Although all dentists, including your family dentist, receive training in dental school in endodontic treatment, a patient may be referred to an endodontic specialist. Endodontists are dentists that have received at least an additional two years of advanced specialty training in the art of Endodontics.
There are many reasons for a referral. Endodontists perform routine as well as difficult and very complex endodontic procedures, including endodontic surgery. Many endodontists use advanced technology, such as surgical operating microscopes, ultrasonics and digital imaging to perform these specialized services. Endodontists are also experienced in determining some causes of oral facial pain.
Endodontic treatment is needed when a tooth becomes infected. Bacteria, which is normally found in the saliva, can gain access through deep caries (decay), traumatic injuries or fractures in a tooth to infect the pulp. The pulp is housed inside the root canal system. The root canal system is a complex space inside your tooth.
This infection can cause, in many people, discomfort or swelling. In others, the infection is discovered during routine visits to a family dentist.
Endodontic treatment is the removal of the pulp tissue and disinfection of the root canal space. The root canal space is then filled with Gutta Percha, a biocompatible filling material. This process can take one or two appointments at our office.
The pulps sole purpose is tooth development, which is completed in our early years of growth. Should the pulp become infected it can be removed so you can preserve your natural tooth.
Oftentimes a crown is recommended for a tooth upon completion of root canal therapy. A crown provides a more even distribution of biting forces and the sealing off of saliva from re-entering the root canal space. Saliva re-entering the root canal space can lead to reinfection of the tooth. Follow up care with your family dentist is crucial to the long term success of any endodontic therapy.
Local anesthetic will be administered prior to your procedure. This anesthetic is not different from any anesthetic you might receive for routine dental procedures. For the most part this is sufficient to ensure a comfortable experience. A small number of patients with highly inflamed tissues or infection may experience some initial discomfort. We will work with you to help you achieve the comfort necessary. Unfortunately, very inflamed tissues may prevent the local anesthetic from working at it.
We offer oral conscious sedation to reduce your anxiety. Oral conscious sedation requires a consultation and additional fees apply If you elect to use nitrous oxide (sweet air) additional fees will apply. Please advise us prior to your appointment if you may need to utilize these services so that we may give you more information.
It is normal to have sensitivity or discomfort after your endodontic therapy. Sometimes this discomfort does not start until a few days later. We will go over with you in detail your individual regiment to control discomfort and provide you with the information you need prior to your departure. Prescription medications may be prescribed. In addition, you will be given direct access to reach the doctors in the practice should an urgent question or situation arise.
IF your heath history permits– the recommendations to control the inflammation that develops with endodontic treatment of infected teeth are as described below (you must confirm that this is appropriate for your particular health history before following these directions):
Two 200mg Ibuprofen tablets every 4-6 hours. For more relief: add two Tylenol (regular or extra strength) in between the ibuprofen doses. (It does mean that you will be taking either two ibuprofen or two Tylenol every 2-3 hours.) For maximum control of your discomfort you can substitute the two Tylenol with one Vicodin (Hydrocodone) between the ibuprofen doses. No driving or alcohol when using Vicodin. Please check with Dr. Wong or Dr. Manders if your health history does not allow you to take any of these medications.
The introduction of surgical operating microscopes has increased the level of care that we can provide our patients. A surgical operating microscope, with it's integrated fiber optic light source magnifies the inside of the tooth, which dramatically improves visualization. As a result, surgical techniques, proficiency of diagnosis and endodontic treatment results are enhanced. An endodontist can view, document and treat previously undetected additional canals, resorptive defects or fractures. Use of the microscope in conjunction with microsurgical instrumentation and ultrasonics allows for surgical techniques which preserve greater root length, precise placement of sealing root end filling materials and a reduction in post surgical trauma.
Surgical operating microscopes have been used extensively by our medical colleagues and we welcome comments and questions regarding the use of microscopes in conventional and surgical endodontics.
Most teeth that have gotten to the point where endodontic therapy is necessary are somewhat broken down. A crown is the best protection to safeguard against leakage of saliva back into the root canal space. In addition, a crown will help disperse biting forces more evenly as a means of protecting the remaining tooth structure against fracture. We recommend that you set up an appointment with your family dentist as soon as possible to start the process for a final restoration.
Teeth that are very broken down will require the support and stabilization from this type of restoration. A post and core is placed in the canal over the completed root canal treatment. The crown will go on over the post and core.
Deep vertical fractures extending below the gumline can allow the continued egress of bacteria into the root canal space resulting in a continued state of infection. Unfortunately, in these cases the only predictable course of action is extraction. Our powerful microscopes help us visualize the extent of most fractures giving us a better idea of how far the damage has gone. This can help us help you determing your treatment options and possible outcomes.
There can be any number of reasons why the initial endodontic therapy failed. The most common reasons could be the presence of new caries (decay) or a fracture that has allowed the egress of bacteria back into the root canal system. Regardless of the reason the canal space has germs in it. We can help you determine your appropriate treatment options.
People often wonder why a tooth with no nerves can still be uncomfortable. The message is sent to the brain from nerve endings around that tooth that bacteria is present.
Depending on the type of injury you sustained the long term outcome, or prognosis, for your specific injury often depends on how quickly you see your dentist. Some traumatic injuries require no intervention with endodontic treatment. Other injuries may result in the eventual loss of the tooth despite all efforts made. We can help you determine your individual course of action.
Antibiotics cannot get inside your tooth. Antibiotics may help you feel better initially but definitive treatment is still mandatory if the pulp in your tooth is infected. Definitive treatment involves either endodontic therapy or extraction.