EndoAsleep

What are Endodontists and what do they do?

Endodontists are dentists who specialize in maintaining teeth through endodontic therapy -- procedures involving the soft inner tissue of the teeth, called the pulp. The word "endodontic" comes from "endo" meaning inside and "odont" meaning tooth. Like many medical terms, it's Greek. All dentists are trained in diagnosis and endodontic therapy, however, some teeth can be especially difficult to diagnose and treat. That’s why you may have been referred to an endodontic specialist.

In addition to dental school, endodontists receive two or more years of advanced education in this kind of treatment. They study root canal techniques and procedures in greater depth, for diagnosis and treatment of more difficult cases. For this reason, many dentists choose to refer their patients to endodontists.

What is Root Canal Treatment?

Following examination of the patient’s mouth, assessment of radiographs (x-rays), a discussion of the options available to the patient, and informed consent, endodontic treatment (root canal therapy) is generally performed in one or two visits and involves the following steps:

1. Local anaesthetic (“dental freezing”) is administered. The tooth is then tested again to make sure that the freezing is working before the procedure is started. After the tooth is anaesthetized, a rubber dam is placed over the area with a ring in order to isolate the tooth and keep it clean and free of saliva during the procedure.

2. A small opening is made into the pulp chamber. It is very similar to having a deep filling performed. 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 space is filled with biocompatible materials. In most cases, special rubber (gutta percha) and cement are used. The gutta-percha and the adhesive cement are used to ensure complete sealing of the root canals. A spacer is placed and then 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 at EndoAsleep, 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. It is generally recommended that the permanent restoration be placed as soon as possible. This is to minimize the chance of bacteria getting back into the tooth and re-contaminating the now clean root canal space.

Diagnosis and Treatment of Pain

Oral pain such as toothaches or cracked / fractured teeth can often be difficult to pinpoint. Because of the vast network of nerves in the mouth, the pain of a damaged or diseased tooth often is felt in another tooth and/or in the head, neck, or ear. An endodontist is a specialist in diagnosing and treating this type of pain.

Treatment of Traumatic Injuries

Pulp damage is sometimes caused by a blow to the mouth, and the endodontist specializes in treating these traumatic injuries. For example, a blow to a child's permanent tooth that is not fully developed can cause the root to stop growing. A procedure called apexification stimulates bone to be deposited at the end of the root which makes it possible to then save the tooth through a root canal procedure. An endodontist is specially trained in procedures for replanting teeth that have been knocked out of their sockets.

Why is root canal treatment required?

There are several scenarios in which the tooth pulp can become diseased. The disease process is generally related to germs (ie. an INFECTION) or due to tissue irritation (INFLAMMATION).

Infectious disease: The mouth is full of bacteria (germs). Through life, these germs attack the teeth. Certain types of oral bacteria produce acid. The acid that is produced burns a hole in the tooth. Commonly, these holes are referred to in more technical language such as “cavities”, “caries”, or “tooth decay”. Sometimes the infection penetrates so deeply into the tooth that the tooth pulp is breached. Other scenarios in which bacteria may penetrate into the tooth are cracks or leaky restorations.

The presence of bacteria in the root canal system may lead to a toothache (due to the germs irritating the pulpal tissues) or it may lead to a silent death of the tooth.

Toothache:

Exaggerated pain to cold/hot and throbbing or spontaneous pain may be the result of inflammation in the tooth. A good example of the irritation of inflamed tissue elsewhere in the body occurs when one has sunburn and then takes a hot shower. When the skin has been irritated by the sun (ie. is inflamed), a relatively minor stimulus such as hot water is suddenly quite painful. The same holds true in the tooth. When the pulp tissue is inflamed, normal stimulation such as room temperature foods and cold air are painful.

The presence of spontaneous or lingering pain indicates that the pulp is diseased and not likely to recover on its own. One option is to extract the tooth. The other option is to perform root canal therapy (see below).

Although a primary reason for inflammation is bacterial invasion, other reasons can include multiple procedures to the tooth such as large fillings or crown preparations.

Infection:

Sometimes the tooth dies silently. Once the pulp tissue is dead, there is no longer blood flow into the root canal space. Therefore, the body’s immune system is not able to protect the tooth against bacterial invasion. When bacteria overwhelm the root canal space, they can then influence the bone around the body. This may result in irritation to the bone surrounding the tooth, or can lead to infection in the body or soft tissues of the mouth. Changes to the bone are generally diagnosed by taking radiographs (x-rays).

Symptoms of infected teeth include no sensation of cold or hot, but pain to biting or chewing. Sometimes the presence of infection such as an abscess leads to the diagnosis of a root canal infection.

Goals of Root Canal Therapy

Maintain the tooth in the mouth
Prevent or eliminate symptoms from the tooth
Prevent or control the germs present in the tooth
Prevent or eliminate inflammation and or infection in the bone surrounding the tooth

Patients often ask if the tooth is “dead”. While there is in fact no living tissue inside the tooth, the tooth still sits in a living socket composed of blood vessels, bone, and ligament.

Will I need to return to your office for Additional Visits?

Once endodontic therapy is completed your tooth should be examined periodically, usually every 6 - 12 months. This allows us to make sure the tooth has healed or is healing properly. You will be contacted if or when we feel it is appropriate to reevaluate the area. Since an abscess may take 2 years to heal, our office might wish to reevaluate the tooth for at least 2 years.

Retreatment

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 crown or other restoration was not placed soon enough after the procedure.
The restoration did not prevent saliva from contaminating the inside of the tooth.

In other cases, a new problem can jeopardize a tooth that was successfully treated. 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 infection.

Following examination of the patient’s mouth, assessment of radiographs (x-rays), a discussion of the options available to the patient, and informed consent, endodontic retreatment (root canal therapy) is generally performed in one or two visits and involves the following steps:

1) Local anaesthetic (“dental freezing”) is administered. The tooth is then tested again to make sure that the freezing is working before the procedure is started. After the tooth is anaesthetized, a rubber dam is placed over the area with a ring in order to isolate the tooth and keep it clean and free of saliva during the procedure. In many cases, complex restorative materials - crown, post, and core material - must be disassembled and removed to permit access to the root canals.

2) After removing the canal filling, the tooth is carefully examined to identify additional canals or unusual anatomy that requires treatment. The internal anatomy of the tooth is cleaned using specialized instruments and various medications.

3) After cleaning the canal(s), the canal(s) are sealed with gutta percha and sealer and a temporary filling is placed in the tooth.

After the final visit at EndoAsleep, 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. It is generally recommended that the permanent restoration be placed as soon as possible. This is to minimize the chance of bacteria getting back into the tooth and re-contaminating the now clean root canal space.

Postoperative Instructions

Following root canal therapy or retreatment:

Swelling and Discomfort:

Some swelling and minor discomfort is to be expected following treatment. Discomfort may be experienced in the jaw joint region from having had your mouth open during the procedure. The site of injection of the local anaesthetic and the gums around the tooth may also be tender. Finally, the tooth may be sensitive to touch or to pressure. This may take up to seven days to resolve. These symptoms may be minimized by following the recommendations for pain medication and antibiotics.

You may still be frozen when you leave the office. Please avoid hot foods until the freezing has worn off so as to avoid burning your mouth.

Permanent Restoration:

Your tooth has a temporary filling in place. It is important that you return to your dentist as soon as possible to have the tooth restored permanently. Ideally, permanent restoration should occur within two weeks following completion of root canal treatment.

Your tooth is fragile! Please be careful. Your jaw muscles can generate enough force to damage the tooth. Please avoid chewing in the area of the root canal-treated tooth until you have seen your dentist.

Pain Control:

It is better to avoid pain rather than to deal with it once it has presented. Your doctor may recommend that you take pain medications prior to the freezing wearing off. Various medications are used to control pain. Options for non-prescription pain medications for adults include:

Ibuprofen 600 mg every six hours (three 200 mg Advil or generic equivalent)
Acetaminophen 1000 mg every four to six hours (two extra strength Tylenol)

Please note: Non prescription pain medication may have serious side effects. Take only the pain medication recommended by your doctor. If you have concerns about pain control, please call us immediately at 416-223-1771.

Apical Surgery

What is apical surgery?

Although there are many surgical procedures that can be performed to save a tooth, apicoectomy or root-end resection is most commonly performed. Following examination of the patient’s mouth, assessment of radiographs (x-rays), a discussion of the options available to the patient, and informed consent, apicoectomy is performed in a single session and involves the following steps:

1. Local anaesthetic is administered. The site is checked for profound anaesthesia prior to starting the procedure. The gum tissue is then raised near the tooth to view the underlying bone.

2. The area of inflammation is identified. The inflamed tissue is then removed. A sample may be collected for biopsy.

3. Often, the tip of the root of the tooth is removed and a small retrofilling is placed. This is done to seal the tooth at the tip and to contain the infection.

4. Small sutures (“stitches”) are placed and the patient is given instructions and prescriptions.

5. Generally, patients are seen twice more in the office. There is a short follow up appointment one week after the procedure to remove the sutures and to assess the soft tissue healing. A second appointment is generally six months or one year later. Radiographs are taken to assess bony healing.

Other surgical procedures performed in the office include removal of a cracked or diseased root (root amputation) and in very complex cases, a procedure called intentional replantation may be performed. In this procedure, a tooth is extracted, treated with an endodontic procedure while it is out of the mouth, and then replaced in its socket.