YOUR GUIDE
TO ENDODONTIC TREATMENT
WHO
PERFORMS ENDODONTIC TREATMENT?
All dentists, including your general dentist, received training in endodontic
treatment in dental school. General dentists can perform endodontic procedures
along with other dental procedures, but often they refer patients needing
endodontic treatment to endodontists.
Endodontists
are dentists with special training in endodontic procedures. They provide
only endodontic services in their practices because they are specialists.
To become specialists, they
complete dental school and an additional two or more years of advanced
training in endodontics. They perform routine as well as difficult and
very complex endodontic procedures, including endodontic surgery. Endodontists
are also experienced at finding the cause of oral and facial pain that
has been difficult to diagnose. (BACK
TO TOP)
WHAT
IS ENDODONTIC TREATMENT?
"Endo" is the Greek word for "inside" and "odont"
is Greek for "tooth". Endodontic treatment treats the inside
of the tooth.
To understand
endodontic treatment, it helps to know something about the anatomy of
the tooth. Inside the tooth, under the white enamel and a hard layer called
the dentin, is a soft tissue called the pulp. The pulp contains blood
vessels, nerves and connective tissue, and creates the surrounding hard
tissues of the tooth during treatment.
The pulp
extends from the crown of the tooth to the tip of the roots where it connects
to the tissues surrounding the root. The pulp is important during a tooth's
growth and development. However, once a tooth is fully mature it can survive
without the pulp, because the tooth continues to be nourished by the tissues
surrounding it. (BACK
TO TOP)
ENDODONTIC
PROCEDURE
Endodontic treatment can often be performed in one ore two visits and
involves the following steps:
1. The endodontist examines and x-rays the tooth, then administers local
anesthetic. After the tooth in 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
canal with a biocompatible material called "gutta-percha." The
gutta-percha is placed with 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 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.
If the tooth lacks sufficient structure to hold the restoration in place,
your dentist or endodontist may place a post inside the tooth. Ask your
dentist or endodontist for more details about the specific restoration
planned for your tooth.
(BACK TO TOP)
WHY WOULD I NEED
AN ENDODONTIC PROCEDURE?
Endodontic treatment is necessary when the pulp becomes inflamed or infected.
The inflammation or infection can have a variety of causes deep decay,
repeated dental procedures on the tooth or a crack or chip in the tooth.
In addition. a blow to a tooth may cause pulp damage even if the tooth
has no visible chips or cracks. If pulp inflammation or infection is left
untreated, it can cause pain or lead to an absces.
Signs of
pulp damage include pain, prolonged sensitivity to heat or cold, discoloration
of the tooth and swelling and tenderness in the nearby gums. Sometimes,
there are no symptoms. (BACK
TO TOP) 
HOW
DOES ENDODONTIC TREATMENT SAVE THE TOOTH?
The endodontists removes the inflamed or infected pulp, carefully cleans
and shapes the inside of the tooth, then fills and seals the space. Afterwards,
you will return to your dentist, who will place a crown or other restoration
on the tooth to protect and restore it to full function. After restoration,
the tooth continues to function like any other tooth. Turn to pages six
and seven for a step-by-step explanation of the procedure.
WILL
I FEEL PAIN DURING OR AFTER THE PROCEDURE?
Many endodontic procedures are performed to relieve the pain of toothaches
caused by pulp inflammation or infection. With modern techniques and anesthetics
most patients report that they are comfortable during the procedure.
For the
first few days after treatment, your tooth may feel sensitive, especially
if there was pain or infection before the procedure. This discomfort can
be relieved with over-the-counter or prescription medications. Follow
your endodontist's instructions carefully.
Your tooth
may continue to feel slightly different from your other teeth for some
time after your endodontic treatment is completed. However, if you have
severe pain or pressure, or pain that lasts more than a few days, call
your endodontist. (BACK
TO TOP)
WILL
THE TOOTH NEED ANY SPECIAL CARE OR ADDITIONAL TREATMENT?
You should not chew or bite on the treated tooth until you have had it
restored by your dentist. The unrestored tooth is susceptible to fracture,
so you should see your dentist for a full restoration as soon as possible.
Otherwise, you need only practice good oral hygiene, including brushing,
flossing and regular checkups and cleanings.
Most endodontically
treated teeth last as long as other natural teeth. In a few cases, a tooth
that has undergone endodontic treatment fails to heal or the pain continues.
Occasionally, the tooth may become painful or diseased months or even
years after successful treatment. Often when this happens, another endodontic
procedure can save the tooth. (BACK
TO TOP)
WHAT CAUSES AN ENDODONTICALLY TREATED
TOOTH TO NEED ADDITIONAL TREATMENT?
New trauma, deep decay or a loose, cracked or broken filling can cause
new infection in your tooth. In some cases, the endodontist may discover
very narrow or curved canals that could not be treated during the initial
procedure.
CAN
ALL TEETH BE TREATED ENDODONTICALLY?
Most teeth can be treated. Occasionally, a tooth can't be saved because
the root canals are not accessible, the root is severely fractured , the
tooth doesn't have adequate bone support or the tooth cannot be restored.
However, advances in endodontics are making it possible to save teeth
that even a few years ago would have been lost. And, when endodontic treatment
is not effective, endodontic surgery may be able to save the tooth. (BACK
TO TOP)
WHAT
IS ENDODONTIC SURGERY?
The most common endodontic surgical procedure is called an apicoectomy
or root-end resection. When inflammation or infection persists in the
bony area around the end of your tooth after endodontic treatment, your
endodontist may perform an apicoectomy. In this procedure, the edndodontist
opens the gum tissue near the tooth to expose the underlying bone and
and the infected tissue is removed. The very end of the root is also removed
and a small filling may be placed to seal the root canal. Local anesthetics
make the procedure comfortable and most patients return to their normal
activities the next day.
 
(BACK
TO TOP)
WHAT
ARE THE ALTERNATIVES TO ENDODONTIC TREATMENT?
When the pulp of a tooth is damaged, the only alternative to endodontic
treatment is extraction of the tooth. To restore chewing function and
to prevent adjacent teeth from shifting, the extracted tooth must be replaced
with an implant or bridge. This requires surgery or dental procedures
on adjacent healthy teeth and can be far more costly and time-consuming
than endodontic treatment and restoration of the natural teeth.
No matter
how effective modern tooth replacements are-and they can be very effective-
nothing is as good as a natural tooth. (BACK
TO TOP)
YOUR GUIDE TO CRACKED TEETH
WHY
DOES A CRACKED TOOTH HURT?
To understand why a cracked tooth hurts, it helps to know something about
the anatomy of the tooth. Inside the tooth, under the white enamel and
a hard layer called the dentin, is the inner soft tissue called the pulp.
The pulp cantains blood vessels, nerves, and connective tissue.
When the
outer hard tissues of the tooth are cracked, chewing can cause movement
of the pieces, and the pulp can become irritated. When biting pressure
is released, the crack can close quickly, resulting in a momentary, sharp
pain. Irritation of the dental pulp can be repeated many times by chewing.
Eventually, the pulp will become damaged to the point that it can no longer
hael itself. The tooth will not only hurt when chewing but may also become
sensitive to temperature extremes. In time, a cracked tooth may begin
to hurt all by itself. Extensive cracks can lead to infection of the pulp
tissue, which can spread to the bone and gum tissue surrounding the tooth.
(BACK
TO TOP)
TYPES
OF CRACKS
There are many different types of cracked teeth. The treatment and outcome
for your tooth depends on the type, location, and severity of the crack.
CRAZE LINES
Craze lines are tiny cracks that affect only the outer enamel. These cracks
are extremely common in adult teeth. Craze llines are very shallow, cause
no pain, and are of no concern beyond appearances.
FRACTURED
CUSP
When a cusp (the pointed part of the chewing surface) becomes weakened,
a fracture sometimes results. The weakened cusp may break off by itself
or may have to be remaoved by the dentist. When this happens, the pain
will usually be relieved. A fractured cusp rarely damages the pulp, so
root canal treatment is seldom needed. The tooth will usually be restored
by your dentist with a full crown.
CRACKED TOOTH
This crack extends from the chewing surface of the tooth vertically towards
the root. A cracked tooth is not completely separated into two distinct
segments. Because of the position of the crack, damage to the pulp is
common. Root canal treatment is frequently needed to treat the injured
pulp. Your dentist will then restore your tooth with a full crown to bind
and protect the cracked tooth. At times, the crack may extend below the
gum line, requiring extraction.
 
Early diagnose
is important. Even with high magnification and special lighting, it is
sometimes difficult to determine the extent of a crack. A cracked tooth
that is not treated will progessively worsen, eventually resulting in
the loss of the tooth. Early diagnosis and treatment are essential in
saving these teeth.
SPLIT TOOTH
A split tooth is often the result of the long term progression of a cracked
tooth. The split tooth is identified by a crack with distinct segments
that can be separated. A split tooth can never be saved intact. The position
and extent of the crack, however, will determine whether any portion of
the tooth can be saved. In rare instances, endodontic treatment and a
crown or other restoration by your dentist may be used to save a portion
of the tooth.
VERTICAL
ROOT FRACTURE
Vertical root fractures are cracks that begin in the root of the tooth
and extend toward the chewing surface. They often show minimal signs and
symptoooms and may therefore go unnoticed for some time. Vertical root
fractures are often discovered when the surrounding bone and gum become
infected. Treatment usually involves extraction of the tooth. However,
endodontic surgery is sometimes appropriate if a portion of the tooth
can be saved by removal of the fractured root.
 (BACK
TO TOP)
WILL
MY TOOTH COMPLETELY HEAL?
Unlike a broken bone, the fracture in a cracked tooth will never heal.
In spite of treatment, some cracks may continue to progress and separate,
resulting in loss of the tooth. Placement of a crown on a cracked tooth
provides maximun protection but does not guarantee success in all cases.
The treatment
you receive for your cracked tooth is important because it will relieve
pain and reduce the likelihood that the crack will worsen. Once treated,
most cracked teeth continue to function and provide years of comfortable
chewing. Talk to your dentist and/or endodontist about your particular
diagnosis and treatment recommendations. They will advise you on how to
keep your natural teeth and achieve optimum dental health.
YOUR GUIDE TO RETREATMENT
With proper
care, most teeth that have had endodontic(root canal) treatment can last
as long as other natural teeth.
In some
cases, however, a tooth that has received endodontic treatment fails to
heal. Occasionally, the tooth becomes painful or diseased months or even
years after successful treatment.
If you tooth
has failed or has developed new problems, you have a second chance. Another
endodontic procedure may be able to save your tooth.
WHO
PERFORMS ENDODONTIC RETREATMENT?
Endodontists are dentists with at least two additional years of advanced
specialty education in diagnosis and root canal treatment. Because they
limit their practices to endodontics, they treat these types of problems
every day. Endodontists are experts in performing nonsurgical and surgical
retreatment. They use their special training and experience in treatiing
difficult cases, such as teeth with narrow or blocked canals or unusual
anatomy. Endodontists may use advanced technology, such as operating microscopes,
ultrasonics and digital imaging, to perform these special services. (BACK
TO TOP)
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WHY
DO I NEED ANOTHER ENDODONTIC PROCEDURE?
As occasionally happens with any dental or medical procedure, a tooth
may not heal as expected after initial treatment for a variety of
reasons:
• Narrow or curved canals were not treated during the initial
procedure. 
• Complicated canal anatomy went undetected in the first procedure.
• The placement of the crown or other restoration was delayed
following the endodontic treatment.
• The restoration did not prevent salivary contamination to
the inside of the tooth.
• In other cases, a new problem can jeopardize a tooth that
was successfully ttreated. For example:
• New decay can expose the root canal filling material to bacteria,
causing a new infection in the tooth.
• A loose, cracked or broken crown or filling can expose the
tooth to new infectiion.
• A tooth sustains a fracture. (BACK
TO TOP)
WHAT
WILL HAPPEN DURING RETREATMENT?
First, the endodontist will discuss your treatment options. If you and
your endodontist choose retreatment, the endodontist will reopen your
tooth to gain access to the root canal filling material. In many cases,
complex restorative materials- crown, post and core material-must be disassembled
and removed to permit acces to the root canals.
After removing
the canal filling the endodontist can clean the canals and carefully examine
the inside of your tooth using magnification and illumination, searching
for any additional canals or unusual anatomy that requires treatment.
Aftter cleaning
the canals, the endodontist will fill and seal the canals and place a
temporary filling in the tooth. If the canals are unusually narrow or
blocked, your endodontist may recommend endodontic surgery. This surgery
involves making an incision to allow the tip of the root to be sealed.
After your
endodontist completes retreatment, you will need to return to your dentist
as soon as possible to have a new crown or other restoration placed on
the tooth to protect and restore it to full function. (BACK
TO TOP)
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