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Endodontics is a sub-speciality of odontology that deals with the study and treatment of the tooth pulp (nerve) diseases. Root canal therapy is made by cleaning and shaping the canal and later filling it with a special material before sealing it permanently. This treatment is recommended for severe cases of cavities in order to avoid removing the tooth.

Your guide to endodontic treatment
You are probably reading this because your dentist or specialist in endodontics advised you need an endodontic treatment. If so, you are not alone. Over 14 million teeth undergo endodontic treatment every year. By choosing endodontics, you choose to keep your natural teeth as a healthy way to being able to chew and bite in the future. If you have never had endodontic treatment - also known as "root canal treatment" - or if it has been many years since your last treatment, you may have questions or doubts about it. This section will answer your questions and explain how endodontic treatments today can help you keep your teeth. If you have further questions, don't hesitate to talk to your dentist.

Who does the endodontic treatment?
While in dental school, all dentists, including yours, have been trained to perform endodontics. General dentists can perform endodontics together with other dental procedures, but they sometimes prefer to refer their patients to specialists in endodontics, who only do endodontics. To specialize in this field, they have to complete an additional two or more years of training following dental school. They do both routine procedures and difficult, complex procedures, including surgery. Specialists in endodontics are also experienced in finding the cause of oral and facial pain, something that has not been easy to diagnose.

What is an endodontic treatment?
"Endo" means "inside" and "odont" means "tooth" in Latin and Greek. The endodontic treatment deals with the inner tooth. A little knowledge about the anatomy of the tooth will help you understand the endodontic treatment: Inside the tooth, under the white enamel and a hard layer called dentine, there is a white tissue called pulp. Pulp contains blood vessels, nerves and connective tissue that feed the tooth during its formation. Pulp extends from the crown of the tooth to the tip of the roots where it connects with the surrounding tissues. Pulp is important during the growth and formation of the tooth. However, when a tooth has completely grown, it can survive without the pulp because the surrounding tissues keep feeding it.

Why do I need endodontics?
Endodontics is necessary in case of inflammation or infection of the pulp. There can be several causes for inflammation or infection: deep cavities, several dental procedures on the tooth or a fracture. A blow on the tooth can also damage the pulp even when there is no visible fracture or crack. If inflammation or infection of the pulp is not treated, it can cause pain or create an abscess. Signs of a damaged pulp include: pain, cold or heat sensitivity, changes in color, swelling and slight pain in the gums around the tooth. Sometimes, there can also be no symptoms.

How does endodontics save the tooth?
The endodontist removes the inflamed or infected pulp, cleans and prepares the inside part of the tooth carefully, closes and seals the space. You must then return to your endodontist to put a crown or other restoration to protect the tooth and make it fully functional again. After being restored, the tooth keeps working just as any other tooth.

Will I feel pain during or after the treatment?
Many endodontic treatments are made to relieve tooth pain caused by inflammation or infection of the pulp. With modern techniques and the use of anesthesia, most patients say they feel well during the procedure. During the first days after the treatment, you will notice a higher sensitivity in the tooth, especially if there was pain or infection before the procedure. This can be relieved with tranquilizers, or stronger medicines that require prescription. Follow your endodontist's recommendations carefully. The tooth will feel different from the others until you visit your endodontist again to have the tooth restored. However, in case of strong pain or pressure for more than a few days, call your endodontist.

Endodontist procedure
The endodontist treatment can be made in one or two visits and consists of the following steps.

1. The endodontist checks the tooth and takes X-rays, before applying a local anesthesia. After anesthetizing the tooth, the endodontist puts a small protecting plate called a "rubber dam" on the area to isolate the tooth and keep it clean and free from saliva during the procedure.

2. The endodontist makes an opening in the center of the tooth crown to get to the nerve. With very thin instruments, he cleans and disinfects the canals of each root.

3. After cleaning and preparing the area, the endodontist covers the canals with a biocompatible material, generally a rubber type material called "gutta-percha". The gutta-percha is fixed in thanks to an adhesive cement to seal the canals. In most cases, a temporary filling is used to close the opening. Later your dentist will remove the temporary filling and then make the permanent restoration.

4. After your final visit to the endodontist, you will have to see your dentist to have a crown or other restoration fitted in order to protect the tooth and make it totally functional again.

If the tooth doesn't have enough structure to hold the restoration in place, the dentist or endodontist can insert a post inside the tooth. For more details about the restoration of your tooth, ask your dentist or endodontist.

How much does the procedure cost?
The cost varies depending on how bad the problem is and the tooth involved. Molars are harder to treat and generally cost more. The endodontic treatment and restoration of the tooth is cheaper than the extraction of the tooth, since the missing tooth must be replaced with a bridge or an implant to make chewing possible again and prevent the adjacent teeth from moving. These alternative treatments tend to cost more than the endodontic treatment and the appropriate restoration.

Will the tooth need special or additional treatment?
You must not chew or bite with the treated tooth until your dentist restores it. An unrestored tooth is likely to break; therefore you must see your dentist as soon as possible to have it restored. In addition, all you need is good oral hygiene, including brushing, flossing, routine check ups and cleaning sessions. Most teeth treated with endodontics last as long as the others. In a few cases however, a tooth that has had endodontic treatment cannot be cured or remains painful. Sometimes, a tooth can ache or turn bad months or even years after a successful endodontic treatment. If this happens, a second endodontic treatment may save the tooth.

What could cause an endodontically treated tooth to require additional treatment?
More trauma, a deep cavity or a wrong, broken or fractured restoration, could cause a new infection of your tooth. In some cases, the endodontist can find very narrow and curved canals that could not be treated during the initial treatment.

Can all teeth get endodontic treatment?
Most teeth can be treated. In some cases, a tooth cannot be saved, because the canals cannot be reached, the root is badly fractured, the tooth lacks an adequate bone support or cannot be restored. However, thanks to important breakthroughs in dental care, it is now possible to save teeth that would have been lost years ago. When the endodontic treatment is not effective, endodontic surgery can still save the tooth.

What is endodontic surgery?
The most common surgical procedure is called apicectomy or resection of the tooth root. If the inflammation or infection persists in the area of the bone around the tip of your tooth after the endodontic treatment, your endodontist can perform an apicectomy. The endodontist cuts the gum close to the tooth to expose the bone and removes the infectious tissue. The tip of the root is also removed, and a little filling is usually used to seal the canal. The procedure is quite comfortable, thanks to the use of local anesthetics, and most patients go back to their daily routine the next day.

What are the alternatives to endodontic treatment?
If the tooth pulp has been affected, the only alternative to endodontics is removing the tooth. To allow the patient to chew again and prevent the nearby teeth from moving, the removed tooth must be replaced by a bridge or implant. This requires surgery or dental procedures on the nearby, healthy teeth, and can end up being much more expensive and longer than the endodontic treatment and the restoration of the natural tooth.