Endodontics is a branch of dentistry recognized by the American Dental Association involving treatment of the pulp (root canal) and surrounding tissues of the tooth. When you look at your tooth in the mirror, what you see is the crown. The rest of the tooth, the portion hidden beneath the gum line, is called the root. Though the outer portion of the root is a hard tissue called dentin, the inside channel or “root canal” contains a pulp of soft tissue, blood vessels and nerves. Bacteria that are introduced into the pulp as a result of tooth decay, periodontal disease, tooth fracture or other problems, can severely damage the pulp. When that happens, an endodontic specialist removes the diseased pulp to save the tooth and prevent further infection and inflammation. After successful endodontic treatment, the tooth continues to perform normally.

“Endo” is the Greek word for “inside” and “odont” is Greek for “tooth.” Endodontic treatment treats the inside of the tooth. Inside the tooth, beneath the hard enamel and dentin, is a soft tissue called the pulp. The pulp contains blood vessels, nerves and connective tissue, and creates the surrounding hard tissues during tooth development. Endodontic therapy is necessary when the pulp of a tooth 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 a 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 an inflamed or infected pulp is left untreated it can cause pain or lead to an abscess. During treatment, Dr. Elena will remove the diseased pulp from inside the tooth, carefully clean and shape the root canal spaces and then seal the prepared canals with special filling materials.

Signs of pulp damage include pain, prolonged sensitivity to heat or cold, swelling, gum tenderness, and discoloration of the tooth. Sometimes, there are no symptoms when a pulp degenerates and it may only be detected by a dental examination and x-rays.

In these busy times, we understand your tight schedule. That’s why Dr. Elena will complete most procedures in a single visit. During your examination, Dr. Elena will thoroughly explain all treatment options as well as answer any questions you might have. She will review your symptoms and digital x-ray with you and determine if treatment is needed. If endodontic therapy is needed, Dr. Elena will usually complete your procedure in one appointment.

With modern anesthetic techniques, people report having a root canal is as unremarkable as having a filling placed. Dr. Elena will make sure your tooth is “sleeping” prior to starting any procedure. After treatment there may be some sensitivity of your tooth, usually with chewing, for a few days. An appropriate over the counter analgesic (like Advil, Aleve or Tylenol) is usually sufficient to help you through your discomfort. It is not unusual for your tooth to feel different for some time after the treatment is completed, however if you have severe pain or pressure, please contact our office.

Although the pulp is removed, your tooth can survive because the tooth continues to be nourished by the surrounding tissues. With regular brushing and flossing, proper diet and periodic dental checkups your tooth should last a lifetime. While there is no guarantee, the success rate of endodontic procedures is very high. Most teeth are savable, however, if Dr. Elena feels that your tooth has a poor prognosis you will be informed of this at the time of the consultation. Occasionally an endodontically treated tooth may need an additional surgical procedure or have to be removed.

Often the only other alternative is removal 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 the endodontic procedure and restoration of the natural tooth. No matter how effective tooth replacements are, nothing is as good as your own natural tooth. You’ve probably already made an investment in saving your tooth. The payoff for choosing endodontic treatment could be a healthy, functioning natural tooth for many years to come.

With proper care, teeth that have had root canal treatment are over 90% successful and can last as long as other natural teeth. In some cases, however, a tooth that has received endodontic treatment fails to heal. Occasionally, the tooth becomes painful or diseased months or even years after successful treatment. If your tooth has not healed or has developed new problems, you have a second chance. Another procedure, endodontic retreatment, may be able to save your tooth. If you and Dr. Elena choose retreatment, she 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, Dr. Elena can clean the canals and carefully examine the inside of your tooth using magnification and illumination, searching for any additional canals or unusual anatomy that requires treatment. After cleaning the canals, they will be filled and sealed and a temporary filling placed in the tooth. If the canals are unusually narrow or blocked, endodontic surgery may be recommended.

If your endodontically treated tooth has not healed or has developed new problems, you have the option of another procedure called endodontic surgery or apicoectomy. If endodontic retreatment is not an option due to a canal obstruction or a post being present in the canal, then endodontic surgery should be considered. In this procedure, Dr. Elena opens the gingival tissue near the tooth to examine the underlying bone and to remove any inflamed or infected tissue. The removal of the very end of the root is called an apicoectomy. After cleaning the root end, a small biocompatible filling called MTA is placed to seal the canal. A few stitches or sutures are placed in the gingiva to help stabilize the tissue for proper healing. Over a period of months, the bone heals around the end of the root. Most patients return to work or other routine activities the next day.

The inflamed pulp tissue inside the tooth will eventually break down and die. Once this happens, bacteria have access to the jaw bone and to your blood system. This leads to bone destruction, swelling or drainage from the gum. Once enough bone is destroyed the only treatment option would be to remove your tooth (see alternatives to endodontic treatment). An untreated infection has the potential for facial swelling, which can lead to life threatening situations of obstructed airway or brain abscess. Untreated chronic jaw infections have also been linked to systemic health problems such as heart disease, stroke and diabetes.

No. While x-rays will be necessary during your endodontics treatment, we use an advanced non-film computerized system, called digital radiography, radiation levels are 90 percent lower than conventional dental x-ray machinery. These digital images can be optimized, archived, printed and sent to cotherapists via e-mail or CD-ROM. For more information contact Sirona Dental Systems, Inc.

Again, there’s no need for concern. We adhere to the most rigorous standards of infection control advocated by OSHA, the Centers for Disease Control and the American Dental Association. We utilize autoclave sterilization and barrier techniques to eliminate any risk of infection.

When your root canal therapy has been completed, a record of your treatment will be sent to your restorative dentist. You should contact his office for a follow-up restoration within a few weeks of completion at our office. Your restorative dentist will decide on what type of restoration is necessary to protect your tooth. It is rare for endodontic patients to experience complications after routine endodontic treatment or microsurgery. If a problem does occur, however, we are available at all times to respond.