Root canal patient X-ray endodontic consultation

What is Endodontics?

Endodontics is a subspecialty of dentistry, relating to the diagnosis and treatment of pathologies (problems) associated with the pulp (nerve) of a tooth. The most common treatments arising from these problems include Endodontic Therapy (root canal), Retreatments (Revision of a root canal), and Apicoectomies (microsurgery). Endodontists must graduate from an accredited dental school and continue their education with a 2-3 year endodontic residency in order to earn their master’s degree as well as an endodontic certificate.

Why do I need an Endodontist?

Accurate Diagnosis

Some cases of oro-facial pain are very straightforward, however many can be difficult to properly diagnose. Many times oro-facial pain is tooth-related; yet it may not be related to the pulp (nerve) of a tooth but rather the hard and soft tissues surrounding a tooth. More rarely, oro-facial pain can be caused by pathologies associated with nerves (neuralgias), fungal or viral infections, tumors and growths, musculoskeletal abnormalities, etc. Many times it takes the experience and education of a specialist to properly determine the potential sources of oro-facial pain.

Treatment of Difficult Root Canals

Every tooth is unique, and therefore every root canal is unique. Many root canals can be routine, however an equal amount can require much more time and skill. This is typically caused by canal obstructions (broken instruments and calcifications), dilacerations (severely curved roots), additional roots (radix entomolaris), additional accessory canals (MB-2 canal of upper first molars), etc. These issues typically require the expertise and technology possessed by a specialist.

Treatment of Failing Root Canals

A root canal may fail for a variety of reasons—missed canals, cracked roots, leakage, and decay. A specialist is typically needed in order to determine if a root canal-treated tooth may be saved and if so how.

Treatment of Cracked Teeth

Endodontists are trained specifically to diagnose and save cracked teeth. These cases can be difficult to diagnose and manage due to the various types of cracks—craze lines, fractured cusps, cracked teeth, split teeth, and vertical root fractures. Depending on the type of crack as well as the pulpal diagnosis, success rates can range from below 30% up to 95%. Endodontists have the technology and training to give you a proper prognosis with realistic expectations.

Treatment of Traumatic Injuries

Traumatic oral injuries are often difficult to manage, due to the number of different structures that can be injured. These include the soft tissues of the face, cranial nerves, facial skeletal fractures, jaw-joint dislocations, and teeth related injuries. Many times, teeth related injuries are the last to be addressed. These include teeth chipping (complicated or uncomplicated), teeth moving (luxations), and teeth falling out (avulsions). Treatments for these issues depend upon the time of injury, involvement of the nerve of the tooth, the age of the patient, as well as the maturity of the tooth. Treatments can range from simple follow-up care to root canal therapy and long term splinting. Endodontists can help you properly diagnose and manage these difficult experiences.

What treatments are available?

Root Canal Therapy

Endodontists are specialists in saving teeth, and root canals are procedures performed in order to relieve pain as well as to maintain one’s natural teeth. At the center of your tooth is a nerve or the pulp—it is a collection of blood vessels and nerves that help to initially form the surrounding tooth. Inflammation or infection of the pulp can be caused by trauma to the tooth, deep decay, cracks or chips. Symptoms of the inflammation or infection can be identified as visible injury to the tooth, intense sensitivity to temperatures or sweets, pain when chewing, spontaneous pain, or pain that wakes you up at night. If you experience any of these symptoms, your dentist will most likely recommend non-surgical treatment to eliminate the diseased pulp. This injured pulp is removed and the root canal system is thoroughly cleaned and sealed. This therapy usually involves local anesthesia and may be completed in one or two visits depending on the treatment required. Success for this type of treatment occurs in greater than 90% of cases.


Failing root canals are often due to missed canals, lack of proper restorations, cracked roots, leakage, and decay. Many times a previously treated tooth may still be salvageable with a revision of the root canal or a “retreatment.” This procedure is done in office with local anesthetic, and typically requires two visits. The first visit involves the removal of the previous root canal filling material and the administration of an antibiotic paste within the root canal system of the tooth. Approximately 2 weeks later the antibiotic paste will be removed and a new root canal filling material placed. Success for this type of treatment occurs in greater than 85% of cases, however a more specific prognosis can be given after an evaluation.


An apicoectomy is a microsurgical procedure used to heal teeth with failing root canals. This procedure may be elected over a retreatment in cases where teeth have fragile porcelain crowns, posts that inhibit root canal access, or cases where cysts have likely developed. The procedure includes small incisions within the gum line, resection of the diseased root tip, a root end filling to seal the root canal system, and in certain cases bone grafting in order to facilitate proper healing. Success for this type of treatment occurs in greater than 85% of cases.

Is Having my Tooth Extracted a Better Option?

Saving your natural teeth, if possible, is often the best option. Nothing can completely replace your natural tooth. Endodontic treatment, along with the appropriate restoration, is a cost-effective way to retain your natural teeth. Additionally, it is usually less expensive than an extraction with the subsequent placement of a bridge or an implant. However there are extenuating circumstances, which can significantly reduce the prognosis of retaining a tooth. In these circumstances, the removal of a tooth is often the preferred treatment. An Endodontist can identify these and make the appropriate recommendations.

Do Root Canals Hurt?

Root canal treatment doesn’t cause pain—it relieves it. The perception of painful root canals began decades ago, particularly when novocaine was the only available anesthetic. However, with the latest technologies and anesthetics, root canal treatment today is no more uncomfortable than having a filling placed. In fact, a recent survey showed that patients who have experienced root canal treatment are six times more likely to describe it as “painless” than patients who have not had root canal treatment.