Updated on March 6, 2024
7 min read

Endodontists: Root Canal & Dental Pulp Experts

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What is an Endodontist?

Endodontists are dental specialists who treat tooth pain, disease, and infection. They are experts in treating dental pulp issues.

They are often called “root canal specialists” because root canal therapy is the most common treatment they provide. 

medically accurate 3d render of an endodontic root canal treatment process

Endodontists have an in-depth understanding of the anatomy of tooth roots, root morphology, dental pulp, and the internal anatomy of teeth. In addition to dental school, these specialists undergo two to three years of advanced education and further training in endodontic care.

What’s the Difference Between a Dentist and an Endodontist?

The primary difference between a dentist and an endodontist is their level of expertise. Dentists typically treat a wide range of general oral health issues but might not be advanced specialists. 

Endodontists are dentists who have completed extra training and specialize in issues relating to dental pulp. An endodontist is a dentist, while a dentist is not always an endodontist.

What is Dental Pulp?

Dental pulp is a living tissue in teeth that contains sensory nerves and blood vessels. It’s essential for oral health. 

3d render of jaw with tooth cavity and cyst or dental pulp

Because pulp is a living tissue, it’s easy to irritate it. Pulp irritation can lead to inflammation and tissue damage in more serious cases.

If tooth decay spreads, it can infringe on the pulp, potentially leading to an infection or severe disease. Even small cavities and trauma-related dental issues can release toxins into the dental pulp.

What Procedures Do Endodontists Perform?

Endodontists spend most of their time diagnosing and treating root canals. 

However, they also specialize in endodontic retreatment, endodontic surgery, and trauma-related dental injuries:

Root Canal Treatment

Endodontists specialize in root canal treatment, also called endodontic treatment or root canal therapy. A root canal is necessary when the pulp within a tooth is severely infected or damaged.Root canal treatment involves removing the infected pulp within a tooth. It saves the tooth and eliminates the need for extraction.

render of root canal

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

Dental Extraction and Implants

When a tooth dies or is determined unsavable, extraction is typically necessary. An endodontist is skilled at complex tooth extractions.

After extracting the infected tooth, the endodontist will place a dental implant where the permanent tooth used to be. A dental implant (artificial tooth root) mirrors the shape of a screw. It is surgically inserted into the jawbone and bonds with the natural bone.

3d render of jaw with dental incisor cantilever bridge supported by implant

Then, a dental crown goes on top of the implant and becomes the only visible part of the artificial tooth. 

Tooth extraction and dental implant treatment are recommended when a root canal isn’t enough to preserve a tooth. Common indicators for implant placement 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 — Tooth loss is more common after age 55. 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 usually successful and can last a lifetime with proper care. However, restorations can occasionally fail, which results in the need for “retreatment.”

Endodontic retreatment is necessary if the treated tooth heals improperly, becomes painful, or is infected months or years after treatment. The procedure helps relieve dental pain and discomfort and promotes healing.

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

  • The root canals were not treated properly during the first procedure
  • Complicated tooth canal anatomy (such as narrow or curved root canals) was not detected during the first procedure
  • Dental crown placement was postponed following the root canal procedure
  • Salivary contamination was not prevented during any phase of treatment

Endodontic Surgery

Nonsurgical root canal therapies may not be enough to save a patient’s tooth. In these cases, an endodontist will perform microsurgery, also called endodontic surgery.

Endodontic surgery involves finding the fractures or root canals an X-ray didn’t detect. The procedure removes calcium buildup in a root canal, treats damaged root surfaces, and stabilizes the surrounding bone near the tooth.

Microsurgery might be necessary if root canal treatment isn’t enough. The tooth won’t need to be extracted during surgery.

4 Types of Dental Pulp Diseases

There are four common dental pulp conditions (pulpitis), including:

1. Reversible Pulpitis

Reversible pulpitis is caused by tooth decay and exposed dentin (the layer under tooth enamel). It’s typically minor and doesn’t require a tooth extraction or root canal.

Treatment involves removing the cavity and covering the tooth with a filling to protect it from infection. Reversible pulpitis commonly develops after dental procedures and often resolves without treatment.

2. Symptomatic Irreversible Pulpitis

Symptomatic irreversible pulpitis develops when cavities get very close to or inside the pulp chamber (interior of a tooth). Traumatic dental injuries can also cause irreversible pulpitis if the trauma exposes the pulp. 

Teeth with this condition are hypersensitive to cold stimuli and develop lingering pain. Root canal treatment is usually recommended.

3. Asymptomatic Irreversible Pulpitis

Asymptomatic irreversible pulpitis is similar to symptomatic irreversible pulpitis (minus the symptoms). You might notice mild or no discomfort, though the affected tooth will be sensitive to cold.

Despite the lack of symptoms, this form of pulpitis also requires root canal treatment.

4. Pulpal Necrosis (Dead Tooth)

Pulpal necrosis is when the tissue inside a tooth dies. When this happens, debris, inflammatory cells, and bacteria replace the healthy dental pulp within the tooth. 

A tooth with pulpal necrosis will not respond to cold and may result in bone loss. Treatment involves root canal therapy or removal of the affected tooth.

When Do I Need a Root Canal?

The need for root canal therapy or a similar endodontic treatment depends on the type and severity of the pulpitis. You’ll need a root canal if you have a severe infection in a tooth or irreversible damage to the pulp.

An endodontist will examine your mouth using radiographic images and pulp testing. They may use thermal and electrical testing to determine the severity of the pulpitis.

Various factors contribute to the need for a root canal, including:

  • Severe tooth decay — Untreated cavities result in severe tooth decay over time. This can provoke a response from the dental pulp.
  • Gum inflammation — When the gums become inflamed, it is more likely that the bacteria will travel to a tooth’s root. Bacteria can severely damage the pulp over time.
  • Tooth chips and cracks — Habitual tooth grinding and clenching (bruxism) can also lead to pulpitis as the enamel thins. 
  • Injury or trauma — If 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 dental pulp infections.

Common Questions About Endodontists

Why would my dentist send me to an endodontist?

Your dentist may send you to an endodontist if you have symptoms of infected tooth pulp and they believe you might need a root canal.

They might also refer you if you have a previous root canal that needs to be examined, have a cracked tooth, or need an apicoectomy.

Do I have to go to an endodontist for a root canal?

General dentists are also qualified to perform root canals. However, endodontists are experts at performing endodontic procedures like root canals and often have higher success rates for saving teeth.

Endodontists also use more advanced technology and might have better pain management protocols. These specialists might be more expensive, though.


Endodontists are dentists with extra training and expertise in oral health issues related to dental pulp. They have an in-depth understanding of tooth anatomy and complex dental problems.

The most common procedure an endodontist performs is a root canal treatment. Root canal therapy removes inflamed or infected tissue, or dental pulp, inside a tooth. Endodontists can also perform microsurgery, tooth extractions, and dental implant placements.

You can see a general dentist for a root canal, though your dentist might refer you to an endodontist for expert treatment.

Last updated on March 6, 2024
6 Sources Cited
Last updated on March 6, 2024
All NewMouth content is medically reviewed and fact-checked by a licensed dentist or orthodontist to ensure the information is factual, current, and relevant.

We have strict sourcing guidelines and only cite from current scientific research, such as scholarly articles, dentistry textbooks, government agencies, and medical journals. This also includes information provided by the American Dental Association (ADA), the American Association of Orthodontics (AAO), and the American Academy of Pediatrics (AAP).
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  3. Syrbu, J.The Complete Pre-Dental Guide to Modern Dentistry.” Google Books, 2013.
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  6. Chen, E., et al. “Dental Pulp Testing: A Review.” International Journal of Dentistry, National Library of Medicine, 2009.
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