What is an Endodontist

Endodontics, or "root canal therapy" is a dental specialty recognized by the American Dental Association.

An endodontist is a dentist who has undergone a minimum of 2 years of extra post graduate training. This specialist training allows an Endodontist to:

  1. deal with disease of the dental pulp and supporting structures.
  2. diagnose facial pain and related problems.

Your general dentist sometimes refers patients for consultation when the diagnosis is complicated or when the treatment is more difficult than normal.


About Your Tooth

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Your tooth consists of two main parts: the crown, which is that part of the tooth above the gum and visible in your mouth; and the roots, that part of the tooth that lies beneath the gum and is surrounded by bone. The outside layer of the tooth is composed of a hard layer called Enamel. Enamel is supported by an inner layer called Dentin, which has at its center a soft tissue known as the Pulp. Inside each root is a channel that runs the length of the root. This channel is the root canal and contains the pulp (nerves, blood vessels, and connective tissue), which is often referred to as the “nerve” of the tooth. Once the pulp has been removed, the tooth continues to function normally because the supporting tissues remain intact to nourish it. Although the pulp is important during the development of the tooth, it is not necessary for the function of the tooth.


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Why would I need Endodontic treatment (root canal treatment)

The pulp may be irreversibly damaged by bacteria associated with decay, very deep restorations, fractures, trauma, or periodontal disease. In order to preserve a tooth in which this has occurred, it is necessary to remove the diseased pulp tissue. The procedure is known as endodontic therapy. If pulp inflammation or infection is left untreated, it can cause pain or lead to an abscess. Our goal is to help achieve and maintain a healthy mouth as quickly and as economically as possible.


Signs & Symptoms

Indications for treatment include prolonged sensitivity to heat or cold, discoloration of the tooth, swelling or tenderness of the tooth or adjacent gums. Sometimes there are no symptoms.

There can be times when you have a tooth that is in need of having root canal treatment but you are unaware of this fact because there has been no swelling or pain associated with the tooth.

  1. Problem teeth identified by x-rays.
    dental infection in tooth The nerve tissue inside a tooth can degenerate and die quietly. The death of a tooth's nerve is not always a painful experience. In these instances a tooth's need for root canal treatment can remain undiscovered, even for some years. This is because the virulence of the infection inside the tooth is low and your body’s defensive mechanisms, while not being able to clear up the infection totally, are able to keep it in check.

    Dentists often discover teeth that need root canal treatment during routine x-ray evaluations. In the most obvious of these cases the dental x-ray will show a dark spot at the tip of the tooth’s root. This dark spot indicates that here has been a reduction in the density of the bone surrounding the root’s tip. This bone damage has occurred as a result of the infection that is present inside the tooth.

  2. A persistent or recurring pimple on your gums.
    Sometimes a tooth whose nerve has died will produce a pimple like lesion on a person's gums.

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  4. Exposure of a tooth's nerve.
    There can be times when your dentist will find that your needed dental work has resulted in the exposure of your tooth’s nerve. The term "exposure" used here simply means that your dentist, while performing your dental work, has literally been able to visualize your tooth's nerve tissue. Sometimes a patient will feel a little prick of pain when the exposure occurs. However, many times a patient is totally unaware of the event.

    An exposure can lead to the degeneration of a tooth’s nerve tissue. Your dentist may determine that in your situation it is best to go ahead and perform root canal treatment on the tooth now so to avoid possible problems and complications with the tooth later (such as a painful tooth abscess).

  5. Teeth which have been traumatized in an accident.
    The nerve tissue in teeth which have a history of having been traumatized (such as being bumped in an accident) can deteriorate, thus leading to the need for root canal treatment.

    discolored toothImmediately after the traumatic event the outlook for the nerve’s health can be difficult to predict. Sometimes traumatized teeth do quite well, even for many years.

    It is always possible however that at some point the health of the tooth’s nerve tissue will degenerate and subsequently die (often without symptoms). A tip off that the nerve tissue inside a tooth is undergoing degenerative changes is that the tooth, in comparison to its neighbors, appears darkened.


How can Endodontic Treatment help me?

The endodontist removes the inflamed or infected pulp, carefully cleans and shapes the canal system and then seals the prepared space. Once the treatment is completed, you are instructed to return to your dentist for permanent restoration. The restoration of the tooth is an important part of the treatment because it seals the cleaned canals from the oral environment, protects the tooth and restores it to function.


Will I feel pain during or after the procedure?

Toothache pain is the main reason for patients seeking treatment. Fortunately, modern anesthetics can make the procedure pain free in most cases. Seeking treatment early makes the procedure more comfortable, so don’t wait! When caught early, treatment should feel no different than having a regular filling. For the first few days after treatment, there may be some sensitivity to biting pressure, especially if there was pain or infection before the procedure. Sometimes over-the-counter anti-inflammatory medications (like Advil) are recommended for a day or two. Your dentist can prescribe other medications but they are rarely required. Whenever you have a question, you should feel free to contact Dr. Bath or Dr. Cramer just to ensure that what you are experiencing is within normal limits.


If your confidence needs a little bolstering...

You might be surprised to learn that it is possible that even without anesthetic many teeth needing root canal treatment could be drilled on and you would feel no pain whatsoever. In fact, it is conceivable that in some isolated cases (those where active infection and inflammation are not complicating factors) the entire root canal treatment process could be completed without any anesthetic or pain. Why? Simply because in these cases the nerve tissue in the tooth has died, and dead nerve tissue cannot transmit pain sensations.


Should you expect that your root canal therapy can be performed without the use of an anesthetic?

No, that's not realistic. But if you are unequivocally anticipating that all root canal treatment results in an excruciatingly painful experience then someone has led you astray.


Will your dentist numb up your tooth prior to performing your root canal treatment?

Almost certainly, and especially if you ask them to. Nobody likes a bad time, not you, not your dentist. Just so things go as smoothly as possible and so there are no surprises, most dentists will go ahead and numb up any tooth on which they are performing root canal treatment.

Remember, your dentist is trying to perform treatment that will hopefully last you a lifetime. They need to be able to concentrate on their work and not on how you are reacting to it. By numbing up your tooth both of you will be more at ease and relaxed.


Root canal treatment is a "good thing."

root canal pre operative root canal post operative

There are many reasons why a person should be eager to begin root canal treatment. In those cases where a person’s tooth has been the source of pain or swelling it is the root canal therapy that will initiate the process by which the painful or swollen tooth can be settled down. In some cases just those beginning steps a dentist takes as a part of performing root canal treatment can provide instant relief. Even in those cases where relief is not total the treatment should at least significantly reduce the pain, and also set the stage where the healing process can begin to take place much more rapidly than if root canal treatment had not been initiated.

Even if an episode of pain and swelling had not been experienced, a person should still be eager to initiate their root canal treatment. In the absence of pain and extensive infection the treatment will just go that much more smoothly. You will be relaxed and well rested. Your tooth will respond to the steps of the procedure more predictably. Additionally, any tooth that is in need of treatment, but has not yet received it, is unpredictable. Having your root canal treatment completed sooner rather than later reduces the chances that you will experience a painful tooth flare up (an acute tooth abscess).


Why go to all this trouble?

If you get an infection, say from bacteria entering a cut in your skin, your body will transport white blood cells to and from the area (by way of your blood vessels and lymphatic system) so to combat the bacteria that have caused the infection. In most cases your body will win the battle and kill off the offending bacteria.

The problem with teeth and infections is that once a tooth’s nerve tissue has started to degenerate and bacteria have taken up residence in the tooth’s nerve area, there is no effective way for white blood cells to get at the bacteria to combat them. The dying nerve’s blood and lymphatic vessels used to transport white blood cells will have begun to degenerate too.

The net result of all of this is that the nerve space inside a tooth can provide a nice cozy cave-like location for bacteria to persist because it’s a place where your body’s defense mechanisms can’t get at them effectively. With this scenario, at best your body will only be able to cordon off the infection caused by the bacteria living inside your tooth. At worst, this bacterial infection will overwhelm your body’s defense mechanisms and pain and swelling will ensue (an acute tooth abscess).

The idea behind having root canal treatment is that it provides the bulk of the clean up work for your body. It removes bacteria and tissue irritants that are present inside the tooth, especially those in the locations where your body would have the most trouble combating them. As an end result, once root canal treatment has been completed it provides your body with an environment where its mechanisms are able to clear away any residual bacteria and tissue irritants that may still be present, thus allowing complete healing (resolution of the inflammation) to occur.


Should you chew on a tooth that has just had root canal treatment?

It is usually best to exercise caution with a tooth which is undergoing root canal treatment or if treatment has just been completed. You should minimize chewing on the tooth to prevent the temporary filling from coming out, as that will cause the root canal to become recontaminated by the oral bacteria. Also you risk fracturing your tooth which could make it unrestorable.


What additional dental work is needed for a tooth that has had root canal treatment?

After your tooth’s root canal treatment has been completed your dentist will need to discuss with you what additional dental work will be required so as to make the tooth fully functional again.

Many times a tooth that has required root canal treatment is one that has a big filling or else has large portions missing due to decay or breakage. These teeth, in this state, are not as sturdy as they once were and for this reason it is commonplace that a dentist will recommend that a tooth that has had root canal treatment should be restored with either a dental crown or else a dental crown in combination with a dental post. Of course your dentist will need to determine what treatment is appropriate in your situation.

The dental restoration that is chosen for rebuilding a tooth that has had root canal treatment provides another function also. It provides a seal protecting the interior of the tooth. This barrier helps to prevent seepage of bacteria from the oral cavity into the interior aspects of the tooth. Your dentist will need to advise you as to what they think is best for your situation but, in general, the sooner arrangements can be made to have the permanent dental restoration placed (thus creating the best possible seal) the better.


Are there any alternatives to having root canal treatment?

If root canal therapy is indicated for a tooth there really is no alternative treatment other than an extraction. Root canal treatment deals with the inner aspects of a tooth unlike any other dental procedure. If it is required, no other dental work can suffice. If root canal treatment will not be a possibility for a tooth then it should be extracted.


Should you have an extraction rather than root canal treatment?

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The cost or simplicity of a tooth extraction might seem attractive in comparison to having root canal treatment performed. But this solution might not be the easiest or least expensive treatment choice in the long run. There is no substitute for your natural dentition. A replacement for an extracted tooth is more expensive than RCT.

When a tooth is missing its neighboring teeth will tend to shift, sometimes significantly. This in turn can have a major impact on your dental health. Even losing a single tooth can lead to problems with your chewing ability or your jaw joint. Teeth that have shifted because of a lost neighboring tooth can be more likely to have dental problems themselves.

So to avoid these complications, in most cases your dentist will probably recommend to you that you have any tooth that has been extracted replaced. Replacing a tooth that has been extracted with an artificial one (using either a dental bridge, removable partial, or implant) can easily cost much more than ideal treatment for your tooth beginning with root canal therapy.

Don’t make the decision to have a tooth extracted quickly. Make sure that you and your dentist have discussed and explored all of the benefits and detriments of all of the treatment options that are available to you before you make a decision.


Timing your root canal treatment.

In those cases where root canal therapy is needed it is always best to go ahead and make plans to have the treatment performed sooner rather than later. Sometimes, however, root canal treatment must be delayed because of scheduling conflicts, the need for other dental work, or financial considerations. Delays such as these can usually be managed, at least to some degree. Often a dentist can perform the initial aspects of root canal treatment, the ones that can make it so your tooth feels better, and then schedule an appointment for you at a later date for the completion of the work.

You should not make a decision to delay root canal treatment unilaterally but instead discuss matters with your dentist. Any tooth that is in need of root canal treatment, but has not yet received it, is not predictable. A tooth could remain asymptomatic for an indefinite period of time or, at the other extreme, could abscess and cause you pain and produce swelling. Even in those cases where a tooth remains asymptomatic, the infection associated with the tooth could cause damage to the bone that surrounds it. Discuss matters with your dentist. Let them explain to you what they would consider a reasonable time frame for the treatment of your tooth.


What can cause root canal treatment to fail?

Previously we described some of the goals of root canal treatment:

  • It removes bacteria, toxins, unhealthy nerve tissue, and irritants that are present in a tooth.
  • It fills in and seals off the nerve space inside a tooth so physically there is no location where bacteria and tissue irritants can exist and be out of effective reach of your body’s defense mechanisms.

If after root canal treatment has been performed a tooth still harbors bacteria or irritants which keep the tissues surrounding the root of the tooth from being healthy (inflamed), then the treatment has not been successful. Some signs of failed root canal treatment can include tooth pain (ranging from very mild to extreme) and tenderness or swelling in the gums in the area near the tooth (ranging from very slight to pronounced).

These signs can either:

  • Persist from the time of the root canal treatment.
  • Be transient (varying week to week or month to month).
  • Appear even though the tooth has been asymptomatic for years. In other cases a tooth may have been, and continues to be, without symptoms but the tissues surrounding the tooth are identified as having the presence of persistent inflammation by way of an x-ray examination by a dentist.

In general, the presence of problems indicates that, despite your dentist’s best efforts to clean and seal up the tooth, bacteria or tissue irritants have found some location in which to persist beyond the reach of your body’s defense mechanisms. As a result there is persistent inflammation in the tissues that surround the tooth’s root. Here are some of the reasons why this scenario might occur:

  • branch of a root canalThe shape of any tooth’s root canals can vary greatly. As an example, there can be root canals that have branches or forks in them. This branching can be hard for a dentist to detect and, as a result, one branch may be cleansed and sealed while the other branch is left untreated.
  • A tooth may have more root canals than is normally anticipated. In these cases, especially when the unexpected tooth canals are very tiny, your dentist may not discover them and as a result not clean and seal them.
  • There is a crack in the root of the tooth. These cracks can be very small or else in a location in which your dentist cannot detect them.
  • The tooth has a defective or inadequate dental restoration and as a result bacteria have been able to seep past this restoration on into the inner aspects of the tooth and recontaminate that area originally cleansed and sealed off by the root canal treatment.
  • Even though a tooth has been expertly cleaned and sealed, with the passage of time the integrity of this seal can degrade, thus allowing bacteria recontaminate the interior aspects of the tooth.

Your dentist will have to evaluate your specific situation and advise you as to if they think the retreatment of your tooth is likely to resolve your problems. They may offer to perform this treatment themselves or they may feel that the expertise of an endodontist is warranted for your case. If retreatment is not a possibility then the tooth should be extracted.


Other problems that can occur with teeth that have had root canal treatment:

It is possible that your tooth’s root canal treatment has been successful but the tooth itself has experienced problems which have compromised it severely.

The tooth has broken in a fashion that cannot be repaired. Teeth that have had root canal treatment are seldom as structurally strong as they once were. These teeth often require a dental post and crown so to adequately strengthen and protect them.

The tooth has extensive decay or gum disease. Teeth that have had root canal treatment are not impervious to tooth decay and gum disease, both of which can lead to the loss of the tooth. You must brush and floss your teeth effectively so to prevent the occurrence of these problems.


How long does root canal treatment take?

The total amount of appointment time that will be required for treatment depends on a lot of factors including number of canals, complexity of treatment, patient cooperation, calcified canals, whether it is an initial treatment or retreatment or whether posts or silver points have to be removed. Most of the time treatment is completed in one visit of 90 minutes unless the endodontist thinks that for optimum treatment multiple visits are necessary.


3d dental diagnostics3D Diagnostics

In an ongoing effort to provide you with the best care possible, our practice utilizes
Cone Beam CT high-resolution cone beam computed tomography (CBCT). This low radiation, high-resolution 3D imaging technology assists Dr. Bath in viewing your teeth more clearly during diagnosis and treatment.


Endodontic Microsurgery

fracture 5 canals

The field of endodontics has undergone radical change in the last decade. The evolution of the surgical endodontic microscope combined with new techniques using superior materials and instruments has enabled the endodontic surgeon to dramatically improve the prognosis of procedures such as apicoectomy, internal and external resorption repair, as well as the repair of iatrogenic and pathological perforations.

The significantly enhanced illumination and magnification of the operating microscope allows superior visualization of root surfaces. This allows Drs. Bath and Cramer to see fractures, missed and lateral canals, isthmuses connecting adjacent canals, perforations and resorptive defects. Retrocavity preparations can be closely inspected to insure accurate and complete placement of filling material. More thorough debridement of infected radicular tissue is possible. All procedures from beginning to end are done under the Zeiss Pro Ergo operating microscope in our practice.

  • Dr. Bath and Dr. Cramer specialize in all phases of conventional and surgical microendodontics maximizing treatment options and outcomes for patients.
  • The ability to provide both conventional and surgical approaches to teeth allows our doctors to select the best treatment plan, and sometimes use a combined approach to resolve a persistent infection.
  • Our doctors have extremely high long-term success rates for apical surgery - even when previous surgery has failed.

Ultrasonics enable the endodontic surgeon to prepare retrocavities that are parallel to the long axis of the root while reducing the need for a long bevel and minimizing bone removal. Micro-instrumentation has evolved in the last decade to facilitate retropreparation under the microscope. These include microexplorers, diamond mirrors, micropluggers, microcarriers and ultrasonic tips for retropreparation and obturation. Mineral Trioxide Aggregate (MTA) is the material of choice for retrofills, perforation repair and resorption repairs. MTA displays superior marginal seal and biocompatibility when compared to root-end fillings of SuperEBA, IRM and amalgam. It also induces cementum formation on its surface and appears to stimulate more rapid bone healing in the surgical site.

At Kennestone Endodontics Dr. Bath and Dr. Cramer, supported by a highly trained and experienced surgical team, are committed to providing patients with the most advanced microendodontics care available. Their assistants are highly skilled and trained to assist under the operating microscope using the assistants' scope.


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