What is endodontics and endodontic treatment? Years ago, teeth with diseased or injured pulps were extracted. Today, endodontic treatment ­also known as a root canal-- gives dentists a safe and effective means of saving teeth. Endodontics is the area of dentistry concerned with the prevention, diagnosis, and treatment of disorders of the dental pulp (the toothıs soft core). What is dental pulp? 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 and creates the surrounding hard tissues of the tooth during development. 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 toothıs 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. All teeth have only one pulp chamber, but teeth with more than one root will have more than one canal. What is a Endodontist? An Endodontist is a dental specialist with special training in endodontic procedures. To become specialists, they complete dental school and an additional two or more years of advanced training in endodontics. They perform routine as well as difficult and very complex endodontic procedures, including endodontic surgery. Endodontists are also experiences at finding the cause of oral and facial pain that has been difficult to diagnose. 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, the tooth and surrounding tissues become infected and it can cause pain and swelling or lead to an abscess. Even in the absence of pain, certain byproducts of a diseased pulp can injure the bone that anchors your tooth in the jaw. Without endodontic treatment, your tooth will eventually have to be removed. 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. What is a Endodontist? Treatment usually requires from one to three appointments. During these treatments, your dentist or endodontist removes the diseased pulp. The pulp chamber and root canal(s) of the tooth are then cleaned, shaped, filled and sealed to prevent recontamination of the root canal system. Root canal therapy is usually a relatively painless procedure. Endodontic treatment can often be performed in one or two visits and involves the following steps: 1. The endodontist examines and x-rays the tooth, then administers local anesthetic. After the tooth is numb, the endodontist places a small protective sheet called a "dental dam" over the area to isolate the tooth and keep it clean and free of saliva during the procedure. 2. The endodontist makes an opening in the crown of the tooth. Very small instruments are used to clean the pulp from the pulp chamber and root canals and to shape the space for filling. 3. After the space is cleaned and shaped, the endodontist fills the root canals with a biocompatible material, usually a rubber-like material called "gutta-percha." The gutta-percha is placed with an adhesive cement to ensure complete sealing of the root canals. In most cases, a temporary filling is placed to close the opening. Your dentist will remove the temporary filling before the tooth is restored. 4. After the final visit with your endodontist, you must return to your dentist to have a crown or other restoration placed on the tooth to protect and restore it to full function. If the tooth lacks sufficient structure to hold the restoration in place, your dentist or endodontist may place a post inside the tooth. Ask your dentist or endodontist for more details about the specific restoration planned for your tooth. Will the tooth need any special care or additional treatment? You should not chew or bite on the treated tooth until you have had it restored by your dentist. The unrestored tooth is susceptible to fracture, so you should see your dentist for a full restoration as soon as possible. Otherwise, you need only practice good oral hygiene, including brushing, flossing, and regular checkups and cleanings. Most endodontically treated teeth last as long as other natural teeth. In a few cases, a tooth that has undergone endodontic treatment fails to heal or the pain continues. Occasionally, the tooth may become painful or diseased months or even years after successful treatment. Often when this happens, another endodontic procedure can save the tooth. What causes an endodontically treated tooth to need additional treatment? New trauma, deep decay, or a loose, cracked or broken filling can cause new infection in your tooth. In some cases, the endodontist may discover very narrow or curved canals that could not be treated during the initial procedure. Can all teeth be treated endodontically? Most teeth can be treated. Occasionally, a tooth canıt be saved because the root canals are not accessible, the root is severely fractured, the tooth doesnıt 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 is endodontic surgery? The most common endodontic surgical procedure is called an apicoectomy or root-end resection. When inflammation or infection persists in the bony area around the end of your tooth after endodontic treatment, your endodontist may perform an apicoectomy. In this procedure, the endodontist opens the gum tissue near the tooth to expose the underlying bone, and the infected tissue is removed. The very end of the root is also removed, and a small filling may be placed to seal the root canal. Local anesthetics make the procedure comfortable, and most patients return to their normal activities the next day. 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. There are many disadvantages to losing a tooth. When a tooth is removed and not replaced, the teeth next to the empty space begin to shift from their normal position. This may cause teeth to become crooked or crowded, which decreases chewing and biting efficiency. Crowded or crooked teeth may be more prone to dental disease because they are harder to keep clean than properly aligned teeth. As a result, other teeth may be lost if the missing tooth is not replaced. A replacement tooth (an implant or a bridge) is usually more expensive than endodontic treatment and involves more extensive dental procedures on adjacent teeth. Endodontic treatment can safely and comfortably save a tooth that otherwise would have to be removed. In fact, root canal therapy is successful approximately 95% of the time. Remember, a healthy restored tooth is always better than an artificial one. * Parts taken with permission from educational materials provided by the American Association of Endodontists and the American Dental Association.