Endodontics

Endodontists are dentists who specialize in maintaining teeth through endodontic therapy -- procedures involving the soft inner tissue of the teeth, called the pulp.  The word "endodontic" comes from "endo" meaning inside and "odont" meaning tooth.  All dentists are trained in diagnosis and endodontic therapy, however, some teeth can be especially difficult to diagnose and treat.  That’s why you may have been referred to an endodontic specialist.

In addition to dental school, endodontists receive two or more years of advanced education in this kind of treatment.  They study root canal techniques and procedures in greater depth, for diagnosis and treatment of more difficult cases.

It is important that patients understand why they require treatment, what treatment involves, and what they can do to ensure the best possible outcome. Dr. Mallick believes that treatment decisions should ultimately be made by you as the patient but will educate you as he feels that a properly informed patient has the ability to make the best decision.

 

In order to understand endodontic treatment, it helps to know something about the anatomy of a tooth. Teeth have several layers. The outside layer of the tooth is composed of a hard layer called enamel. Enamel is supported by an inner layer called dentin, which has at its center a soft tissue known as the pulp.

The pulp contains blood vessels, nerves, and connective tissue that are responsible for forming the surrounding dentin and enamel during tooth development. The pulp receives its nourishment supply from vessels which enter the end of the root. Although the pulp is important during development of the tooth, it is not necessary for function of the tooth. The tooth continues to be nourished by the tissues surrounding it even after the pulp is removed.

Endodontic treatment is necessary when the pulp becomes inflamed or infected. The most common reasons for inflammation or infection are deep cavities (caries), repeated dental procedures, cracks or chips. Trauma can also cause inflammation and often shows up as discoloration of the tooth. If pulp inflammation or infection is left untreated, it can cause pain or lead to an abscess.

Indications for treatment include prolonged sensitivity to heat or cold, discoloration of the tooth, swelling or tenderness of the tooth or adjacent gums. Sometimes there are no symptoms.

Millions of teeth are treated and saved each year with root canal, or endodontic, treatment. During root canal treatment, the inflamed or infected pulp is removed and the inside of the tooth is carefully cleaned and disinfected, then filled and sealed with a rubber-like material called gutta-percha. Afterwards, the tooth is restored with a crown or permanent filling for protection. After restoration, the tooth continues to function like any other tooth.

Modern root canal treatment is very similar to having a routine filling and usually can be completed in one or two appointments, depending on the condition of your tooth and your personal circumstances. You can expect a comfortable experience during and after your appointment. 

Saving the natural tooth with root canal treatment has many advantages:

• Efficient chewing
• Normal biting force and sensation
• Natural appearance
• Protects other teeth from excessive wear or strain

Endodontic treatment helps you maintain your natural smile and continue to eat the foods you love.  With proper care, most teeth that have root canal treatment can last as long as other natural teeth, and often for a lifetime.

Why do I need another endodontic procedure?

Occasionally, a tooth may not heal as expected after the intial treatment for a variety of reasons:

• Narrow or curved canals were unable to be treated during the initial procedure.
• Complicated canal anatomy went undetected in the first procedure.
• The placement of the crown or other restoration was excessively delayed following the endodontic treatment.
• The restoration did not prevent salivary contamination to the inside of the tooth.

In other cases, a new problem can jeopardize a tooth that was successfully treated. For example:

• New decay can expose the root canal filling material to bacteria, causing a new infection in the tooth.
• A loose, cracked, or broken crown or filling can expose the tooth to new infection.
• The tooth sustains a fracture.

What will happen during retreatment?

First, Dr. Mallick will discuss your treatment options.  If you choose retreatment, your tooth is reopened and the filling materials that were placed in the root canals during the first procedure are removed. In many cases, complex restorative materials--crown, post and core material--must also be disassembled and removed to permit access to the root canals.

After removing the canal filling, Dr. Mallick cleans and shapes the canals and carefully examins the inside of your tooth using magnification and illumination, searching for any unusual anatomy that requries treatment.  After thorough disinfection, the new root canal filling material is placed and the opening in the tooth is then sealed with either a temporary or permanent filling, depending on the needs of the tooth. After retreatment is completed, 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 and restore it to its full function.

Is retreatment the best choice for me?

Whenever possible, it is best to save your natural tooth. Retreated teeth can function well for years, even for a lifetime.

Advances in technology are constantly changing the way root canal treatment is performed, so new techniques may be used that were not available when you had your first procedure. Retreatment alone may solve the issue with your tooth, however, as with any dental or medical procedure, there are no guarantees. Dr. Mallick will discuss your options and the chances of success before beginning treatment.

What are the alternatives to retreatment?

If nonsurgical retreatment is not an option, then endodontic surgery can be considered. This involves making an incision to allow access to the tip of the root. Endodontic surgery may also be recommended in conjunction with retreatment or as an alternative. Dr. Mallick will discuss your options and recommend appropriate treatment.

What are the alternatives to endodontic retreatment and/or endodontic surgery?

The only other alternative is extraction of the tooth. The extracted tooth should then be replaced with an implant, bridge, or removal partial denture to restore chewing function and to prevent adjacent teeth from shifting. Becuse these options can require extensive surgery or dental procedures on adjacent healthy teeth, they can be far more costly and time consuming than procedures to maintain the natural tooth. Each tooth and set of circumstances are different and thus treatment options are tailored accordingly.

Occasionally, a nonsurgical root canal procedure alone cannot save your tooth and surgery will be recommended. Endodontic surgery can be used to locate small fractures or hidden canals that weren't detected on radiographs or during previous treatment. Surgery may also be needed to remove obstructions in rooth canals, or to treat damaged root surfaces of the tooth or the surrounding bone.

There are many surgical procedures that can be performed to save a tooth. The most common is called apicoectomy, or root-end resection, which is occasionally needed when inflammation or infection persists in the bony area around the end of your tooth after a root canal procedure. In this microsurgical procedure, Dr. Mallick 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 to help the tissue heal. Over a period of months, the bone heals around the end of the root.

Local anesthetics make the procedure comfortable, and most patients return to their normal activities the next day. Postsurgical discomfort is generally mild. Of course, you may feel some discomfort or experience slight swelling while the incision heals. This is normal for any surgical procedure. Dr. Mallick will recommend appropriate pain medication to alleviate your discomfort.

Traumatic dental injuries often occur in accidents or sports-related injuries. Treatment depends on the type, location, and severity of each injury. Any dental injury, even if apparently mild, requires examination by a dentist or an endodontist immediately. Endodontists are dentists who specialize in treating traumatic dental injuries. With their advanced skills, techniques, and technologies they can often save injured teeth.

Chipped or Fractured Teeth

Most chipped or fractured tooth crowns can be repaired either by reattaching the broken piece or by placing a tooth-colored filling. If a significant portion of the tooth crown is broken off, an artifical crown or "cap" may be needed to restore the tooth.

If the pulp/nerve is exposed or damaged after a crown fracture, root canal treatment may be needed. These injuries require special attention.

Injuries in the back teeth often include fractured cusps, cracked teeth, and the more serious split tooth. Because treatment and prognosis for cracked teeth varies from tooth to tooth, Dr. Mallick will spend time discussing your individual situation with you before making recommendations for treatment.

Dislodged (Luxated) Teeth

A dislodged, or luxated, tooth is one that has been partially pushed into or out of its socket, or sideways, during an injury. The tooth will be repositioned and stablized. Root canal treatment is usually necessary for permanent teeth that have been luxated.

Children may not need root canal treatment since their teeth are still developing. New research indicates that stem cells present in the pulps and outside the roots of undeveloped teeth can be stimulated to complete root growth and heal the pulp following injuries or infection. An endodontist or dentist will monitor the healing carefully and intervene immediately if any unfavorable changes appear. Therefore, multiple follow-up appointments are likely to be needed. 

Knocked-Out (Avulsed) Teeth

With proper emergency action, a tooth that has been knocked out of its socket can be successfully replanted and last for years. It's important to see a dentist or endodontist as soon as possible after the tooth is knocked out. Quick action will increase the likelihood of saving the tooth.

SAVING A KNOCKED-OUT TOOTH

Locate the tooth immediately; do not leave it at the site of the accident. The tooth should be handled carefully to minimize injury to the root. Pick up the tooth by the crown (chewing surface) not the root. If dirty, gently rinse the tooth with water. Do not use soap or chemicals. Do not scrub the tooth. Do not dry the tooth. Do not wrap it in a tissue or cloth. Reposition the tooth in the socket immediately if possible. The sooner the tooth is replanted, the greater the likelihood it will survive. To reinsert, carefully push the tooth into the socket with fingers, or position it above the socket and close mouth slowly. Hold the tooth in place with fingers or by gently biting down on it. Keep the tooth moist at all times.  It must not be left outisde the mouth to dry. If it cannot be replaced in the socket, put it one of the following: 1) Emergency tooth preservation kit (such as Save-a-Tooth®), 2) Milk, or 3) Mouth (next to cheek). Regular tap water is not recommended for long-term storage because the root surface cells do not tolerate water for long periods of time.

See an endodontist or the nearest available dentist within 30 minutes. Once you arrive at out office, the tooth will be evaluated, placed back in its socket and Dr. Mallick will examine for any other dental or facial injuries. A stablizing splint will be placed for a few weeks. Depending on the stage of root development, root canal treatment may be initiated a week or two later.

Root Fractures

A traumatic injury to the tooth may also result in a horizontal root fracture. The location of the fracture determines the long-term health of the tooth. If the fracture is close to the root tip, the chances for success are much better. However, the closer the fracture is to the gum line, the poorer the long-term success rate. Sometimes, stablization with a splint is required for a period of time.

Vertical root fractures often require extraction of the tooth.