What Does An Endodontist Do

Endodontists are dental specialists focused on the diagnosis, prevention, and treatment of diseases and injuries to the dental pulp and periradicular tissues. This essentially means they are experts in saving teeth that would otherwise be lost due to infection or damage within the tooth. When the pulp, the soft tissue inside the tooth containing blood vessels, nerves, and connective tissue, becomes inflamed or infected, endodontic treatment becomes necessary. Let us delve into the comprehensive role these specialized dental professionals fulfill.

1. Diagnostic Acumen: Identifying the Root of the Problem

The first crucial step in any endodontic procedure is accurate diagnosis. Endodontists employ a variety of methods to pinpoint the source of dental pain and pathology. These include:

• Patient History: A detailed account of the patient’s symptoms, including the location, intensity, and duration of pain, as well as any contributing factors, is essential. It provides the initial clues in unraveling the diagnostic puzzle.
• Clinical Examination: Visual inspection of the teeth and surrounding tissues is paramount. They assess for signs of inflammation, swelling, discoloration, and any existing restorations or fractures. Palpation and percussion of the teeth help determine sensitivity and identify the affected tooth.
• Radiographic Evaluation: Radiographs, such as periapical X-rays and cone-beam computed tomography (CBCT), are indispensable tools. Periapical radiographs provide two-dimensional images of the tooth and surrounding bone, revealing signs of infection, bone loss, and root abnormalities. CBCT offers three-dimensional imaging, allowing for a more detailed assessment of complex anatomical structures and pathological processes. This level of precision is often required for intricate cases.
• Pulp Vitality Testing: This assesses the health and responsiveness of the dental pulp. Tests such as thermal testing (using cold or heat stimuli) and electric pulp testing help determine if the pulp is vital, necrotic (dead), or undergoing reversible or irreversible inflammation.

2. Root Canal Therapy: The Core Procedure

Root canal therapy, also known as endodontic treatment, is the bread and butter of an endodontist’s practice. The objective is to remove the infected or inflamed pulp, disinfect the root canal system, and seal it to prevent future infection. The process typically involves:

• Access Cavity Preparation: Creating an opening in the tooth to access the root canals. Precise execution is critical to ensure complete access to all canals.
• Cleaning and Shaping: Using specialized instruments, such as endodontic files, to remove the infected pulp, debris, and bacteria from the root canals. The canals are shaped to facilitate disinfection and obturation (filling). Irrigation with antimicrobial solutions, such as sodium hypochlorite, plays a vital role in eliminating bacteria and dissolving organic tissue.
• Obturation: Filling the root canals with a biocompatible material, typically gutta-percha, along with a sealer, to prevent reinfection. The canals are densely packed to ensure a hermetic seal.
• Restoration: After root canal therapy, the tooth needs to be restored to protect it from fracture and restore its function. This usually involves placing a crown or filling. The type of restoration depends on the amount of tooth structure remaining and the location of the tooth.

3. Retreatment: Addressing Previous Failures

Sometimes, a tooth that has undergone root canal therapy can become reinfected or develop new problems. This may be due to inadequate initial treatment, missed canals, or new decay. Endodontists perform retreatment to address these issues. Retreatment involves:

• Removal of Existing Filling Materials: Carefully removing the gutta-percha and sealer from the root canals. This can be a challenging process, especially if the canals are curved or blocked.
• Re-Cleaning and Shaping: Thoroughly cleaning and shaping the root canals to remove any remaining infection or debris.
• Identification and Treatment of Missed Canals: Locating and treating any canals that were not addressed during the initial root canal therapy.
• Obturation and Restoration: Filling the root canals with gutta-percha and sealer and restoring the tooth.

4. Apicoectomy: Surgical Intervention

An apicoectomy is a surgical procedure that involves removing the apex (tip) of the tooth root and surrounding infected tissue. This procedure is typically performed when root canal therapy or retreatment is not sufficient to resolve the infection or when there are anatomical complexities that prevent complete cleaning and shaping of the root canals. This procedure can involve:

• Flap Creation: A small incision is made in the gum tissue to expose the underlying bone and root.
• Apex Resection: The infected root tip is surgically removed.
• Retrograde Filling: A filling is placed in the prepared root-end cavity to seal the root canal.
• Tissue Closure: The gum tissue is repositioned and sutured back into place.

5. Treatment of Traumatic Dental Injuries

Endodontists are frequently involved in the treatment of teeth that have been injured due to trauma, such as falls or sports injuries. This can include:

• Pulp Capping: Placing a medicament on the exposed pulp to promote healing and prevent infection.
• Pulpotomy: Removing the coronal portion of the pulp in a tooth with an open apex (immature root) to allow for continued root development.
• Apexification: Inducing the formation of a calcified barrier at the apex of a tooth with an open apex and necrotic pulp.
• Root Canal Therapy: Performing root canal therapy on teeth that have been luxated (displaced) or avulsed (knocked out).

6. Internal Bleaching: Restoring Aesthetics

Sometimes, a tooth that has undergone root canal therapy can become discolored. Internal bleaching is a procedure that involves placing a bleaching agent inside the tooth to lighten its color. This is a cosmetic procedure that improves the tooth’s appearance.

7. Diagnosis and Management of Orofacial Pain

Endodontists possess a deep understanding of orofacial pain, including pain of pulpal origin and referred pain. They can diagnose and manage various types of dental pain, helping patients find relief. Their expertise extends to differentiating odontogenic pain from non-odontogenic pain, such as trigeminal neuralgia or temporomandibular joint disorders.

In conclusion, endodontists are highly skilled specialists who play a critical role in preserving natural teeth and alleviating dental pain. Their expertise in diagnosing and treating diseases of the dental pulp and periradicular tissues makes them indispensable members of the dental healthcare team. From root canal therapy to surgical procedures, endodontists employ a range of advanced techniques to save teeth that would otherwise be extracted, improving patients’ oral health and overall well-being.