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What is an Endodontist and what do they do?
An Endodontist is a dentist who has undergone a minimum of 2 years of extra postgraduate training. This Specialist training allows an Endodontist to:
- deal with diseases of the dental pulp and supporting structures
- diagnose facial pain and related problems.
Your general dentist sometimes refers patients for consultation when the diagnosis is complicated or when treatment is more difficult than normal. Aside from providing treatment, Dr. Morrison believes in patient education. It is important that patients understand why they require treatment, what treatment involves and what they can do to ensure the best possible outcome. In our office, Dr. Morrison deeply believes that a properly informed patient has the best chance of achieving the optimal treatment result.
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What is Endodontics?
Endodontics is a specialty of Dentistry that deals with diseases of the dental pulp and its supporting structures. Endodontists are Dentists with special post-graduate training in this field. Endodontists are also experienced at finding the cause of oral and facial pain that has been difficult to diagnose.
Although General Dentists can perform Endodontic treatment, patients are often referred to an Endodontist when the case is complicated or more difficult than usual.
In order to understand Endodontic treatment, it helps to know something 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.
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Why do I need a root canall?
Infection of the pulp can be caused by trauma to the tooth, deep decay, cracks and chips, or repeated dental procedures. Symptoms of the infection can be identified as visible injury or swelling of the tooth, sensitivity to temperature or pain in the tooth and gums
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How is a root canal performed?
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 more visits depending on the treatment required. Success for this type of treatment occurs in about 90% of cases. If your tooth is not amenable to endodontic treatment or the chance of success is unfavorable, you will be informed at the time of consultation or when a complication becomes evident during or after treatment. We use local anesthesia to eliminate discomfort. In addition, we will provide nitrous oxide analgesia if indicated. You will be able to drive home after your treatment, and you probably will be comfortable returning to your normal routine.
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What happens after treatment?
When your root canal therapy has been completed, a record of your treatment will be sent to your restorative dentist. You should contact their office for a follow-up restoration 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. To prevent further decay, continue to practice good dental hygiene.
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Endodontic Retreatment
With the appropriate care, your teeth that have had endodontic treatment will last as long as other natural teeth. Yet, a tooth that has received treatment may fail to heal or pain may continue to exist. Sometimes, the pain may occur months or years after treatment. If so, Endodontic Retreatment may be needed.
Improper healing may be caused by:
- Curved or narrow canals were not treated during the initial treatment.
- Complicated canals went undetected during the initial treatment.
- The crown or restoration was not placed within the appropriate amount of time following the procedure.
- The crown or restoration did not prevent saliva from contaminating the inside of the tooth.
In some cases, new problems can influence a tooth that was successfully treated:
- New decay can expose a root canal filling material, causing infection.
- A cracked or loose filling or crown can expose the tooth to new infection.
Once retreatment has been selected as a solution to your problem, Dr. Morrison will reopen your tooth to gain access to the root canal filling material. This restorative material will be removed to enable access to the root canal. The doctor will now clean your canals and carefully examine the inside of the problematic tooth. Once cleaned, Dr. Morrison will fill and seal the canals and place a temporary filling in the tooth. At this point, you will need to return to your general dentist in order to have a new crown or permanent filling placed. Please telephone your restorative dentist for an appointment.
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Endodontic Surgery - Apicoectomy
Why would I need Endodontic Surgery? Generally, a root canal is all that is needed to save teeth with injured pulp from extraction. Occasionally, this non-surgical procedure will not be sufficient to heal the tooth and Dr. Morrison will recommend surgery. Endodontic surgery can be used to locate fractures or hidden canals that do not appear on x-rays but still manifest pain in the tooth. Damaged root surfaces or the surrounding bone may also be treated with this procedure. The most common surgery used to save damaged teeth is an apicoectomy or root-end resection.
What is an Apicoectomy? The diagram below illustrates this simple procedure. An incision is made in the gum tissue to expose the bone and surrounding inflamed tissue. The damaged tissue is removed along with the end of the root tip. A root-end filling is placed to prevent reinfection of the root and the gum is sutured. The bone naturally heals around the root over a period of months restoring full function.
Following the procedure, there may be some discomfort or slight swelling while the incision heals. This is normal for any surgical procedure. To alleviate any discomfort, an appropriate pain medication will be recommended. If you have pain that does not respond to medication, please call our office.
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Cracked Teeth
Cracked teeth demonstrate many types of symptoms, including pain when chewing, temperature sensitivities, or even the release of biting pressure. It is also common for pain to come and go, making it difficult to diagnose the cause of discomfort.
Chewing can cause movement of the cracked pieces of your tooth, and the pulp within the tooth becomes irritated. At the same time, when biting pressure is released, the crack can close quickly, resulting in sharp pain. Eventually, the pulp will become damaged and tooth will consistently hurt, even when you are not chewing. It is possible that cracks can lead to infection of the pulp tissue, which can spread to the bone and gum surrounding the problematic tooth.
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Fractured Cusp
When a cusp becomes weakened, a fracture may result. The cusp may break off or be removed by a dentist. A fractured cusp can damage the nerve, and root canal treatment may necessary. If the nerve is not damaged your dentist will usually restore the tooth with a full crown.
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Cracked Tooth
This type of crack extends from the chewing surface of the tooth and vertically migrates towards the root. In some cases, the crack may extend below the gum line. It is possible for the crack to extend further into the root. Damage to the pulp is commonplace. In this case, root canal treatment is usually necessary. A cracked tooth that is not treated will worsen, resulting in the possible loss of the tooth. Therefore, early detection is essential.
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Split Tooth
A split tooth is usually the result of an untreated cracked tooth. It can be identified by a crack with distinct segments. This type of tooth can never be saved intact. Yet, the position and extent of the problem will dictate whether any portion of the tooth can be saved. Sometimes, endodontic treatment by the endodontists and restoration by your dentist can be used to save a portion of the tooth.
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Vertical Root Fracture
A vertical root fracture begins at the root and extends towards the chewing surface of the tooth. Unfortunately, they show minimal symptoms and may go unnoticed. Treatment involves endodontic surgery if a portion of the tooth can be saved by removal of the fractured root. Otherwise the tooth will have to be extracted.
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