You Have Been Referred to an Endodontist for Root Canal Therapy

Your dentist has referred you to an endodontist. Endodontists are dentists who limit their practices to root canal treatment and other procedures involving the tooth pulp - the soft inner tissue of the tooth. They are experienced in treating complicated cases and specialize in diagnosing and relieving oral pain and treating traumatic injuries to the teeth.

Understanding root canal therapy

Root canal therapy, or endodontic treatment, is a preventive technique that enables dentists to save and subsequently restore teeth that might otherwise have to be removed. It is performed when the pulp of the tooth has been damaged, usually by decay or physical trauma. Treatment consists of removing the pulp and cleaning, sterilizing, filling and sealing the root canals. The tooth remains alive, nourished by the adjacent tissues of the gums and jaw.

Why do I need root canal therapy?

To answer this questions, one must first understand the make up of a tooth. A tooth consists of a crown and one or more roots. The root or roots help anchor the tooth in the jaw bone. The bulk of the tooth consists of dentin. Inside the dentin is a space called the pulp chamber. This chamber houses the pulp, which consists of blood vessels and nerves. This soft tissue extends throughout the root (or roots) in a canal (or canals) from an opening at the tip. If the pulp becomes injured or diseased, it may become infected. The germs causing the infection may spread throughout the entire pulp and eventually reach the jawbone, causing an abscess. If this happens, it is necessary to remove the pulp and to clean, sterilize and seal the root canal system of the tooth.

How does the pulp become infected?

There are several possible ways:

1. Bacteria from a deep cavity may infect the pulp.
2. Nerves and blood vessels may be damaged by a sudden blow to your tooth.
3. A tooth can be fractured or broken, exposing the pulp to harmful bacteria in your mouth.
4. Severe periodontal (gum) disease may affect the pulp, requiring endodontic as well as periodontal therapy.

Can a pulp be diseased if it doesn't hurt?

Yes, pain and disease do not always go hand in hand. Deterioration of the pulp can be so gradual that it may be nearly painless. An x ray examination of the teeth will often show evidence of disease before it causes pain. Radiographs are an important part of periodic dental check ups.

What are the symptoms of a diseased pulp?

Often, a diseased pulp is painful. Or, your tooth may become very sensitive to hot or cold foods and beverages. It is also possible that the tooth may be uncomfortable during chewing, or in extreme cases, highly sensitive to the touch.

How successful is endodontic treatment?

Research shows that 90 to 95 cases out of 100 are successful. In certain situations root canal therapy is not feasible and the tooth may have to be removed. If this happens, a replacement tooth, either bridge or implant, should be put in its place.

Usually not. Local anesthetic solutions are used to eliminate any discomfort associated with the endodontic procedure. Occasionally teeth will react to the treatment or infection may take hold again resulting in discomfort. In both cases, this can easily and quickly be brought under control.

What does endodontic treatment involve?

Endodontic treatment is usually performed in stages. The first of these is called pre treatment. This consists of removal of decayed tooth substance from the interior of the crown. The missing tooth structure is replaced by a temporary filling material in order to prevent leakage of saliva into the root canal space during the treatment.

The second stage is the actual root canal procedure itself. A small opening is made through the crown into the pulp chamber. In front teeth, the opening will be on the tongue side of the tooth; in back teeth, it will be on the chewing surface.

After the opening has been made, the inside of the tooth is carefully cleaned of all infected material.

When the dentist is satisfied that the root is free from infection, he will fill and seal the root canals and pulp chamber with a material which will prevent bacteria from re entering the tooth. Sometimes, it is necessary to remove infected tissue from the ends of the root in addition to treating the tooth through the crown. This is called periapical surgery and has saved many teeth which cannot be treated by regular root canal therapy alone.

The next stage involves the restoration of the tooth structure by your dentist. This can be achieved in a variety of ways. The choice as to the most appropriate method will be decided when you return to your dentist after the endodontic treatment has been completed.

How long will endodontic treatment take?

This will depend on a number of factors, such as the degree of difficulty and the access to the tooth. The treatment generally takes from one to two appointments.

Will my tooth discolour?

It may become less translucent and therefore appear to darken. If this happens, the tooth often can be bleached to its original colour. Bleaching is a relatively simple process which is done from the inside of the tooth. But if the tooth darkens again, your dentist may put a crown on it to restore its original appearance.

We want to know how you are.

Follow up visits and radiographs are part of your care in our office. These are necessary to evaluate the healing process as this can take 6 to 18 months. A notice will be mailed to you at the appropriate time for your re examination. It is important to note that we all heal differently. Successful root canal therapy means that there is an absence of pain, swelling, no discharge in evidence, normal gum contour and colour. Radiographically we expect to see regeneration of bone about the root of the tooth. Vague feelings, occasional twinges, the sense that the tooth is different from other teeth are possible. This does not mean the outcome is less than expected, it is merely part of the healing response. Please notify us if you have any concern.

You Have Been Referred to an Endodontist for Surgical Root Canal Therapy

It has been determined that surgical root canal therapy is the treatment of choice to treat the problem with your tooth.

There are several reasons why surgical root canal therapy may be necessary. These include:

1. A need to institute drainage which cannot be achieved through the tooth
2. An inability to seal the root end by normal means due to calcification, obstructions, resorption or previous treatments
3. Persistent post procedural discomfort
4. The presence of infection which will not heal in the normal manner.

No tooth will be treated unless we feel that there is an excellent chance for success. While there is no absolute certainty about healing anywhere in the body, studies indicate that treatment is successful in 80 to 90% of cases. It is possible that your chances of success may fall below this expectancy, or that your tooth may not be amenable to surgical root canal therapy at all. You will be advised of this at the time of your consultation and informed of your treatment alternatives.

It is our policy that no treatment be rendered until our patients are completely comfortable with all aspects of their care.

The procedure involves making an incision in the gum tissue around your tooth. This tissue is then carefully lifted away so that the bone overlying the area can be examined. The soft tissue infection is cleaned from inside of the bone and the end of the root is prepared to receive a root end filling in order to arrest the infection. There are a number of filling materials than can be used. We recommend either IRM, SuperEBA cement or MTA. Please discuss the choice of filling material with us. Please note that silver amalgam is no longer used for this procedure.

The surgical procedure involves the use of microsurgical techniques. The area is examined under high powered magnification for structural defects and fractures in the tooth and/or root.

If the infection is severe, then it is often necessary to place a bone graft in the area to optimise the healing potential. If this applies to your specific case, you will be informed of this. Once the procedure has been completed, the gum tissue will be repositioned and stitches placed to hold it in place.

The procedure is performed after the area is well anaesthetized with local anaesthetic. In some instances, sedation is also recommended. If you would like to have sedation for your surgical procedure, please advise us so that we can discuss this with you.

Schedule your time so that you do not have to resume any activity for the remainder of the day of the procedure. Depending on your individual situation, you should be able to resume normal activity the next day. Call us if you have any concerns. Remember that you have stitches in your mouth. If not the dissolving type, these will be removed at your next appointment. If you have any questions, stop before proceeding and call our office.

Follow up visits and radiographs are part of your care in our office. These are necessary to evaluate the healing process as this can take 6 to 18 months. A notice will be mailed to you at the appropriate time for your re examination.

It is important to note that we all heal differently. Successful surgical root canal therapy means that there is an absence of pain, swelling, no discharge and normal gum contour and colour. Radiographically we expect to see the regeneration of bone around the root of the tooth. Following all surgical endodontic procedures, vague feelings, occasional twinges, or the sense that the tooth is different from other teeth are all possible outcomes. This is merely part of the healing response Please notify us if you have any concern.

As endodontists, we solely perform root canal treatments and corrective surgery when failures occur. Please feel free to discuss any aspect of treatment with us.