Endodontics is a specialty of dentistry that deals with the pulp of the tooth which is essentially the nerves and vascular tissue inside the tooth. Treatment predominately entails root canals, root canal retreatment and root surgery.

An Endodontist is a dentist who has undergone 2-3 years post graduate training beyond dental school. While most dentists can and do perform root canals, they may choose to refer patients to an endodontist when the diagnosis or treatment is more complicated than usual.

The role of the endodontist is to provide information about specific procedures that may apply to your situation including the pros and cons of these options in order for you to make an informed decision about your dental care. 

For further information:

American Association of Endodontists

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 inflamation and often show up as discoloration of the tooth. If pulp inflammation or infection is left untreated, it could possibly lead to an abscess which may or may not be accompanied by pain.

Indications for treatment include prolonged sensitivity to heat or cold, discoloration of the tooth, and tenderness of the tooth or adjacent gums. Additional symptoms include constant and severe pain and/or pressure, swelling of the gum and/or sensitivity to touch. Sometimes there are no symptons and your dentist may identify an endodontic concern through x-rays or the radiographic examination.

Endodontic treatment can often be performed in one or two visits and involves the following steps:

1. A local anesthetic will be administered to "numb" the tooth. 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. The TEMPORARY FILLING will be removed by your dentist before the tooth is permanently 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.

Occasionally a tooth that has undergone endodontic treatment fails to heal or pain continues despite therapy. Although rare, sometimes a tooth initially responds to root canal therapy but becomes painful or abscessed months or years later. When either of these situations occur, the tooth often can be saved with a second endodontic treatment (Retreatment).

Generally a root canal is all that is needed to save a tooth, but occasionally it will not be sufficient to heal the tooth and surgery might be recommended.

The most common surgery used to save non-healing teeth that have had root canal therapy is an apicoectomy or root-end resection. This process is performed when inflammation or infection persists in the bony area around the end of the tooth, and requires the endodontist to open up the gum tissue near the tooth apex to expose the underlying bone.  The infected tissue is then removed, along with the apex or tip of the root, and a small filling is paced to seal the root canal.