Endodontists: Root Canal & Dental Pulp Experts

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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.

Overview: 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 (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.

4 Types of Dental Pulp Diseases

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:

  • If a tooth responds positively to the 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 dental pulp is likely infected or “dead.” These teeth require endodontic treatment.

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

1. Reversible Pulpitis

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.

2. Symptomatic Irreversible Pulpitis

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.

3. Asymptomatic Irreversible Pulpitis

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.

4. Pulpal Necrosis (Dead Tooth)

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.

Endodontic 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:

Root Canal Treatment

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.

endodontic root canal procedure steps

Patients undergo root canal treatment for a variety of reasons, including:

  • Severe tooth decay — untreated cavities result in severe tooth decay over time.
  • 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 dental pulp infections.

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

Dental Implants

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.

dental implants 01

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:

  • 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" 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:

  • 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. 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.

Updated on: September 3, 2020
Alyssa Hill
Medically Reviewed: October 2, 2019
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Lara Coseo