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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.
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 (cavities) grow, they get closer to the pulp, which may lead to an infection or a serious pulpal disease. Even small cavities and trauma-related dental issues can release toxins to the dental pulp.
The need for root canal therapy, or similar endodontic treatment, depends on the type of pulpitis (dental pulp disease) a patient has. Pulpitis refers to inflammation of the dental pulp tissue.
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To assess the infection, an endodontist will examine the mouth using radiographic images and pulp testing:
There are four common types of dental pulp conditions (pulpitis), including:
This dental pulp 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.
However, removing the cavity and covering the tooth with a filling typically protects the tooth from infection. Reversible pulpitis commonly develops after dental procedures and typically resolves on its own without treatment.
Symptomatic irreversible pulpitis develops when cavities get very close to or inside the pulp chamber. Traumatic injuries can also cause irreversible pulpitis if the pulp becomes exposed. Teeth with this condition will test positive to cold stimuli. But, the pain lingers, which means root canal treatment is necessary.
Asymptomatic irreversible pulpitis is similar to symptomatic irreversible pulpitis except patients do not develop symptoms. An individual will respond positively to cold tests. Although, in a radiograph, deep cavities will be found within the dental pulp chamber of the patient's tooth or teeth.
Pulpal necrosis refers to a “dead tooth” or “non-vital tooth.” When a tooth dies, debris, inflammatory cells, and bacteria replace the healthy dental pulp within the tooth. A tooth with pulpal necrosis will not respond to cold tests and may result in bone loss.
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 canal treatment, also known as endodontic treatment or root canal therapy. During the procedure, an endodontist removes the infected dental pulp within the patient's tooth. Root canal therapy saves the tooth and eliminates the need for extraction.
Patients undergo root canal treatment for a variety of reasons, including:
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 will be placed where the permanent tooth was. A dental implant (artificial tooth root) mirrors the shape of a screw. It is surgically inserted into the patient’s jawbone and bonds with the natural bone.
Then, a dental crown is placed on top of the implant and becomes the only visible part of the artificial tooth. Common indicators for implant placement include:
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" will be necessary. The procedure helps relieve dental pain, discomfort, and promotes healing.
A tooth may not heal after root canal therapy for a few reasons, including:
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.
Endodontic surgery consists of finding the fractures or hidden root 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.