You have been referred to an Endodontist, a dentist who specializes in endodontic (root canal) therapy. Endodontics is a highly specialized type of dental care developed to save teeth. We, at Endodontic Associates, are dedicated to providing you with the highest quality of endodontic care. The latest proven clinical techniques are used with skill and precision. We understand that you may be apprehensive about your endodontic treatment. We will make every effort to ensure that your visit is as comfortable as possible and becomes a good dental experience. We seek to create an atmosphere of understanding, open communications and mutual respect. Please do not hesitate to ask questions or offer any suggestions.

We are dedicated to the advancement of materials and techniques, the skilled delivery of endodontic care, and the belief and practice that root canals can be performed painlessly in a manner that can alleviate your anxiety and apprehension.

Drs. Alan and Leonard Sedell and the staff of Endodontic Associates appreciate the trust you have placed in us by selecting our office for your root canal related needs.

WHAT IS ENDODONTIC (ROOT CANAL) TREATMENT?

Endodontics means inside (endo) the tooth (dontia). The dental pulp is the tissue (composed of nerves, blood vessels, etc.) that is contained inside the tooth. Its primary function in life is first, the development of the tooth, then secondly, the sensation or feeling in the tooth. The specialty of endodontics is devoted to the biology, physiology, pathology and treatment of the human dental pulp.

• The reason you need a root canal can be placed into two broad categories of pathology:

• Vital Pulp Pathology
• Non-vital Pulp Pathology

• The most common reasons a tooth develops trouble or disease are:

• Dental decay (large deep cavities)
• Accumulative effects of placing several fillings over a number of years
• Restorative insults to teeth (drilling, heat and drying)
• Traumatic injury (accident or fall)

For vital pathology, the dental pulp and nerves have become diseased and inflamed yet the tissue is still alive and vital. The damage (most often indicated by unusual severe sensitivity to temperature changes or a severe toothache) is so advanced that the condition of the nerve tissue is not expected to get better. This irreversible problem requires removal of the nerve, meaning a root canal treatment. Many times only your symptoms reveal the source of the problem as it is too early in the process for anything to show up on a dental x-ray.

For the non-vital pathology, the dental pulp and nerve tissue have already become dead tissue. This tooth will no longer respond to stimuli such as temperature changes and sweets. The dead and dying contents of the inside of the tooth affect the bone and cause disease outside the tooth at the tip of the root(s). Symptoms most commonly associated with non-vital pathology are a tooth that hurts to bite on, becomes sore to touch or push on, and in some stages causes facial swelling.. An x-ray will help in the diagnosis of this problem, but only when the disease is so advanced as to cause an abscess of the bone around the end of the root.

The treatment of either of those two types of disease is the same in routine cases. The treatment options are root canal therapy or extraction of the offending tooth. Root canal therapy is the treatment of the inside of the tooth so that the source of the infection and/or the inflammation causing the dental pain can be removed and then the tooth is protected from the problem recurring in the future.

The goal of root canal therapy is to create an environment inside the tooth so that the disease can heal, and remain symptom free, allowing you to keep your tooth for many years to come. This environment should be as clean and sterile as possible (all tissue debris and bacteria removed all the way to the end of the root), and the space must then be permanently filled with an inert material to maintain this clean, sealed space.

ARE ADDITIONAL X-RAYS NEEDED?

Usually at least three or four x-rays are required during treatment to insure that every step is performed correctly. We are concerned about reducing the radiation exposure to our patients. Our office takes computerized dental radiographs. This new x-ray technique reduces your radiation exposure by 90%. Since the x-ray image is viewed on a computer screen, you can more easily see and understand the problem associated with your tooth, and the steps in providing therapy. This technology also saves time because the x-ray image is seen immediately without having to wait for it to be manually or machine developed.

WHAT STEPS ARE INVOLVED IN ROOT CANAL THERAPY?

• Root Canal Therapy Involves:

Diagnosis - A series of tests (only one of which is an x-ray) that relates your chief complaint of pain to a specific tooth requiring treatment.

Access - A hole made in the back side or top of the tooth to gain entry into the root canal system so a root canal can be performed.

Instrumentation (Cleaning and Shaping of the root canal space) - The preparation of the root canal space is performed to the end of each root. Files (small, metal wire like instruments) and irrigation (continuous flushing) are used to remove tissue, debris, and bacteria contamination.

Filling the root canal space - This step involves placing a rubber filling material (gutta percha) along with a sealer cement to seal the canal (s) and prevent future contamination.

Recall checkup - An evaluation 6 months to 1 year after an endodontic procedure is performed to check the healing.

Just described is the simplest and most routinely performed endodontic procedure. Other procedures commonly advised are root canal retreatments and periapical surgery. Both are generally performed on teeth that have had a previous root canal. The tooth either did not respond to the previous treatment or has redeveloped a bony infection at the tip of the root. This tooth may also have had a post and crown placed on it. More information is available on these treatments at the following area of this web page: Retreatment and Surgical Procedures.

IS ROOT CANAL THERAPY FOR EVERYONE?

Yes! Everyone who wants to save her or his teeth (having been diagnosed as having a problem needing root canal therapy) can benefit and expect to maintain the tooth in its healthiest state, once the root canal is completed. There is no limitation for age or state of health. Endodontic therapy is an elective procedure for those people who want to invest their time and money in keeping their teeth.

The single limitation for root canal therapy for any given tooth is the final restorability of the tooth by the general dentist. Simply, restorability means confirming there is enough tooth structure to save and ultimately restore the tooth to function. Once treated through root canal therapy and appropriately restored, a tooth (with a previous abscess or infected dental pulp) can function normally for a very long time. Overall. 93% of teeth receiving root canal therapy have successful outcomes. Your general dentist can best determine the final permanent restoration for the root canal treated tooth. If a root canal ever does fail, consider that there are still treatment options with very good success rates that can save your tooth, root canal retreatment and endodontic surgery.

Clearly root canals ARE NOT for everyone. Everyone who has been told they need a root canal has the option of having the tooth extracted. If you have not in the past, or do not intend in the future, to make a concerted effort to be a dental wise patient who wants to keep the only set of teeth you will ever have for the remainder of your lifetime, and are not serious about routine dental care, or are not committed to having the tooth properly restored after the root canal, and you do not mind the thought of losing a tooth (or another tooth), then endodontic therapy may not be the treatment of choice for you.

CHOOSING A GENERAL DENTIST OR ENDODONTIST?

The vast majority of root canals in the United States and worldwide are performed by general dentists who do not have advanced specialized training in performing root canals. Remember the four main steps in root canal therapy are diagnosis, access, cleaning & shaping, and filling. You are looking for an individual who is capable of doing these steps as proficiently as possible, keeping the treatment comfortable (painless), and being able to manage unforeseen problems that may arise either during or after treatment. There is nothing routine about doing a root canal. Every tooth is unique just as every person is unique. Most certainly, there is a wide variable in the skill, experience, and expertise of dental providers. It may be more true of root canals than any other dental procedure. Complexity is an important factor affecting the performance of successful root canal treatment

One thing is certain, competent dentistry costs money, whether performed by a general dentist or an endodontic specialist. Like everything else of consequence in life things of value, like dental services, are expensive but worthwhile.

The experience as a general dentist may not always be a substitute for the training and perspective of years of postgraduate education and specialized practice .

DO NOT:

1. Allow anyone to do a root canal who is not confident in providing you good profound local anesthesia. Today there is no reason for a root canal to hurt while you are being treated. Continued treatment by anyone not willing to make the procedure painless and get you numb must be addressed immediately. You are the patient, you can stop the procedure by informing the dentist that you are feeling something unpleasant.

2. Allow a root canal to be performed without the use of a rubber dam. The standard of care for root canal therapy requires the use of a rubber dam to isolate the tooth and protect you, the patient, during the procedure. There are many methods, materials, supplies, and accepted steps for doing root canals. Dental schools and Endodontic departments worldwide have not agreed on the best single method of doing a root canal, but they all agree on the necessary use of the rubber dam. Anything less is considered malpractice.

3. Allow a root canal to be performed by someone who suggests a long waiting period (2 -6 months or longer) before the tooth receives the permanent crown or some type of protective restoration. Root canal treated teeth should be permanently restored as soon the initial tenderness of the procedure is healed, the tooth is comfortable to bite on, and no drainage or swelling of the gum is present. Long waiting periods suggest a low confidence in the treatment, and question the success rate by the practitioner. Of more concern is that longer waiting periods increase the chances of the tooth fracturing off, chipping, loosing a filling, and contamination of the root canal space. A tooth worth the investment for a root canal must have the permanent crown or restoration placed as soon as possible to ultimately protect the tooth in the future.

4. Hesitate to request a referral for a second opinion or treatment. This is your assurance that the root canal treatment advised is appropriate therapy and has a favorable prognosis for success. After all, you deserve the best, and have the right to know your options. The tooth proposed for extraction with the old root canal may be saved, by an endodontist who treats this type of case on a regular basis.

TECHNOLOGY IMPROVING ROOT CANALS

The ways root canals and endodontic therapy can be performed today is vastly different than those done four years ago, not to mention a decade ago. The potential level for quality care has increased dramatically. These improvements are not without the cost of new and more expensive instruments (six times more expensive), the need for significant amounts of increased training (continuing education), and (most importantly) the requirement that old philosophies be questioned and habitual ways of providing treatment be changed. To you as a patient, if your dentist says there is nothing new in doing root canals, consider a referral for a second opinion.

• Computer generated x-rays (Digital X-RAY system, such as Schick)
Dental x-rays can now be taken with sensors and seen immediately on the computer screen, instead of film that needs to be developed. The improvement to you is less radiation, probably in the range of 80% -90% less without loss of diagnostic information. Because three to five x-rays are needed during the treatment of a tooth, this increases the safety of dental radiation even further.

• Nickel Titanium Files
Files are used to clean and enlarge (essentially bore out) the space inside the tooth prior to filling. Until now files were made of stainless steel, which inherently had the problems of breaking and limiting the amount a canal could be safely enlarged (yet it remained dirty). Both problems are caused by curved areas of the root. Nickel Titanium is 500 times more flexible thereby overcoming the problems of stiff stainless steel files..

• Canal Dressings (though rarely required)
No more smell or medicine taste, yet better protection and sterilization of the root canal space in between appointments. Calcium hydroxide is placed into the canal as a paste or powder.

• Ultrasonic hand pieces
A device used for cleaning and preparation of a root canal with vibration. It has also revolutionized endodontic (root end) surgery, making surgical correction of root canal problems safer, easier, and more accessible in any portion of the mouth. The result is that molars (as well as front teeth and premolars) are frequently good candidates to be saved through surgery instead of having to have the tooth extracted.

• Microscopes
Yes, microscopes and the need for magnification and supplemental lighting. Probably not essential for most routine root canal cases, but a great benefit for complex root canal therapy cases, teeth with difficult access, searching for difficult or nearly impossible to find canal openings, removing broken posts or instruments, and an absolute requirement for endodontic root end surgery. We have performed over 4000 microscopic procedures and are experienced in the utilization of the latest technologies for performing complicated, technologically advanced procedures.