Definition and Overview
Endodontics is a branch of dental medicine that specializes in the treatment and management of conditions affecting the dental pulp or the interior of the tooth. It is used when the dental pulp, which contains the tooth's nerves, arterioles, lymphatic tissue, fibrous tissue, and venules, are injured, damaged, or diseased. The primary goal of endodontist is to save the natural tooth for as long as possible, thus also protecting patients from the long process and the high costs of tooth replacement.
A dental professional who specializes in this field is called an endodontist. To become one, a dental professional who has already graduated from dental school will have to undergo specialized training that lasts for at least two years.
In performing their duties, endodontists use several tools, including digital imaging technologies, and carry out different treatment procedures, including:
- Endodontic therapy, or more commonly known as root canal therapy
- Endodontic retreatment, which can either be similar to the original treatment or progress to a more aggressive procedure, such as surgery
- Oral surgery
- Treatment of dental trauma
- Treatment of cracked or damaged teeth
Surgery is not always necessary when treating dental pulp problems. However, some circumstances may make primary root canal therapy impossible, such as when there is calcification involved. Calcification refers to the accumulation of calcium deposits in the root canal, making the instruments used in non-surgical therapy unable to access the end of the root. Surgery can open up the canal, clean it, and perform the necessary treatment. Moreover, it is also best to consider surgery if the affected tooth continues to be painful even after a successful root canal therapy or retreatment.
The most common type of endodontic surgery is apicoectomy, also known as a root-end resection. This procedure requires the endodontist to make an incision through the gum tissue to access the underlying bone so the infected tissue, as well as the end of the tooth root, can be removed. The dentist ends the procedure by sealing the end of the root canal with a small filling before suturing the gums.
In other types of endodontic surgery, the endodontist may also repair an injured tooth root, remove one or more tooth roots, or divide a tooth in half. Another type is called the intentional replantation, wherein the tooth is first extracted, operated on, then placed back into its original socket.
Root canal procedures can be painful, but local anesthetics make them manageable. They also do not require a long recovery downtime, with most patients able to resume their normal activities the day after the procedure. Although it is normal to experience some post-surgical discomfort, this is usually mild and does not get in the way of normal activities.
When should you see an Endodontist
Patients should see an endodontist when they suffer from the following conditions:
- Tissue inflammation inside the pulp
These are commonly caused by:
- Deep cavities, usually those that were left untreated for a long time, allowing the cavity to grow and spread to the pulp
- Dental traumatic injuries
These conditions may cause the following symptoms:
- Tooth pain, which can be sharp and sudden when pressure is placed on the affected tooth
- Facial pain
- Tooth discoloration
- Sensitivity to hot and cold temperatures
- Swelling of gums surrounding the affected tooth
- Tenderness of tooth and gums
- Dull ache in the jaw
Most endodontic appointments take between one and two hours depending on the extent of the damage and the number of teeth involved. A root canal treatment is sometimes followed by internal bleaching procedures, which help prevent or lessen the tooth discoloration that may occur as a side effect of the root canal procedure.
- Christian JM. Odontoogenic infections. In: Flint PW, Haughey BH, Lund LJ, et al, eds. Cummings Otolaryngology: Head & Neck Surgery. 5th ed. Philadelphia, Pa: Mosby Elsevier; 2010:chap 12.