Endodontics

Dental pulp is the soft tissue inside the teeth that consists of connective tissue, blood vessels, and nerve endings. Endodontics is the medical study of this dental pulp, including the diagnosis, prevention, and treatment of diseases and injuries that can occur inside of the teeth. In many cases, endodontists strive to preserve at least part of the dental pulp in a diseased or damaged tooth; when this is not possible, an endodontist will remove the affected dental pulp from the affected tooth and treat the disease, infection, or injury.

Because healthy dental pulp is necessary to keep teeth alive and strong, endodontic treatments are relatively common dental procedures. Probably the most well-known endodontic treatment is the root canal procedure. A root canal procedure most often becomes necessary if the dental pulp becomes infected because of a very deep cavity or a broken filling. In a root canal procedure, the endodontist first anesthetizes the affected area of the mouth, isolating the surgical site from the rest of the mouth with a rubber dam. The endodontist then removes any damaged or infected pulp, cleans and reshapes the root canals inside the tooth, treats the inside of the tooth and remaining pulp to prevent further infection, and then fills and seals the tooth with a restoration, like a filling or a crown. This treatment may be performed in a single visit, or it may require multiple visits, depending on many factors including severity and location of the damaged tooth. Root canal treatment may be performed preventatively, in the case of trauma or injury to a tooth, or therapeutically, when the pulp is known to be diseased or infected. Root canal therapy and other endodontic treatments can help preserve both the function and the appearance of the teeth.

Endodontists also perform surgeries on the roots of the teeth, including removal of damaged portions of the root, removal of the entirety of a root, repair of a damaged or injured root, and removal of fractured teeth or filling material from the root. These surgeries all fall under the umbrella term, “periradicular surgery.” In some cases, these periradicular surgeries may be necessary when a root canal treatment has been ineffective due to certain anatomical features in the mouth that may interfere with the proper cleaning of the interior of the tooth and the root system, while other periradicular surgeries are necessitated by injury or disease. These surgeries are also performed under anesthesia.

In addition to these two broader types of surgeries, endodontists also perform many procedures to protect and preserve the pulp of the teeth, including capping and regenerating the pulp itself. Endodontists use a variety of tools, including magnification devices, to closely and effectively examine and treat the pulpal tissues and interiors of the teeth with focus and precision. Endodontists are highly trained specialists who receive additional qualifications in endodontic treatment, as well as in dental emergency management and trauma response. In the United States, dentists must train for two to three years after completing their dental degree in order to become an accredited endodontist. All postgraduate endodontics programs that are certified by the American Dental Association are two-year programs at a minimum. Once the endodontics program is completed, the dentist sits for an examination sponsored by the American Board of Endodontics. General dentists may be qualified to perform some endodontic treatments, but endodontists are far better qualified in the use of microscopic equipment which allows them to treat the very small openings and crevices inside the teeth, and many endodontists also have advanced training in the use of 3D imaging to assist in diagnosis and treatment of diseases, infections, and injuries of dental pulp and the insides of the teeth.