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Dr. Thomas Vokal DDS, MS
What is Endodontics?
What is an Endodontist?

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.


Endodontic treatment is necessary when the pulp becomes inflamed or infected. The most common reasons for inflammation or infection are deep cavities (caries), repeated dental procedures, cracks or chips. Trauma can also cause inflamation and often show up as discoloration of the tooth. If pulp inflammation or infection is left untreated, it could possibly lead to an abscess which may or may not be accompanied by 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.


Indications for treatment include prolonged sensitivity to heat or cold, discoloration of the tooth, and tenderness of the tooth or adjacent gums. Additional symptoms include constant and severe pain and/or pressure, swelling of the gum and/or sensitivity to touch. Sometimes there are no symptoms and your dentist may identify an endodontic concern through x-rays or the radiographic examination. 


Endodontic treatment can often be performed in one or two visits and involves the following steps:


1. A local anesthetic will be administered to "numb" the tooth. After the tooth is numb, the endodontist places a small protective sheet called a “dental dam” over the area to isolate the tooth and keep it clean and free of saliva during the procedure.


Abscessed Tooth


2. The endodontist makes an opening in the crown of the tooth. Very small instruments/files are used to clean the pulp from the pulp chamber and to shape the canal spaces for filling.


Root Canal Access Opening  


3. After the space is cleaned and shaped, the endodontist fills the root canals with a biocompatible material, usually a rubber-like material called gutta-percha. The gutta-percha is placed with an adhesive cement to ensure complete sealing of the root canals. In most cases, a TEMPORARY FILLING is placed to close the opening. The TEMPORARY FILLING will be removed by your dentist before the tooth is permanently restored.


Root Canal Filling


4. After the final visit with your endodontist, 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.


Healed Tooth Following Root Canal Treatment


Occasionally a tooth that has undergone endodontic, treatment fails to heal or pain continues despite therapy. Although rare, sometimes a tooth initially responds to root canal therapy but becomes painful or diseased months or years later. When either of these situations occur, the tooth often can be maintained with a second endodontic treatment.




Generally a root canal is all that is needed to save a tooth, but occasionally it will not be sufficient to heal the tooth and surgery might be recommended.


The most common surgery used to save non-healing teeth that have had root canal therapy is an apicoectomy or root-end resection. This process is performed when inflammation or infection persists in the bony area around the end of the tooth, and requires the endodontist to open up the gum tissue near the tooth apex to expose the underlying bone.  The infected tissue is then removed, along with the apex or tip of the root, and a small filling is paced to seal the root canal.  A root-end filling is placed to prevent reinfection of the root and the gum is sutured. The bone naturally heals around the root over a period of months restoring full function. Following the procedure, there may be some discomfort or slight swelling while the incision heals. This is normal for any surgical procedure. To alleviate any discomfort, an appropriate pain medication will be recommended.


Modern anesthetics can make the procedure pain free in most cases. We also have nitrous oxide available upon request for those who need additional help in dealing with dental anxiety and phobia. 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 are recommended for a day or two. We will prescribe you any other medications you may need following treatment.