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 -odonto, 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 so as to save the affected tooth before extraction becomes necessary. Prior to the emergence of endodontics around the mid-twentieth century, extraction was the only definitive 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 nine 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, and dental public health. 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.

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.

The remaining branch of dentistry is endodontics, which focuses on the treatment of the soft tissue within each tooth.

Overview

The field of endodontics consists of three primary forms of treatment: nonsurgical endodontic treatment, endodontic retreatment, and endodontic surgery. 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 into the side of the tooth through which he or she extracts dead or infected tissue with the aid of tiny files. When the pulp is fully removed, the endodontist then proceeds to clean, decontaminate, and reshape the now 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 new 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 finds an issue with the root structure or root canals of a tooth that could cause endodontic retreatment to fail, he or she 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, he or she 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.

Bibliography

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“What’s the Difference between a Dentist and an Endodontist?” American Association of Endodontists, www.aae.org/patients/why-see-an-endodontist/whats-difference-dentist-endodontist/. Accessed 15 Oct. 2018.

“Why See an Endodontist.” American Association of Endodontists, www.aae.org/patients/why-see-an-endodontist/. Accessed 15 Oct. 2018.

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