What is endodontics?Endodontics is a branch of dentistry recognized by the American Dental Association involving treatment of the pulp (root canal) and surrounding tissues of the tooth. When you look at your tooth in the mirror, what you see is the crown. The rest of the tooth, the portion hidden beneath the gum line, is called the root. Though the outer portion of the root is a hard tissue called dentin, the inside channel or “root canal” contains a pulp of soft tissue, blood vessels and nerves. Bacteria that are introduced into the pulp as a result of tooth decay, periodontal disease, tooth fracture or other problems, can severely damage the pulp. When that happens, an endodontic specialist removes the diseased pulp to save the tooth and prevent further infection and inflammation. After successful endodontic treatment, the tooth continues to perform normally.
I’m worried about x-rays. Should I be?
No. While x-rays will be necessary during your endodontics treatment, we use an advanced non-film computerized system called digital radiography, that produces radiation levels up to 90% lower than those of already low dose conventional dental x-ray machinery. These digital images can be optimized, archived, printed and sent to co-therapists via e-mail. For more information contact Sirona Dental Systems, Inc.
Will additional X-rays need to be taken? (“I dont’ want any more X-rays. My dentist took one.”)
A recent x-ray (radiograph) is a valid two dimensional image of a three dimensional object. X-rays from different angles are frequently needed to better visualize the tooth in three dimensions and to make a proper diagnosis. Therefore, it is possible that additional x-rays may need to be taken for proper therapy. A digital x-ray system is used in our office to minimize the radiation exposure. (There is a substantially lower radiation exposure needed with digital x-ray systems.) Current radiographs (possibly from multiple angles) are required to make an accurate diagnosis for your condition, so additional fees to obtain these required additional x-rays in our office will not be billed to your account as separate charges or services.
What about infection from the procedure?
Again, there’s no need for concern. We adhere to the most rigorous standards of infection control advocated by OSHA, the Centers for Disease Control and the American Dental Association. We utilize autoclave sterilization and barrier techniques to eliminate the risk of transferring infectious agents between patients, surfaces and personnel. The dental or surgical procedure itself is designed to remove infected tissue and/or debris from the tooth and/or bone and to provide a better environment for appropriate healing after treatment.
What happens after treatment?
When your root canal therapy has been completed, a record of your treatment will be sent to your restorative dentist. When directed, you should contact his/her office for a definitive restoration or evaluation of the restoration placed at the completion of treatment within a few weeks of completion at our office. Your restorative dentist will decide on what type of restoration is necessary to protect your tooth. It is rare for endodontic patients to experience complications after routine endodontic treatment or microsurgery. If a problem does occur, however, we are available at all times to respond.
What new technologies are being used?
In addition to digital radiography, we utilize special operating microscopes. Magnification and fiber optic illumination are helpful in aiding the doctor to see tiny details inside your tooth. Also, a digital camera may be attached to the operating microscope to record images of your tooth and further document the doctor’s findings.
Why do teeth need a root canal procedure?
A root canal procedure is needed to save a tooth that has a damaged dental pulp. Once pulps are damaged they can no longer heal themselves following an injury and the damaged tissue needs to be removed before the body rejects the tooth or becomes infected. Teeth with damaged pulps that are left untreated will always be rejected by the body or become infected.
What types of procedures will be referred by a general dentist to a specialist?
Your general dentist may diagnose damage to the pulp tissue, and then refer you to a specialist for the root canal treatment. Or, your general dentist may send you to the specialist for a consultation to make the pulpal diagnosis because you exhibit signs and symptoms that are consistent with a damaged pulp, but the specific offending tooth cannot be easily identified, or located in the general denist’s office. Teeth that have had previous root canal treatment that are not responding to the root canal treatment as expected, may also be referred for evaluation and treatment by a specialist. Very young, medically compromised, or elderly patients often have special needs during root canal treatment, so these patients are frequently referred to a specialist for these procedures. Any time a root canal procedure is expected to be complicated or when complications arise during the treatment of a routine root canal, the specialist may be called upon to perform or complete the root canal.
Why did my dentist refer me to you, a specialist (endodontist), for a root canal procedure rather than complete the treatment in their office?
The endodontic specialist is usually called upon to perform endodontic treatment or an endodontic evaluation for complicated situations. An endodontist is a dental specialist with a minimum of 2 additional years of formalized dental training in an ADA accredited residency program, after dental school, in the field of Endodontics. They also have special equipment to complete complicated root canal treatment procedures. Root canals for patients with special needs, such as very young, or old patients, or patients with conditions that compromise their systemic health are usually referred to an endodontic specialist for root canal treatment. The endodontic specialist performs a consultation to make a pulpal diagnosis when pain is present and a tooth is suspected to have a damaged pulp, but the appearance of the tooth, or clinical findings are inconclusive in the general dental office. The endodontist has additional training and equipment which assists them in their ability to make a difficult diagnosis and provide recommendation(s) for endodontic treatment when the clinical situation is complicated.
What type of appointment do I need in your office? (a root canal appointment, a consultation appointment, a surgical or re-treatment appointment)
If the problem has been previously diagnosed by a dentist then you will need to schedule a root canal treatment appointment. If there is a question about the diagnosis, or if a diagnosis needs to be made for your tooth, a consultation appointment needs to be scheduled. If a tooth has been previously treated with a root canal and healing has not occurred as expected, or pain and symptoms still persist following a previous root canal treatment, a consultation appointment needs to be scheduled. If an endodontic surgical procedure was recommended by your general dentist, then a consultation appointment needs to be scheduled prior to scheduling the surgical treatment.
Can I send you my x-ray instead of coming in to the office for a consultation appointment?
A consultation visit includes an evaluation of the soft and hard tissues and clinical testing that is used to assess the health of the dental pulp. Radiographs are only one part of the evaluation of a tooth for pulpal disease and therefore, a proper diagnosis of the tooth condition cannot be made from only evaluating radiographs.
Do I really need a root canal if I’m not having pain at this time?
Yes, it is very common for teeth that need root canals to have periods of time where no pain is present. A lack of pain does not mean that a root canal is not needed to save a tooth. A non-painful tooth will always be tested prior to endodontic treatment to verify that the pulp is damaged and treatment is required before root canal treatment is done.
Do I need to stop prescribed medications prior to endodontic treatment?
You should always check with your medical provider who prescribed the medication prior to stopping any drug. Most routinely prescribed medications will not interfere with conventional root canal treatment or re-treatment procedures. Patients who are taking blood pressure medications and medications for diabetes should definitely take medications as prescribed preceding their dental procedure. If a surgical root canal procedure is to be performed, the endodontist and physician prescribing the medication will have a direct conversation to determine if medications taken will need to be altered prior to the surgical procedure.
Can I eat before the appointment?
Yes. It is acceptable to eat prior to the root canal treatment. In fact, it is very desirable to eat before the appointment because it can be difficult to eat for a few hours following the procedure when the tissues are anesthetized.
Should I pre-medicate with antibiotics before this appointment?
Patients with prosthetic joints, or heart valve replacements, or a history of sub-acute bacterial endocarditis will usually require antibiotic pre-medications at least 1 hour prior to any dental procedure that may produce bleeding in the mouth. (Your physician who manages your medical condition will instruct you to pre-medicate prior to dentistry, and prescribe appropriate medications if you truly require these protective drugs before dental treatment.) Extremely anxious patients may also need to pre-medicate with sedative medications prior to dental treatment. If sedative medications are required by the dental patient, then a driver will also be necessary to transport the patient to and from the dental procedure. Medications required prior to appointments may be prescribed by the endodontist at a consultation appointment, or by the general dentist who referred the patient to the endodontist for treatment, or by a medical practitioner responsible for monitoring the patient’s medical condition which necessitates premedication prior to dentistry.
Do I need a driver for the appointment?
Most patients who routinely drive themselves to other types of dental appointments do not require a driver to transport them to or from a root canal appointment. Depending on the complexity of the root canal procedure, and the length of time required to obtain anesthesia of the infected/inflamed tissue near the tooth to be treated, the root canal appointment can take 1-2 hours to complete. Patients who are exhausted by long treatment procedures may desire to have a ride home from the dental visit rather then be responsible for driving themselves. No medications will be routinely administered during the root canal procedure that would interfere with the patient’s ability to drive themselves home from the root canal treatment procedure. However, if a sedative medication is taken prior to the dental visit to decrease anxiety during the root canal procedure, a driver will be required to transport the patient home from the procedure.
Can I return to work after the appointment?
Most people can return to routine activities after the procedure. The jaw and soft tissues will remain anesthetized for at least 1-2 hours following the treatment. Caution will be needed for eating as long as the tissues remain anesthetized (especially for hot temperatures and biting) to avoid trauma or incidental injury. Following a typical root canal procedure, mild achiness or soreness of the tooth and surrounding tissues (similar to the discomfort level associated with a bruise) should be expected. A healthy person can easily eliminate this mild discomfort with over-the-counter analgesics such as Ibuprofen or Tylenol.
Who do I call if I have pain before my appointment?
We cannot prescribe pain medications prior to evaluating your systemic health in our office. Most healthy people can safely take Ibuprofen or Tylenol. You can usually get tooth pain relief from whatever analgesic that you normally take for headaches and minor muscle pains. If these medications have been tried and are ineffective, or you have swelling or an acute infection, and require a prescription for an antibiotic, your family physician or general dentist who has a current record of your health status can provide you with the proper prescription. If you cannot reach these individuals you should be seen in an urgent care clinic or emergency room to get the proper prescriptions. Emergency dental treatment appointment time is usually available each day we are in the office (Monday-Friday), so an emergency dental appointment can usually be made in our practice where proper health information can be collected and appropriate prescriptions made.
My dentist told me that I would need a crown after the root canal. Will you be doing this procedure also?
The crown procedure will be completed by your general dentist after the root canal procedure is done. The tooth will be slightly sensitive to pressure and bite immediately after the procedure. The tooth will remain tender to this type of pressure for a few days (approcimately 2-7 days) with the symptoms gradually improving each day. Once the tooth feels completely back to normal (usually within 1-2 weeks of the root canal), the crown treatment can be done. Teeth that require root canal treatment are “weaker” than teeth that have not had root canals. Delaying crown placement on the root canal treated tooth, puts the tooth at risk to fracture. If a tooth fractures below the gingival tissues or below the crestal bone, it will result in loss of the tooth.
Who do I call if I have pain after the procedure?
Most teeth will be comfortable within a few days of the root canal appointment. If pain or swelling develops after the procedure, our office should be contacted immediately. All patients who have been treated in our office will be given contact information to reach their doctor (during or after scheduled business hours) in case a post-treatment emergency develops.
Will my medical insurance cover this treatment?
Medical insurance will not cover dental procedures. A root canal is considered a dental procedure even though it may be complicated or completed using surgical approaches.
Does Medicare insurance cover this type of treatment?
Medicare insurance covers only medical procedures and does not cover dental procedures such as root canal or surgical root canal treatment.
Does Medicaid insurance cover root canal procedures?
Medicaid insurance does not cover root canal procedures for an adult patient.
Are you in my dental network?
We file paperwork for all dental insurance carriers. We are not a participating dentist in any of the dental networks so we are considered a non-participating dental provider. We will be happy to assist you in determining the differences in cost between a participating and non-participating dental specialist. In our experience of filing dental insurance for our patients, we have noticed that the “out of pocket” cost differential to our patients who require specialist endodontic treatment is very similar to the out of pocket treatment costs of a “participating” practitioner.