A root canal is one of the most common dental procedures performed, well over 14 million every year. This simple treatment can save your natural teeth and prevent the need of dental implants or bridges.

Endodontics is a specialty of Dentistry that deals with diseases of the dental pulp and its supporting structures. Endodontist are dentist who have undergone a minimum of 2 years of extra postgraduate training. They study root canal techniques and procedures in greater depth, for diagnosis and treatment of more difficult cases. All dentist are trained in diagnosis and endodontic therapy, however, some teeth can be especially difficult to diagnose and treat. That's why you have been referred to an endodontic specialist.

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 the 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 the development of the tooth, it is not necessary for function of the tooth. The tooth continues to be nourished by the tissue surrounding it even after the pulp is removed.

Why would I need endodontic treatment? Endodontic treatment is necessary when the pulp becomes inflamed or infected.The most common reasons for inflammation or infection are deep cavities, repeated dental procedures, cracks or trauma. If pulp inflammation is left untreated, it can cause pain or lead to an abscess.

Indications for treatment may include swelling, spontaneous pain, prolonged sensitivity to heat or cold or discoloration of the tooth.

How can endodontic treatment help me? The dentist removes the inflamed or infected pulp, carefully cleans and shapes the canals and then seals the prepared space.

With the appropriate care, your teeth that have had endodontic treatment will last as long as other natural teeth. Yet, a tooth that has received treatment may fail to heal or pain may continue despite therapy. Although rare, sometimes a tooth initially responds to root canal therapy but becomes painful or diseased  months or years after treatment. When either of these situations occur, the tooth often can be maintained with a second endodontic treatment (Retreatment).

Improper healing may be caused by:

• Curved or narrow canals were not accessible during initial treatment.
• Complicated canals went undetected during initial treatment.
• The crown or restoration was not placed within the appropriate amount of time following the procedure.
• The crown or restoration did not prevent bacteria from contaminating the inside of the tooth.
• New decay can expose a root canal filling material, causing infection.
• A cracked or loose filling or crown can expose tooth to new infection.

The above diagram illustrates this simple procedure. An incision is made in the gum tissue to expose the bone and surrounding inflamed tissue. The damaged tissue is removed along with the end of the root tip. A root-end filling is placed to prevent reinfection of the root and the gum is sutured. The bone naturally heals around the root over a period of months restoring full function.

Following the procedure, there may be some discomfort or slight swelling while the incision heals. This is normal for any surgical procedure. To alleviate any discomfort, an appropriate pain medication will be recommended. If you have pain that does not respond to medication, please call our office.

Why would I need Endodontic surgery (Apicoectomy)?

Generally, a root canal is all that is needed to save teeth with injured pulp from extraction. Occasionally, this procedure will not be sufficient to heal the tooth and your Endodontist will recommend surgery. Endodontic surgery can be used to locate fractures or hidden canals that do not appear on x-rays but still manifest discomfort in the tooth.

Cracked teeth demonstrate many types of symptoms, including pain when chewing, temperature sensitivities, or even the release of biting pressure. It is also common for pain to come and go, making it difficult to diagnose the cause of discomfort.

Chewing can cause movement of the cracked pieces of your tooth, and the pulp within the tooth becomes irritated. At the same time, when biting pressure is released, the crack can close quickly, resulting in sharp pain. Eventually, the pulp will become damaged and tooth will consistently hurt, even when you are not chewing. It is possible that cracks can lead to infection of the pulp tissue, which can spread to the bone and gum surrounding the problematic tooth.

Craze lines

These are tiny cracks that only affect the outer enamel of the tooth. These cracks are more common in adults. These types of cracks are superficial and are usually of no concern.

Fractured Cusp

When a cusp becomes weakened, a fracture may result. The cusp may break off or be removed by a dentist. A fractured cusp rarely damages the pulp, so root canal is not necessary. Your dentist will usually restore the tooth with a full crown.

Cracked Tooth

This type of crack extends from the chewing surface of the tooth and vertically migrates towards the root. In some cases, the crack may extend below the gum line. It is possible for the crack to extend further into the root. Damage to the pulp is commonplace. In this case, root canal treatment is usually necessary. A cracked tooth that is not treated will worsen, resulting in the loss of the tooth. Therefore, early detection is essential.

Split Tooth

A split tooth is usually the result of an untreated cracked tooth. It can be identified by a crack with distinct segments. This type of tooth can never be saved intact. Yet, the position and extent of the problem will dictate whether any portion of the tooth can be saved. Sometimes, endodontic retreatment by the doctors and restoration by your dentist can be used to save a portion of the tooth.

Vertical Root Fracture

A vertical root fracture begins at the root and extends towards the chewing surface of the tooth. Unfortunately, they show minimal symptoms and may go unnoticed. Treatment involves endodontic surgery if a portion of the tooth can be saved by removal of the fractured root. Otherwise the tooth will have to be extracted.

Injuries to the mouth can cause teeth to be pushed back into their sockets. Your endodontist or general dentist may reposition and stabilize your tooth. Root canal treatment is usually started within a few weeks of the injury and a medication, such as calcium hydroxide, will be placed inside the tooth. Eventually, a permanent root canal filling will be implanted.

Sometimes a tooth may be pushed partially out of the socket. Again, your endodontist or general dentist may reposition and stabilize your tooth. If the pulp remains healthy, then no other treatment is necessary. Yet, if the pulp becomes damaged or infected, root canal treatment will be required.

If an injury causes a tooth to be completely knocked out of your mouth, it is important that you are treated immediately! If this happens to you, keep the tooth moist. If possible, put it back into the socket. A tooth can be saved if it remains moist. You can even put the tooth in milk or a glass of water (add a pinch of salt.) Your Endodontist may start root canal treatment based upon the stage of root development. The length of time the tooth was out of your mouth and the way the tooth was stored, may influence the type of treatment you receive.

An injured immature tooth may need one of the following procedures to improve the chances of saving the tooth:

This procedure encourages the root to continue development as the pulp is healed. Soft tissue is covered with medication to encourage growth. The tip of the root (apex) will continue to close as the child gets older. In turn, the walls of the root canal will thicken. If the pulp heals, no additional treatment will be necessary. The more mature the root becomes, the better the chance to save the tooth.

In this case, the unhealthy pulp is removed. The Doctors place medication into the root to help a hard tissue form near the root tip. This hardened tissue provides a barrier for the root canal filling. At this point, the root canal walls will not continue to develop, making the tooth susceptible to fractures. So it is important to have the tooth properly restored by your dentist.