Nothing is as good as a natural tooth! And sometimes your natural tooth may need root canal (endodontic) treatment for it to remain a healthy part of your mouth.

Most patients report that having root canal (endodontic) treatment today is as unremarkable as having a cavity filled.

If you've been told you need root canal (endodontic) treatment, you can find the answers to your questions below.

1. Who performs endodontic treatment?
2. What is an "endodontist"?
3. Why is there a need for endodontic treatment?
4. What are the signs of needing endodontic treatment?
5. How does endodontic treatment save the tooth?
6. Will I feel pain during or after the procedure?
7. How much will the procedure cost?
8. Will the tooth need any special care or additional treatment?
9. What causes an endodontically treated tooth to need additional treatment?
10. What is endodontic surgery?

Who performs endodontic treatment?
All dentists, including your general dentist, received some training in endodontics while in dental school. Often general dentists refer patients needing root canal treatment to endodontists.

What is an "endodontist"?
Endodontists are dentists who specialize in treating the soft inner tissue of your tooth's roots. After they complete dental school, they attend another dental school program for two or three more years. This program is called an advanced specialty education program. They study only endodontic treatment and learn advanced techniques so they can give you the very best care.

Why is there a need for endodontic treatment?
Sometimes the pulp inside your tooth becomes inflamed or infected. This can be caused by deep decay, repeated dental procedures on the tooth, a crack or chip in the tooth, or a blow to the tooth.

What are the signs of needing endodontic treatment?
Signs to look for include pain, prolonged sensitivity to heat or cold, discoloration of the tooth, and swelling and tenderness in the nearby gums. But sometimes, there are no symptoms.

How does endodontic treatment save the tooth?
After obtaining good anesthesia, the endodontist removes the inflamed or infected pulp, carefully cleans and shapes the inside of the tooth, then fills and seals the pulp space with the gutta percha root filling material. Afterwards, you return to your general dentist, who will place a crown or other restoration on the tooth to protect it and restore it to full function.

Will I feel pain during or after the procedure?
While many patients may be in great pain before seeing an endodontist, most report that the pain is relieved by the endodontist and that they are comfortable during the procedure. For the first few days after treatment, the tooth may feel sensitive, especially if there was pain or infection before the procedure. This discomfort can be relieved with over-the-counter or prescription medications. The endodontist will tell you how to care for your tooth at home.

How much will the procedure cost?
The cost varies depending on how severe the problem is and which tooth is affected. Many dental insurance policies cover endodontic treatment. Generally, treatment and restoration of your natural tooth is the least expensive option. The only alternative is having the tooth extracted and replaced with a bridge, implant, or removable partial denture to restore chewing function and prevent adjacent teeth from shifting.

Will the tooth need any special care or additional treatment?
You should not chew or bite on the treated tooth until you have had it restored by your general dentist because your tooth could fracture. Otherwise, just practice good oral hygiene - brushing, flossing and regular checkups and cleanings. Endodontically treated teeth can last for many years, even a lifetime.

What causes an endodontically treated tooth to need additional treatment?
New trauma, deep decay, or a loose, cracked or broken filling can cause new infection in your tooth. In some cases, your endodontist may discover very narrow or curved canals that could not be treated during the initial procedure. Sometimes a previously root canaled tooth may develop an infection of the external surface of the root and may need endodontic surgery to be saved.

What is endodontic surgery?
The most common endodontic surgical procedure is an apicoectomy or root-end resection. It is used to relieve inflammation or infection in the bony area around the end of your tooth that continues after endodontic treatment. The endodontist lowers the gum tissue and removes the infected tissue and may remove the very end of the root. A small filling may be placed to seal the root canal. Endodontists use local anesthetics, like those used when you have a cavity filled. Most patients return to their normal activities the next day. For more on surgery, see Endodontic Surgery.

Why do I need endodontic surgery?
Before understanding endodontic surgery, it is important to understand nonsurgical endodontic treatment. Nonsurgical endodontic treatment is more commonly known as root canal treatment. It is necessary when the soft inner tissue of the tooth, the pulp, becomes inflamed or infected. Endodontic treatment involves removal of the damaged pulp. The canals are then cleaned, filled and sealed to preserve the tooth.

Sometimes endodontic treatment alone cannot save your tooth, and your dentist or endodontist may recommend endodontic surgery. Endodontic surgery includes any surgical procedures used to remove infection from your root canals and surrounding areas. Surgery can also be used in diagnosing problems that do not appear on your x-ray, such as root fractures, or in treating problems in the surrounding bone.

Who performs endodontic surgery?
All dentists are trained in endodontic treatment. Because endodontic surgery can often be more challenging than routine treatment, many dentists refer patients needing surgery to endodontists.
Endodontists are dental specialists who diagnose and treat oral pain. They specialize in endodontic (root canal) treatment, including any treatment for the inner tissues of the tooth. In addition to dental school, endodontists receive two or more years of advanced education. They study root canal techniques and procedures in greater depth, including the area of endodontic surgery.

What is an apicoectomy?
An apicoectomy is the most common endodontic surgical procedure. This procedure is used to remove infection or inflammation from the bony area around the end of your tooth. The endodontist starts by lowering the gum tissue near the tooth. This allows direct viewing of the underlying bone. Next, your endodontist will remove any inflamed or infected tissue. The very end of the root is also removed.

After the inflamed or infected tissue is removed, a small filling may be placed in the root-end to seal the root canal. A few stitches are placed in the gum to help the tissue heal properly. Within a few months, the bone heals around the end of the root.

Are there other types of endodontic surgery?
There are several other types of surgery that are performed, depending upon the situation. Your endodontist will be happy to discuss the specific type of surgery that you might need.

Will endodontic surgery hurt?
Your endodontist will provide you with local anesthetics that will make the procedure comfortable. As with any surgical procedure, there will be minor swelling following the procedure. The swelling usually peaks by the second day and is gone by the fourth day. Most people experience no pain during the procedure and mild post surgery discomfort. Usually only over the counter medications such as ibuprofen or acetominophen are needed to manage the discomfort. Your endodontist will recommend appropriate pain medication to alleviate your discomfort.

What do I do after the surgery?
Your endodontist will give you specific postoperative instructions to follow. If you have questions or if you have pain that does not respond to medication, call your endodontist.

Can I drive myself home?
Patients who have had endodontic surgery are usually able to drive themselves home. But it is a good idea to talk to your endodontist about this prior to your appointment to decide if other transportation arrangements will be necessary.

When can I return to my normal activities?
Most patients return to their normal daily activities one or two days after their surgery. Your endodontist will discuss your expected recovery time with you.

Does insurance cover endodontic surgery?
Many insurance plans do cover endodontic surgery. Each insurance plan is different, however. You should consult with your employer or insurance company prior to treatment.

What are the chances that the surgery will be successful?
Your dentist and endodontist have suggested endodontic surgery because they believe it is the best option for you. Your endodontist will discuss your chances for a successful surgery so you can make an informed decision. Keep in mind that there are no guarantees with any surgical procedure.

What are the alternatives if I choose not to have surgery?
Most often, the only alternative to surgery is extraction of the tooth. You must then replace the extracted tooth with an implant, bridge or removable partial denture. These will restore chewing function and prevent adjacent teeth from shifting. Because these alternatives require surgery or dental procedures on adjacent healthy teeth, endodontic surgery is usually the most cost-effective option. No matter how effective modern tooth replacements are, nothing is as good as your natural tooth.

Microscopes Help Endodontists See Inside Root Canal
A relatively new addition to the instruments used in dentistry, the operating microscope has been used by medical specialists for decades. Endodontists, the dental specialists who treat problems originating inside the tooth, began experimenting with microscopes in the early 1990's, using them to enhance surgical procedures they perform around the roots of teeth. The microscope helps not only by magnifying the surgical field but also by providing more light. In addition, tiny mirrors no more than one tenth the size of traditional dental mirrors help the endodontist see into places where the human eye alone never could.

When endodontists perform endodontic (or root canal) procedures, the goal is to remove pulp tissue comprised of nerves, blood vessels, and connective tissue from canals inside the teeth. The canals are then cleaned, shaped and filled with a special material, and the tooth restored, usually with a crown. This procedure saves teeth when their internal tissues have been damaged by serious decay or other trauma. Without a root canal, these teeth would have to be extracted and replaced with expensive bridgework, partials, or implants.

In most teeth, a canal containing nerves and blood vessels runs from the center of the crown (the part you can see above the gumline) of the tooth through the root and out into the jaw. Near the end of the root, the canal branches into many smaller canals, almost like a river delta. These smaller branches of the canal can be much easier to see with the microscope.

After initially using the mciroscope in surgery, many endodontists discovered that it can also help with diagnosis and nonsurgical endodontic procedures. Endodontists have used the microscope to find tiny fractures, which are often difficult to detect with traditional diagnostic methods. In addition, very small or unusually positioned canals become easier to see.

Sometimes new infection or injury will cause a tooth that has been treated before to need a second endodontic procedure. Endodontists call this "retreating" the tooth. To accomplish retreatment, all previous filling material and posts that may have been placed to support a crown must be removed from the tooth. The microscope can help with these procedures as well.

See a dentist as soon as possible.
Bring the tooth to a dentist or endodontist as soon as possible - ideally within 30 minutes. However, it is possible to save the tooth even if it has been outside the mouth for an hour or more.

Cracked teeth
Today, people are keeping their teeth longer thanks to advances in dental procedures. At the same time, people are also exposing their teeth to many more years of crack-inducing habits and stress. Although cracked teeth are becoming more and more common, these teeth can often be saved if treated promptly.

1. How do I know if my tooth is cracked?
2. Why does my cracked tooth hurt?
3. Why have I been referred to an endodontist?
4. Why does my cracked tooth need to be treated?
5. How will my cracked tooth be treated?
6. After treatment for a cracked tooth, will my tooth completely heal?
7. What can I do to prevent my teeth from cracking?

How do I know if my tooth is cracked?
Cracked teeth exhibit a variety of symptoms. If your tooth is cracked, you might feel occasional sharp, jolting, pain when chewing, particularly between bites as you release the pressure on your teeth. You might also feel pain when you eat or drink something hot or cold. Cracks are difficult to diagnose because the pain comes and goes, and cracks rarely show up on x-rays. Because of this, you may see your dentist several times before the crack is diagnosed.

Why does my cracked tooth hurt?
A crack in a tooth usually affects the soft inner tissue of the tooth called the pulp. The pulp contains blood vessels and nerves. When it is damaged, it causes pain. That is why a cracked tooth hurts-the pulp is damaged. To relieve the pain and save your tooth, the pulp needs to be gently treated.

Why have I been referred to an endodontist?
Endodontists are dental specialists who diagnose and treat oral and facial pain. They specialize in root canal (endodontic) treatment, including any treatment for the inner soft tissues of the tooth. During dental school, all dentists are educated in treating the dental pulp. In addition to dental school, endodontists receive two or more years of advanced education in this kind of treatment. They study root canal techniques and procedures in greater depth, including the treatment of cracked teeth. For this reason, many dentists choose to refer their patients with cracked teeth to endodontists.

Why does my cracked tooth need to be treated?
As mentioned earlier, cracks in teeth often affect the inner tissue of the tooth, the pulp. The pulp contains blood vessels, nerves and connective tissue. When a tooth is cracked, chewing can cause movement of the separate pieces of the tooth. This movement irritates the pulp and often causes pain. The tooth may also become sensitive to temperature extremes. In time, the pulp may become so irritated that your tooth may hurt by itself, even when you are not chewing, or eating or drinking something hot or cold. When the pulp becomes irritated, it needs to be treated in order to save the tooth.

How will my cracked tooth be treated?
The treatment of your cracked tooth depends on the type and severity of the crack. There are five common types of cracks.

Craze lines are tiny cracks that affect only the outer enamel of the tooth. They are common in all adult teeth and cause no pain. Craze lines need no treatment.

The second type of crack involves the cusp. The cusp is the pointed part of the chewing surface of your tooth. If a cusp becomes weakened, a fracture can result. Part of the cusp may break off or may need to be removed by your dentist. But this type of crack, a fractured cusp, rarely affects the pulp. Because the pulp is not affected, it is very unlikely that you would need root canal treatment. Your tooth can usually be restored by your dentist with a crown or other restoration.

If your crack is diagnosed as a cracked tooth, then the crack probably extends from the chewing surface of the tooth vertically towards the root. Sometimes it extends below the gum line and into the root. A cracked tooth is not separated into two distinct segments, but the soft inner tissue of the tooth is usually damaged anyway. If this happens, you will probably need root canal treatment to remove the damaged tissues and save the tooth. It is particularly important to diagnose this type of crack early. In its earlier stages, a cracked tooth can still be saved.

If you have a split tooth, on the other hand, it can never be saved intact. A split tooth is often the result of an untreated cracked tooth that splits into two distinct segments. With endodontic (root canal) treatment, however, a portion of the tooth can sometimes be saved.

Vertical root fractures are cracks that begin in the root and extend toward the chewing surface. They show very few signs and symptoms and therefore may go unnoticed for some time. You may discover that you have a vertical root fracture when the bone and gum surrounding the root become inflamed and infected. Treatment usually involves extraction of the tooth, but sometimes endodontic surgery can save a portion of the tooth.

After treatment for a cracked tooth, will my tooth completely heal?
Unlike a broken bone, the fracture in a cracked tooth will never completely heal. In fact, even after treatment, it is possible that a crack may continue to worsen and separate, resulting in the loss of the tooth.

Despite the possibility for the tooth to worsen, the treatment you receive is important. It will relieve your pain and reduce the chances that the crack will worsen. Most cracked teeth continue to function for years after treatment. Your dentist or endodontist will be able to tell you more about your particular diagnosis and treatment recommendations.

What can I do to prevent my teeth from cracking?
While cracked teeth are not completely preventable, you can take some steps to make your teeth less susceptible to cracks.

• Don't chew on hard objects such as ice, unpopped popcorn kernels or pens.
• Don't clench or grind your teeth.
• If you clench or grind your teeth while you sleep, talk to your dentist about getting a splint or nightguard to protect your teeth.

Wear a mouthguard or a mask when playing contact sports.
And if you experience symptoms of a cracked tooth, see your dentist immediately. If detected early, a cracked tooth can often be saved.