General Information

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.'  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 the diagnosis and treatment of more difficult cases. For this reason, many dentists choose to refer their patients to endodontists.

Our office is committed to providing the highest quality of patient care.  Dr. Graver uses the latest technology including the surgical operating microscope which offers increased magnification and illumination for all procedures.  Whether we are evaluating the outside surface of a tooth for a crack, locating miniscule root canals, removing a broken file from a root canal, ensuring the canals are thoroughly cleaned, or filling the root canal systems, the microscope greatly enhances treatment.   Even the smallest detail is brought clearly into view, which allows for advanced precision.  Dr. Graver also uses digital radiography, rather than conventional dental x-rays. This advancement significantly reduces radiation exposure to our patients and eliminates the hazardous byproducts of film developing.

Our office has a state-of-the-art sterilization room, which includes the latest equipment and technology.  Our staff follows a strict infection control policy to ensure the safety of our patients and staff.

In order to understand Endodontic treatment, it helps to know some basic information about the anatomy of a tooth.  Teeth have several layers.  The outside layer of the tooth is composed of a hard layer called Enamel.  Enamel is supported by an inner layer called Dentin, which has at its center a soft tissue known as the Pulp.

The Pulp contains blood vessels, nerves, and connective tissue that are responsible for forming the surrounding Dentin and Enamel during tooth development.  The pulp receives its nourishment supply from vessels which enter the end of the root.  Although the pulp is important during development of the tooth, it is not necessary for function of the tooth.  The tooth continues to be nourished by the tissues surrounding it even after the pulp is removed.

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 inflammation and often shows up as a discoloration of the tooth.  If pulp inflammation or infection is left untreated, it can cause pain or lead to an abscess.

Some of the signs and symptoms that you may need endodontic treatment include: prolonged sensitivity to heat or cold, discoloration of the tooth, swelling or tenderness of the tooth or adjacent gums.  Sometimes there are no symptoms and the need for treatment is discovered on a routine x-ray.

The treatment consists of three or four basic steps, but the number of visits will depend on your particular case.  Some treatments take multiple visits, but many are just a single visit.  In any case, it depends on the degree of infection/inflammation and degree of treatment difficulty.  To us, it's more important to do the very best we can, rather than to meet a specific time criteria.  Let's look at the basic steps for an endodontic procedure.

1.     The endodontist examines and x-rays the tooth, then administers local anesthetic.  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.

 2.     The endodontist makes an opening in the crown of the tooth.  Very small instruments are then used to remove the inflamed or infected pulp from the chamber and root canals.

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. 

4.     After the final visit with your endodontist, it is important that you return to your general dentist to have a crown or other restoration placed on the tooth to protect and restore it to full function. 

Occasionally, a tooth that has undergone endodontic treatment fails to heal or pain continues despite therapy.  Sometimes a tooth may initially respond to root canal therapy but become painful or diseased months or years later.  New trauma, deep decay, or a loose, cracked or broken filling can also cause new infection in your tooth.  When any of these situations occur, the tooth often can be maintained with a second endodontic treatment, or retreatment.  In some cases, the endodontist may discover additional, very narrow or curved canals that could not be treated during the initial procedure.  Advances in technology are constantly changing the way root canal treatment is performed, so your endodontist may use new techniques that were not available when you had your first procedure.

During retreatment, the endodontist will reopen your tooth to gain access to the root canal filling material.  In many cases, complex restorative materials - crown, post and core material - must be disassembled and removed to permit access to the root canals.  After removing the canal filling, the endodontist can clean the canals and carefully examine the inside of your tooth using magnification and illumination, searching for any additional canals or unusual anatomy that requires treatment.  After your endodontist completes retreatment, you will need to return to your dentist to have a new crown or other restoration placed on the tooth to protect and restore it to its full function.

Most teeth can be retreated.  Occasionally, a tooth cannot be saved, though, because the root canals are not accessible, the root has a pre-existing fracture, the tooth doesn't have adequate bone support, or the tooth cannot be restored.  However, advances in endodontics are making it possible to save teeth that even a few years ago would have been lost.  When endodontic retreatment is not effective, endodontic surgery may be able to save the tooth.

Endodontic surgery can help save your tooth in a variety of situations:

• Surgery may be used in diagnosis.  If you have persistent symptoms but no problems appear on your x-ray, your tooth may have a tiny fracture or canal that could not be detected during nonsurgical treatment.  In such a case, surgery allows your endodontist to examine the entire root of your tooth, find the problem, and provide treatment.
• Sometimes calcium deposits make a canal too narrow for the instruments used in nonsurgical endodontic treatment to reach the end of the root.  If your tooth has this 'calcification,' your endodontist may perform surgery to clean and seal the remainder of the canal.
• In a few cases, a tooth that has previously undergone endodontic treatment may not heal or become infected.  Surgery could help save your tooth in these situations.
• Surgery may also be performed to treat damaged root surfaces or surrounding bone.

Let's look at the basic steps for an endodontic surgery:

1.     First, the endodontist opens the gum tissue near the tooth to see the underlying bone and to remove any inflamed or infected tissue.  The end of the root is also removed.

2.     A small filling may be placed in the root to seal the end of the root canal, and a few stitches or sutures are placed in the gingiva to help the tissue heal properly.

3.     Over a period of months, the tissue and bone heals around the end of the root.

Often, the only alternative to surgery is extraction of the tooth.  The extracted tooth must then be replaced with an implant, bridge, or removable partial denture to restore chewing function and to prevent adjacent teeth from shifting.  Because these alternatives require surgery or dental procedures on adjacent healthy teeth, endodontic surgery is usually the most biologic and cost-effective option for maintaining your oral health.

No matter how effective modern artificial tooth replacements are - and they can be very effective - nothing is as good as a natural tooth.  You have already made an investment in saving your tooth.  The pay-off for choosing endodontic surgery could be a healthy, functioning natural tooth for the rest of your life.

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.  Additional causes of facial pain that can mimic toothache include:  sinus symptoms, periodontal inflammation, myofascial pain, TMJ disfunction, and neuropathies.  An endodontist is a specialist in diagnosing the origin of your pain and in treating pain of root canal origin. 

Cracked teeth show a variety of symptoms, including erratic pain when chewing, possibly with release of biting pressure, or pain when your tooth is exposed to temperature extremes.  In many cases, the pain may come and go and your dentist may have difficulty locating which tooth is causing the discomfort.

When the outer hard tissues of the tooth are cracked, chewing can cause movement of the pieces, and the pulp can become irritated.  When biting pressure is released, the crack can close quickly, resulting in a momentary, sharp pain.  Irritation of the dental pulp can be repeated many times by chewing.  Eventually, the pulp will become damaged to the point that it can no longer heal itself.  The tooth will not only hurt when chewing, but may also become sensitive to temperature extremes.  In time, a cracked tooth may begin to hurt all by itself.  Extensive cracks can lead to infection of the pulp tissue, which can spread to the bone and gum tissue surrounding the tooth.

There are many different types of cracked teeth.  The treatment and outcome for your tooth depends on the type, location, and extent of the crack.

Unlike a broken bone, the fracture in a cracked tooth will not heal.  In spite of treatment, some cracks may continue to progress and separate, resulting in loss of the tooth.  Placement of a crown on a cracked tooth provides maximum protection but does not guarantee success in all cases.

The treatment you receive for your cracked tooth is important because it will relieve pain and reduce the likelihood that the crack will worsen.  Once treated, most cracked teeth continue to function and provide years of comfortable chewing. 

Pulp damage is sometimes caused by a blow to the mouth, and the endodontist specializes in treating these traumatic injuries.

Chipped or fractured teeth account for the majority of all dental injuries.  These fractures can occur in the crown as well as the root of the tooth.  Most chipped or fractured tooth crowns can be repaired either by reattaching the broken piece or by placing a tooth-colored filling.  If the pulp is damaged after a crown fracture or if a crack extends into the root, then root canal treatment may be needed.

Dislodged or knocked-out teeth are examples of less frequent, but more sever injuries.  Root canal treatment is usually needed for permanent teeth that have sustained these types of injuries and should be started within a few days.  An endodontist is specially trained in procedures for replanting teeth that have been knocked out of their sockets.

Following are links to other websites that Dr. Graver recommends for additional information about your dental health:

American Association of Endodontists  www.aae.org/patients

American Dental Association  http://www.ada.org/public.aspx