Endodontics

Endodontics is the branch of dentistry that focuses on the treatment of the soft inner tissue of teeth, known as the pulp and other tissues surrounding the roots of a tooth. The term endodontics is taken from the Greek words endo-, meaning “inside,” and -odont, meaning “tooth.” The primary endodontic procedure is endodontic therapy, which is more commonly known as a root canal. A root canal is typically performed to treat an infection in the pulp to save the affected tooth before extraction becomes necessary. Prior to the emergence of endodontics around the mid-twentieth century, extraction was the most common treatment for endodontic disease. Because endodontics is considered a specialized dental field, professional endodontists are required to complete four years of dental school and two or more years of specialty training in endodontics. To earn board certification, an endodontist must also pass three qualifying examinations offered by the American Board of Endodontics.

Background

In addition to general dentistry, the American Dental Association (ADA) recognizes twelve separate dental specialties. These include orthodontics and dentofacial orthopedics, periodontics, prosthodontics, endodontics, oral and maxillofacial pathology, oral and maxillofacial radiology, oral and maxillofacial surgery, pediatric dentistry, dental public health, oral medicine, dental anesthesiology, and orofacial pain. Each of these branches focuses on specific parts of the mouth, functionalities of the orofacial region, or otherwise specialized dental concerns.

Orthodontics and dentofacial orthopedics are a combined branch of dentistry concerned with the alignment of teeth and dental arches. This field is most commonly associated with the use of braces or other methods of straightening teeth.

The field of periodontics focuses on the supporting and surrounding tissues of the teeth. Periodontists are primarily concerned with treating these tissues when inflammatory diseases affecting the gums occur and preventing such diseases from becoming a problem in the first place.

Prosthodontics centers on the creation and installation of artificial replacements for teeth and other parts of the mouth. Typical forms of prosthodontic treatment include the placement of dentures, crowns, and bridges.

Endodontics is the branch of dentistry that focuses on the prevention and treatment of diseases that affect the soft tissue dental pulp within each tooth. They closely study the pathology, regeneration, morphology, biology, and physiology of the patient’s dental pulp.

Oral and maxillofacial pathology is a dental field that is focused on the treatment of various diseases of the mouth, jaws, and other oral structures and the pathology, or essential nature, of these diseases. This branch of dentistry is closely related to the fields of oral and maxillofacial radiology and oral and maxillofacial surgery. While the former is mainly concerned with the diagnosis of oral diseases through different imaging techniques, the latter is focused on the surgical procedures commonly used to treat these diseases.

Pediatric dentistry is concerned with the treatment of young dental patients, ranging from infants to adolescents. As such, this field is primarily focused on the specific dental issues and needs associated with oral development during childhood.

Dental public health is a broader branch of dentistry concerned with preventing and controlling the spread of dental diseases and promoting good dental health on the community level. Dental public health specialists often work to develop policies and programs aimed at educating the public about dental health.

Oral medicine focuses on providing oral healthcare for patients with complex medical conditions, as well as diagnosing and treating medically related diseases, disorders, and conditions that affect the oral and maxillofacial region.

Dental anesthesiology is focused on ensuring patient safety and improving access to care for all dental patients, including young children and those with special healthcare needs. Dental anesthesiologists monitor patients and manage their pain, anxiety, and overall health during diagnostic and surgical procedures through the use of local anesthesia, sedation, and general anesthesia.

Orofacial pain is a dental specialty focused on the diagnosis, management, and treatment of pain disorders affecting the head, neck, face, mouth, and jaw.

Overview

The field of endodontics consists of three primary forms of treatment: nonsurgical endodontic treatment, endodontic retreatment, and endodontic surgery, with regenerative endodontic procedures representing an emerging area of treatment. The most common of these is nonsurgical endodontic treatment, otherwise known as root canal. A root canal is a procedure in which an infection in the soft tissue within a tooth is treated through the complete removal of the infected pulp itself.

There are several steps in a typical root canal. Once the patient has been put under local anesthesia to minimize pain, the endodontist removes the pulp from the pulp chamber and the root canal itself. The pulp chamber is the hollow chamber inside the tooth where most of the pulp is found. The root canal is the narrowing part of the pulp chamber inside the tooth near its root or roots. To remove the pulp, the endodontist drills a small hole through the crown of the tooth, through which they extract dead or infected tissue with tiny files. When the pulp is fully removed, the endodontist then proceeds to clean, decontaminate, and reshape the hollow interior of the tooth. Next, the endodontist fills the tooth with a rubber-like material and seals it with adhesive cement. Finally, a crown or filling is applied to give the tooth added stability. While many root canals are performed during a single visit, two or more visits may be required if the affected tooth presents with curved canals, multiple canals, or especially large infections. Once the procedure is completed, pain is relieved and the patient’s tooth is preserved.

Endodontic retreatment refers to any treatment undertaken to correct problems with the original root canal procedure or to treat problems with the affected tooth, such as decay, damage, or infection. In most cases, the endodontist removes the original filling, cleans out the interior of the tooth again, and refills and seals the tooth.

In the event that an endodontist locates an issue with the root structure or root canals of a tooth that could cause endodontic retreatment to fail, they may recommend endodontic surgery. Endodontic surgery includes a number of different procedures used to diagnose and treat problems at the tooth root. In some cases, the endodontist may remove calcium deposits that could interfere with normal endodontic treatment from inside the root canal. In other cases, they may make an incision in the gum and peel back the tissue to look for a small fracture or fractures that may be causing the patient’s pain. An apicoectomy, or a surgery to trim and smooth the root tip or remove infected tissue adjacent to the tip, might also be necessary.

Most teeth in need of treatment for a pulp infection can be repaired through some form of endodontic procedure, but there are certain circumstances under which this may not be possible. This is often true of teeth with inaccessible root canals due to structural irregularity, teeth with severely fractured roots, or teeth that are extremely loose because of bone loss. In these cases, extraction is the only viable approach to treatment.

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