Natasha Flake, DDS, PhD, MSD, vice president of the American Association of Endodontists. Dr. Flake is an associate dean and professor in the department of endodontics at University of Washington School of Dentistry, Seattle.
You’re eating ice cream with your grandchild when a sudden, intense jolt of pain shoots through your molar and lingers for the rest of the afternoon. Or while attempting to rip open the plastic packaging on a new refrigerator filter several months ago, you unknowingly cracked your front tooth and now it’s starting to ache. Or perhaps you were diagnosed with a cavity just before the COVID-19 pandemic hit and never had it treated because you were scared to be maskless in a medical setting…now you can barely chew food without searing pain.
For each of these scenarios, most people would dial their general dentist…and chances are that he/she could squeeze you in and craft a treatment plan. But there is an alternative when it comes to painful dental emergencies—an endodontist…and he/she may be better equipped to fix the problem.
Endodontists are dentists who have undergone two or more additional years of advanced training beyond dental school, during which they become experts in tooth pain, infection and disease. All endodontists are dentists, but less than 3% of dentists are endodontists. An endodontist’s practice focuses on treating the inside of teeth—the pulp, which includes blood vessels, nerves and connective tissues. (“Endo” is Greek for “inside” and “odon” is Greek for “tooth.”)
These highly specialized dentists do everything they can to save damaged or infected teeth and prevent them from being pulled. Damage may happen when bacteria sneak into the pulp through a long-neglected cavity or a crack created by dental trauma such as a fall, a car accident or even just biting down on something the wrong way. When bacteria infiltrate a tooth, they can cause inflammation, infection, lingering sensitivity to hot or cold temperatures, pain (especially when eating sticky or crunchy foods and particularly on the release portion of the bite) and even tooth loss. You may also find a pimple-like bump on the gum, which is evidence of the buildup of bacteria in and around a tooth.
This is where endodontists come in. They are experts at saving teeth using two procedures in particular…
Root canal: This in-office procedure is designed to save natural teeth. A root canal starts with a hole being cut in the top of the affected tooth so that the endodontist can access the pulp. Through that hole, the inside of the tooth is cleaned and disinfected. The tooth is then sealed, and a new filling or a crown is placed. This procedure takes only one or two visits.
Endodontists perform up to 25 root canals a week. Most general dentists perform two or fewer a week.
In many cases, diseased teeth that would have been pulled can be saved with endodontic treatment. That’s important, because missing teeth allow remaining teeth to shift, affecting your ability to chew and significantly changing the aesthetics of your smile. A pulled tooth can be replaced with a replica of some sort—an implant, denture or removable partial denture—but the artificial tooth will never function as well as the original one.
Unfortunately, root canals have a bad reputation, making them among the most feared medical procedures. A recent study by the American Association of Endodontists (AAE) found that 53% of US adults would rather have a snake in their lap for 15 minutes than get a root canal…62% would rather run a marathon…and 54% would rather sing the national anthem at a sporting event.
When given the choice between having a root canal or having a painful, infected tooth pulled, patients usually opt for the extraction. Reason: They think having a tooth pulled will hurt less and cost less.
Reality: The opposite is true. An endodontist’s skill in administering anesthetics and using cutting-edge dental technology means that the procedure can be virtually painless. Most patients remain awake during root canals, which are done under local anesthesia. Particularly anxious patients may opt for nitrous oxide, also known as laughing gas, or an oral antianxiety medication to help them through the procedure. The negative, painful connotations that root canals have earned usually are due to the pain associated with the tooth before the treatment, not during it.
Tooth extraction, on the other hand, frequently hurts more than the infection itself and is more traumatic to the mouth and gums. Root canal patients are six times more likely to describe the procedure as painless compared with patients who have a tooth pulled, according to the AAE.
Replacement of a natural tooth also requires multiple dental visits that can quickly add up cost-wise, as prosthetics such as implants and bridges must be placed and then maintained over the years. When an endodontist saves a natural tooth, he/she also is saving the patient the future expenses and time associated with pulled teeth.
Sometimes a tooth is too damaged or diseased to be saved and must be pulled, but whenever saving it is possible, an endodontist will try.
Apicoectomy: Calcium deposits in the pulp are a natural part of aging and can develop in response to trauma. When calcium deposits in the tooth make it difficult for traditional root canal instruments to be used effectively, an endodontist can perform a root-end resection, also called apicoectomy. This surgery also may be needed to help teeth that are causing trouble even after a root canal procedure…or to treat teeth with damaged roots.
Like root canals, apicoectomies are done in the endodontist’s office under local anesthesia. Rather than approaching the pulp from the top of the tooth, the endodontist opens the gum tissue and enters the tooth through the base of the root to clear out any infected or inflamed tissue. A filling is then placed, and a few stitches are used to close up the gums.
The sooner you treat a cracked, chipped or infected tooth, the better your chances are of saving it. Under the best circumstances, your dentist and endodontist will work together to ensure the optimal dental outcome—general dentists refer about half of their root canal patients to an endodontist in an average year.
Your dentist can give you a referral to an endodontist, or you can find one using AAE’s “Find My Endodontist” search tool at FindMyEndodontist.com or by asking friends for recommendations. Most insurance companies cover root canal therapy and other endodontic treatment, but call your insurer first to double check.
According to the American Dental Association Health Policy Institute, 69% of dentists have reported an increase in teeth grinding and clenching among patients since the start of the pandemic…and 63% have seen an increase in cracked teeth. The likely culprit? Stress.
Stress-related clenching and grinding create wear and tear on teeth, which may ultimately necessitate root canal treatment. Symptoms of damaged teeth include sensitivity to cold and hot temperatures that lingers after swallowing as well as pain when biting.
Nearly 40% of the dentists surveyed reported an increase in cavities and gum disease. This may be due to changing diets (stress-eating sweets, for instance) and deteriorating oral hygiene habits (it was a lot easier to forget to brush your teeth when every day blurred into the next).
If you suspect a cracked tooth or have put off seeing your dentist because of the pandemic, make an appointment as soon as possible.