retreatment.” If the root canal treated tooth heals improperly, becomes painful, or is infected months or years after treatment, retreatment saves the tooth. The procedure helps relieve dental pain, discomfort, and promote healing.

A tooth may not heal after root canal therapy for a few reasons, including:

  • The curved or narrow canals were not treated properly during the first procedure.
  • Complicated tooth canal anatomy was not detected during the first procedure.
  • Placement of the dental crown was postponed following endodontic treatment.
  • Salivary contamination was not prevented during any phase of treatment.
dentist appointment

Endodontic Surgery

Nonsurgical root canal therapies may not be enough to save a patient’s tooth. If this is the case, an endodontist will perform microsurgery, also referred to as endodontic surgery. This procedure consists of finding fractures or hidden canals that an x-ray did not detect. The surgery removes calcium deposits in a patient’s root canals, treats damaged root surfaces, and stabilizes the surrounding bone near the tooth.

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“Endodontic Retreatment.” American Association of Endodontists, www.aae.org/patients/root-canal-treatment/endodontic-treatment-options/endodontic-retreatment/.

Hollins, Carole. Basic Guide to Dental Procedures. John Wiley & Sons, Inc., 2015.

Syrbu, John DDS. The Complete Pre-Dental Guide to Modern Dentistry. 2013.

Updated on: May 22, 2020
Alyssa Hill
Medically Reviewed: October 2, 2019
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Lara Coseo