An endodontist is a dentist who specialises in treating endodontic problems (endo-within, dontic-tooth). In general, this mostly involves root canal treatment. The sole purpose of Endodontists is to perform root canal treatments with the aim of improving the chances of saving your natural teeth.
Although all dentists have received training in endodontic procedures, Endodontists’ extensive training and clinical experience, depth of scientific knowledge and their ability to use specialist equipment such as endodontic microscopes and micro-instruments, allows them to access the fine and curved root canals within the tooth, that can be very difficult to reach, disinfect, and to carry out the treatment to the highest standards.
There are approximately 230 specialist endodontists on the Dental Register in the UK.
Root canal treatment is required when the nerve (pulp) inside a tooth becomes inflamed and dies. The cause of this inflammation or the dead nerve is primarily the microbes in the decayed tooth, cracks or leaking fillings or crowns.
When the inflamed nerve dies, the space it inhabits (the root canal) rapidly becomes infected with bacteria. This may cause pain and swelling in the supporting tissues (abscess) or the tooth may remain symptom-free.
This typically occurs when:
- A tooth has suffered trauma, has a deep decay or a large restoration. The injured pulp tissue can die causing the root canal to become infected.
- When a root‐treated tooth gets infected again.
- Sometimes, in order to restore a tooth, it is necessary to perform root canal treatment.
In severe cases a root canal infection could spread to the surrounding bone. If root canal treatment is not performed the tooth may have to be removed.
The purpose of root canal treatment is to remove the inflamed nerve and bacteria inside the root canal and thus allow the surrounding tissues to heal.
Treatment is usually done under local anaesthetic administered into the gum adjacent to the tooth that is being treated. The tooth under treatment is then isolated with a rubber sheet in order to firstly prevent the tooth from being contaminated with saliva (which contains bacteria), and secondly to improve the patient’s safety and comfort.
An opening is prepared on the biting surface of the tooth to allow identification of the root canals of the tooth. Special, flexible and disposable nickel-titanium files are then used to enlarge the root canals, in order to create space for disinfectant solutions to be inserted into the canals.
Once the root canals have been disinfected, they are filled with a rubber like material, which coupled with a good seal of the crown of the tooth could prevent re‐infection of the disinfected root canals.
Your dentist will refer you to our specialist practice. We will only treat you for the specific referral. A consultation appointment prior to your treatment is not always required, although we do recommend this to discuss your treatment plan and especially in more complex cases.
Most root canal treatments can be completed in one or two visits. Re-root canal treatments, more complex cases and severely infected teeth could need more visits. On average the length of each appointment could be 1.5 to 2 hours.
The treatment is painless. It is normal for patients to experience some soreness after treatment as the supporting tissues of the tooth may be a little bruised. This discomfort is usually resolved with over the counter painkillers.
The root canal system is complex, particularly in molars. A specialist (endodontist) will use their training, specialist equipment (such as a dental microscope) and vast experience, to enhance the levels of success.
Controlled clinical studies have shown success rates of around 90-95% for first time root treatments carried out by specialists. These success rates reduced to about 85% if the tooth has already been root canal treated.
After root canal treatment of the premolars and molars, a crown is usually required to protect the tooth from fracture. Sometimes the existing crown can be retained and the opening simply filled. You will be referred back to your own dentist for these procedures.
Although it is impossible to guarantee the success of any medical or dental procedure, root canal treatment has a very high success rate and provided the tooth is subsequently restored, it should last for many years.
The factors influencing the success of root canal treatment include how infected the tooth is, how long the infection has been present and if the tooth has previously been root treated.