Endodontics is the diagnosis and treatment of pain relating to teeth. It's a specialist
area of dentistry and in general terms, it involves either root canal treatment or apical surgery.
Often the patients come in pain or with infections and are referred to us either
by their general dentist or find us via other sources.
Patients are usually very anxious and the treatment itself is not usually too difficult.
We either are doing primary treatments, where teeth have got damaged either through fractures
or decay or leakage around old crowns, or, in some cases, the teeth have been traumatised.
Other times we are redoing teeth which have been treated in the past and, using our specialist
equipment, we are able to redo these teeth and hopefully to prolong the life of them
for many years. Often dentists struggle to do endodontics,
even though they should be well trained and will refer difficult cases on to us directly,
so that we can do it right the first time. The whole purpose of this, of course, is to
save teeth so that people can have them for much longer and can chew comfortably, without
the need for extractions and then dentures or implants.
When people come to us, they're often apprehensive and they're in pain and they've got broken-down
teeth or swellings or infections and the purpose of the endodontics is to resolve the pain
and the infection so that people can save their teeth. In the past, the options were
to take the teeth out and then replace with either dentures or bridges or these days with
implants. However, a much more cost-effective kind of
treatment is to actually save the teeth themselves. This is done by removing any damaged bits
of nerve and pulp in inflamed teeth so that these teeth can become infection-free.
It's often we're redoing treatments and again, the ultimate aim is so that people do not
lose their teeth and can have their teeth for a lot longer. Sometimes, we have to do
surgery to teeth and this is when there is infection in the bone which can't be got out
by conventional means and by conventional root canal treatment going through teeth,
and in these cases we will perform surgery where we lift up the gum and take a little
bit of bone away, but ultimately to get that tooth infection free so that tooth isn't lost
at any time. This really should prolong the lifetime of a tooth by decades and is a very
good cost-effective way of dealing with problems.
One of the myths of dentistry and endodontic treatment is very painful and really it shouldn't be.
If done well with great anaesthesia, it should be a very comfortable procedure.
Often, people have heard stories from their friends or well-meaning colleagues that this
is a very painful procedure, but really it is due to poor anaesthetic techniques and
there are some teeth which are very difficult to anaesthetise, lower molars which are very
inflamed, but once anaesthetised, endodontics should be as comfortable as any other dental
procedure. Sometimes the procedures are quite long and
it's not unusual for patients to fall asleep. Also, if people are very apprehensive, they
can be offered options such as different sedatives to really help with the procedure.
However, generally patients are not in pain during the procedures, as this would be counterproductive
to any treatment as we wouldn't be able to do our jobs, but also, we don't want the patient
to suffer in any way whatsoever. I think a calm technique and explaining everything that
goes on with the treatment really does help. We do our best to make sure the patient is
comfortable throughout the whole procedure.
In general terms, patients who come to us have damaged teeth with an infection or inflamed
nerves and the bacteria are residing inside the canals and therefore the best treatment
is to do treatment non-surgically. This is where we access the teeth and go into the
canals cleaning them, preparing them, enlarging them and ultimately sealing them.
If there is damaged, inflamed tissue, all of that's removed and if there's infected tissue, the canals
are disinfected and sealed. Sometimes patients come to us and the treatment
has already been done once, but the treatment hasn't gone so well, then the primary option
is to take out the initial root filling and redo it. Sometimes, however, it's not possible
to access these canals in cases where there was a crown present and maybe a post cemented
into the roots. In these cases, we would opt for surgery. This involves lifting up the
gum and taking bone away and moving damaged tissue around the tip of the tooth and sealing
the apex. We only do this if the root canal treatment
has failed or we can't access the canals. Also, in some cases, patients have had very
new, very expensive restorative care done and don't want any potential damage to it.
Doing root canal treatment may involve removing the crown and having to retreat the tooth.
So sometimes the expenses of redoing a treatment, compared to doing apical surgery where we
leave the crown as is and do surgery at the apex, is often a cheaper option.