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Frequently Asked Questions
Who performs endodontic treatment?
All dentists are educated in endodontic treatment in dental school. However, because retreatment can be more challenging than providing initial treatment, many dentists refer patients needing retreatment to endodontists.
Endodontists are dentists with at least three additional years of advanced education in root canal techniques and procedures. Because they limit their practices to endodontic cases, they have concentrated experience in endodontic treatment. In addition to treating routine cases, they are experts in performing complicated procedures, such as surgery, and in treating difficult cases, such as teeth with narrow, blocked, or unusually positioned canals. This special training and experience can be valuable if retreatment is necessary.
Why would I need an endodontic procedure?
Endodontic treatment is necessary when the pulp becomes inflamed or infected. The inflammation or infection can have a variety of causes: deep decay, repeated dental procedures on the tooth, or a crack or chip in the tooth. In addition, a blow to a tooth may cause pulp damage even if the tooth has no visible chips or cracks. If pulp inflammation or infection is left untreated, it can cause pain or lead to an abscess.
Signs of pulp damage include pain, prolonged sensitivity to heat or cold, discoloration of the tooth, and swelling and tenderness in the nearby gums. Sometimes, there are no symptoms.
Why have I been referred to an endodontist?
All dentists are trained in the diagnosis and treatment of cracked teeth in dental school. Some cracked teeth, however, can be especially difficult to diagnose, and treatment may involve root canal treatment. That's why you have been referred to an endodontist.
Endodontists are dentists with at least three additional years of education that include the diagnosis and treatment of unusual dental pain. Cracked tooth pain often comes from damage to the inner soft tissue of the tooth, the pulp. Endodontic treatment, also known as root canal treatment, can relieve that pain.
Early diagnosis is extremely important. Like cracks in a windshield, cracks in teeth often start small and progress slowly. The sooner a crack is detected and treated, the better the chance of saving your tooth. The endodontist's special training and experience can be valuable when a cracked tooth is suspected.
Why does a cracked tooth hurt?
To understand why a cracked tooth hurts, it helps to know something about the anatomy of the tooth. Inside the tooth, under the white enamel and a hard layer called the dentin, is the soft tissue called the pulp. The pulp contains blood vessels, nerves, and connective tissue.
When the outer hard tissues of the tooth are cracked, chewing can cause movement of the pieces, and the pulp can become irritated. When biting pressure is released, the crack can close quickly, resulting in a momentary, sharp pain. Irritation of the dental pulp can be repeated many times by chewing. Eventually, the pulp will become damaged to the point that it can no longer heal itself. The tooth will not only hurt when chewing but may also become sensitive to temperature extremes. In time, a cracked tooth may begin to hurt all by itself. Extensive cracks can lead to infection of the pulp tissue, which can spread to the bone and gum tissue surrounding the tooth.
What are the different types of cracks?
There are many different types of cracked teeth. The treatment and outcome for your tooth depend on the type, location, and severity of the crack.
Craze lines are tiny cracks that affect only the outer enamel. These cracks are extremely common in adult teeth. Craze lines are very shallow, cause no pain, and are of no concern beyond appearance.
When a cusp (the pointed part of the chewing surface) becomes weakened, a fracture sometimes results. The weakened cusp may break off by itself or may have to be removed by the dentist. When this happens, the pain will usually be relieved. A fractured cusp rarely damages the pulp, so root canal treatment is seldom needed. The tooth will usually be restored by your dentist with a full crown.
This crack extends from the chewing surface of the tooth vertically towards the root. Sometimes the crack may extend below the gum line, and in severe instances, into the root. A cracked tooth is not completely separated into two distinct segments. Because of the position of the crack, damage to the pulp is common. Root canal treatment is frequently needed to treat the injured pulp. Your dentist will then restore your tooth with a full crown to bind and protect the cracked tooth.
Early diagnosis is important. Even with high magnification and special lighting, it is sometimes difficult to determine the extent of a crack. A cracked tooth that is not treated will progressively worsen, eventually resulting in the loss of the tooth. Early diagnosis and treatment are essential in saving these teeth.
A split tooth is often the result of the long-term progression of a cracked tooth. The split tooth is identified by a crack with distinct segments that can be separated. A split tooth can never be saved intact. The position and extent of the crack, however, will determine whether any portion of the tooth can be saved. In rare instances, endodontic treatment and a crown or other restoration by your dentist may be used to save a portion of the tooth.
Vertical root fracture
Vertical root fractures are cracks that begin in the root of the tooth and extend toward the chewing surface. They often show minimal signs and symptoms, and may therefore go unnoticed for some time. Vertical root fractures are often discovered when the surrounding bone and gum become infected. Treatment usually involves extraction of the tooth. However, endodontic surgery is sometimes appropriate, as a portion of the tooth can be saved by removal of the fractured root.
Conventional Root Canal Treatment
What is endodontic treatment?
To understand endodontic treatment, it helps to know something about the anatomy of the tooth. Inside the tooth, under the white enamel and a hard layer called the dentin, is a soft tissue called the pulp. The pulp contains blood vessels, nerves, and connective tissue.
The pulp extends from the crown of the tooth to the tip of the roots, where it connects to the tissues surrounding the root. The pulp is important during a tooth's growth and development. However, once a tooth is fully mature it can survive without the pulp, because the tooth continues to be nourished by the tissues surrounding it.
How does endodontic treatment save the tooth?
The endodontist removes the inflamed or infected pulp, carefully cleans and shapes the inside of the tooth, then fills and seals the space. Afterwards, you will return to your dentist, who will place a crown or other restoration on the tooth to protect it and restore it to full function. After restoration, the tooth continues to function like any other tooth.
Will I feel pain during or after the procedure?
Many endodontic procedures are performed to relieve the pain of toothaches caused by pulp inflammation or infection. With modern techniques and anesthetics, most patients report that they are comfortable during the procedure.
For the first few days after treatment, your tooth may feel sensitive, especially if there was pain or infection before the procedure. This discomfort can be relieved with over-the-counter or prescription medications. Follow your endodontist's instructions carefully.
Your tooth may continue to feel slightly different from your other teeth for some time after your endodontic treatment is completed. However, if you have severe pain or pressure, or pain that lasts more than a few days, call your endodontist.
What is involved in an endodontic procedure?
Endodontic treatment can often be performed in one or two visits and involves the following steps:
Most teeth can be treated. Occasionally, a tooth can't be saved because the root canals are not accessible, the root is severely fractured, the tooth doesn't have adequate bone support, or the tooth cannot be restored. However, advances in endodontics are making it possible to save teeth that even a few years ago would have been lost. And, when endodontic treatment is not effective, endodontic surgery may be able to save the tooth.
What are the alternatives to endodontic treatment?
When the pulp of a tooth is damaged, the only alternative to endodontic treatment is extraction of the tooth. To restore chewing function and to prevent adjacent teeth from shifting, the extracted tooth must be replaced with an implant or bridge. This requires surgery or dental procedures on adjacent healthy teeth and can be far more costly and time-consuming than endodontic treatment and restoration of the natural tooth.
No matter how effective modern tooth replacements are - and they can be very effective - nothing is as good as a natural tooth.
Surgical Root Canal Treatment
Why would I need endodontic surgery?
Surgery can help save your tooth in a variety of situations.
What is an apicoectomy?
In this procedure, the endodontist opens the gum tissue near the tooth to see the underlying bone and to remove any inflamed or infected tissue. The very end of the root is also removed.
A small filling may be placed to seal the end of the root canal, and a few stitches or sutures are placed in the gum to help the tissue heal properly.
Over a period of months, the bone heals around the end of the root.
Are there other types of endodontic surgeries?
Other surgeries endodontists might perform include dividing a tooth in half, repairing an injured root, or even removing one or more roots. Your endodontist will be happy to discuss the specific type of surgery your tooth requires.
In very complex cases, a procedure called intentional reimplantation may be performed. In this procedure, a tooth is extracted, treated with an endodontic procedure while it is out of the mouth, and then replaced in its socket.
These procedures are designed to help you save your tooth.
Will the procedure hurt?
Local anesthetics make the procedure comfortable. Of course, you may feel some discomfort or experience slight swelling while the incision heals. This is normal for any surgical procedure. Your endodontist will recommend appropriate pain medication to alleviate your discomfort.
Your endodontist will give you specific postoperative instructions to follow. If you have questions after your procedure, or if you have pain that does not respond to medication, call your endodontist.
Can I drive myself home?
Often you can, but you should ask your endodontist before your appointment so that you can make transportation arrangements if necessary.
When can I return to my normal activities?
Most patients return to work or other routine activities the next day. Your endodontist will be happy to discuss your expected recovery time with you.
What are the alternatives to endodontic surgery?
Often, the only alternative to surgery is extraction of the tooth. The extracted tooth must then be replaced with an implant, bridge, or removable partial denture to restore chewing function and to prevent adjacent teeth from shifting. Because these alternatives require surgery or dental procedures on adjacent healthy teeth, endodontic surgery is usually the most cost-effective option for maintaining your oral health.
No matter how effective modern tooth replacements are - and they can be very effective - nothing is as good as a natural tooth. You've already made an investment in saving your tooth. The pay-off for choosing endodontic surgery could be a healthy, functioning natural tooth for the rest of your life.
Why do I need another endodontic procedure?
As occasionally happens with any dental or medical procedure, a tooth may not heal as expected after initial treatment, for a variety of reasons:
First, the endodontist will discuss your treatment options. If you and your endodontist choose retreatment, the endodontist will reopen your tooth to gain access to the root canal filling material. In many cases, complex restorative materials - crown, post, and core material - must be disassembled and removed to permit access to the root canals.
After removing the canal filling, the endodontist can clean the canals and carefully examine the inside of your tooth, searching for any additional canals or unusual anatomy that requires treatment. After cleaning the canal(s), the endodontist will fill and seal the canal(s) and place a temporary filling in the tooth. Post space may also be prepared at this time.
After the final visit with your endodontist, you will need to return to your dentist as soon as possible to have a new crown or other restoration placed on the tooth to protect it and restore it to full function.
If the canals are unusually narrow or blocked, your endodontist may recommend endodontic surgery. This surgery involves making an incision near the end of the root to allow the tip of the root to be sealed.
Is retreatment the best choice for me?
Retreated teeth can function well for years, even for a lifetime. It's always best to save the tooth if your endodontist believes retreatment is the best option for you.
Advances in technology are constantly changing the way root canal treatment is performed, so your endodontist may even be able to use a new technique that was not available when you had your first procedure. If your tooth has an unusual anatomy that was not cleaned and sealed during the first procedure, your endodontist may be able to resolve this problem with a second treatment.
Of course, there are no guarantees with any dental or medical procedure. Your endodontist will discuss your options and the chances of success before beginning retreatment.
What are the alternatives to retreatment?
For some patients considering retreatment, endodontic surgery is also an option. This surgery involves making an incision near the end of the root to allow the tip of the root to be sealed. Endodontic surgery may be recommended in conjunction with retreatment or as an alternative. Your endodontist will discuss your options and recommend appropriate treatment.
The only other alternative is extraction of the tooth. The extracted tooth must then be replaced with an implant, bridge, or removable partial denture to restore chewing function and to prevent adjacent teeth from shifting. Because these options require extensive surgery or dental procedures on adjacent healthy teeth, they can be far more costly and time-consuming than retreatment and restoration of the natural tooth.
No matter how effective modern tooth replacements are - and they can be very effective - nothing is as good as your natural tooth. You've already made an investment in saving your tooth. The payoff for choosing retreatment could be a healthy, functioning natural tooth for many years to come.
Dr. Michael H. Weber, Dr. Ian K. Walker, Dr. Yaser Roumani|