What is Endodontics?

Endodontics is a specialized area of dentistry, which focuses on preserving the patient’s own teeth using many different techniques comprising of both the nerve and root of the tooth.  The root of the word Endodontics means inside (“endo”) and tooth (“odont”).  Similarly to many other healthcare fields, all dentists are educated on diseases involving the nerve of the tooth, though dentists trained in endodontics are more capable of diagnosing and treating complicated teeth situations.  A referral from a general dentist due to dental pain or tooth discoloration is a common reason to schedule an appointment with the endodontist.

Endodontics is defined as the field of dentistry handling the cause, diagnosis, and treatment of the dental pulp (nerve) heavily utilizing root canal therapy with other endodontic treatments and medical imaging.  After becoming a board certified dentist, someone interested in this specialty will then pursue additional training to obtain a specialization in endodontics.  After completion of the specialized training and passing the board examinations, a dentist is then considered board certified to practice endodontics.  Root canal therapy is one of the most used treatments, however, the field of endodontics diagnoses many different diseases of the nerve with other various techniques and equipment.

Dental and Facial Pain

One of the common referrals to endodontics is dental pain, including toothaches or fractured teeth due to the complicated nature of diagnosing the pain.  The nerves within the mouth are such an intricate network that sometimes what the patient identifies as the painful tooth may not identify which nerve is actually in need of treatment.  Many times the pain may also be felt in other areas of the body such as the head, neck, or ears.  Seeking assistance from a specialist in endodontics will help in diagnosing and treating the source of pain.

Traumatic Injuries and Accidents

There are many causes of dental pain and sometimes a traumatic injury to the mouth will cause nerve damage that requires endodontic treatment.  Many times if a child receives an injury to an underdeveloped tooth, it will cause the root to stop growing and prevent the permanent tooth from fully emerging.  If the child seeks endodontic treatment there are procedures to assist in stimulating the deposit of bone at the end of the root, therefore saving the child’s permanent tooth.  Other treatments that endodontists specialize in are replanting teeth into the socket when they have been knocked out from an injury.

Root Canal Therapy

A root canal is one of the most common treatments that is performed in the field of endodontics.  This therapy is performed using local anesthesia to remove the damaged nerve from the tooth and replace the canal with a permanent material to keep out infection.  Depending on the amount of damage, a filling is used to cap the tooth in order to prevent damage from occurring again within the tooth. The number of treatment sessions required to fully complete this endodontic therapy are case dependent but may vary between one to three appointments.

It is very important to meet the patient’s individual needs based on degree of damage instead of trying to rush through this procedure, as there is a very high success rate when it is properly completed.  However, all teeth and diagnoses are different and certain endodontic treatments, such as root canal therapy, may not be the most appropriate for every patient’s therapeutic plan.

Root Canal Retreatment

Although there is a very high success rate on endodontic therapy treatments, sometimes the procedure does not completely heal the tooth and a subsequent treatment is required.  There are also situations that arise when the tooth heals yet the pain returns at a later time and calls for retreatment.  Endodontic retreatments may be surgical or non-surgical depending on the needs of the individual’s diagnostic plan.  The amount of visits required to finish the procedure are dependent on the treatment needed and the patient’s diagnosis.  Further evaluation using medical imaging may be helpful if there is a persistent pain that does not diminish after the root canal therapies are completed.

Tooth Discoloration and Single Dark Tooth

If the endodontic treatment required is completed using the most up to date technology, there will not be any tooth discoloration due to the procedure.  However, if older techniques are utilized there is a chance discoloration may occur of the tooth effected.  Tooth discoloration may also be a concern before the root canal therapy due to the impact that dead nerves may have on tooth color.  In certain patients, the damaged nerve may cause the tooth to become gray or brown in color indicating that a root canal may be necessary to repair the tooth.  After the root canal treatment, there are endodontic therapies available to help even out the color of the damaged tooth with the color of the remaining teeth.  This procedure whitens the tooth from the inside unlike bleaching which whitens from the outside of the tooth.

Cone Beam Computed Tomography

A common piece of technology utilized in the field of endodontics is the Cone Beam Computed Tomography (CBCT) which is an X-Ray machine but with significantly lower amounts of radiation.  The CBCT is more compact than a CT-scan machine making it easier to use in the office, and is safer and quicker than traditional scans.  The CBCT works in the same manner as a CT-scan, taking hundreds of sliced images in order to recreate the internal structure of the tooth in a 3D image and assist in diagnosing the damage more accurately.

The scan takes less than one minute to complete and the images are configured very quickly.  After the images are complete, this scan may be uploaded for viewing on the computer and used to develop the appropriate endodontic treatment plan.  The more information the endodontist has to work with regarding the dental pain, the higher chance of success with the initial endodontic treatment.

Many individuals are justifiably concerned with the amount of radiation that may be received from most medical imaging machinery, however the CBCT uses a considerable amount less than other machines due to its smaller size and the shape of the beam used to capture the images.  The cone shape allows for less exposure of radiation to areas not being imaged for the diagnostic purposes while still obtaining the targeted region for the endodontic diagnosis.

The CBCT is typically used in diagnosing endodontic cases where the source of pain is not quite able to be pinpointed amongst the vast network of nerves within the mouth and the X-Rays failed to show enough to diagnose the dental pain.  Without the proper diagnosis, the treatment plan may take many more attempts than normal if it is even able to begin at all.  If the patient has already received one root canal treatment then the CBCT may be helpful in verifying that the tooth getting treatment is the one that is damaged.  An additional reason for a CBCT scan is due to the calcification of the inside of the tooth.  The canal of the tooth is where the damaged nerves would be noticeable, yet if there is calcification present, the X-Ray may not be accurate in diagnosing damage.

In some circumstances, such an accident or traumatic injury, the CBCT may be used in addition to the standard X-Ray to see how severe the nerve damage is to the tooth and what type of injury the tooth suffered.  Internal root resorption occurs when the inflammation in the nerve occurs for a long time without treatment, this may also be identified with a CBCT clear enough to begin treatment before it is no longer an option.  Also, when performing implants it is common to execute this scan in order to assess the location of the nerves inside the tooth to safely place the implant.  When there are cysts or tumors located in or near the mouth, the scan may also be used to show their location before beginning an endodontic treatment.  Locating an endodontist facility with this equipment may help ensure that your treatment plan is as accurate as possible.

Contact Progressive Dental Care Center today with any questions you may have regarding endodontics!

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