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What is Endodontics?
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, in which there is a center a soft tissue known as the pulp. Endodontics is a specialty of dentistry that specializes with diseases of the dental pulp and the surrounding area.

What is an Endodontist?
An endodontist is a dentist who has undergone a minimum of two years of extra training in endodontics after graduating from dental school. Both Drs. Yamauchi and Nogueira completed a three-year residency program after dental school. Additionally, Dr. Yamauchi completed a master’s thesis in endodontic research as part of his program.

Endodontists are experienced at finding the cause of oral and facial pain that has been difficult to diagnose. Although some general dentists may perform endodontic treatment, patients are often referred to an endodontist when a case is complicated or more difficult than usual. They have been trained in utilizing a dental operating microscope which allows for much more precise treatment.

Why would I need endodontic treatment?
Endodontic treatment is necessary when the pulp becomes irritated, inflamed or infected. The most common reasons for inflammation or infection are deep cavities (known as caries), repeated dental procedures, cracks or chips. Trauma can also cause inflammation and often discolors the tooth. If pulp inflammation or infection is left untreated, it can cause pain and swelling, or lead to an abscess.

What are signs and symptoms of a tooth requiring endodontic treatment?
Indications for endodontic treatment include prolonged sensitivity to heat or cold, discoloration of the tooth, swelling or tenderness of the tooth, or adjacent gums. Many times, however, there are no symptoms, which is why it’s important to have regular check-ups with your general dentist and endodontist.

How can endodontic treatment help me?
The endodontist removes the inflamed or infected pulp, carefully cleans and shapes the canal system, and then seals the tooth (Figures 1 and 2). Once treatment is completed, you may be instructed to return to your dentist for permanent restoration, such as a crown (Figures 3 and 4). The restoration of the tooth is an important part of treatment because it seals the cleaned canals from the oral environment, protects the tooth and allows it to function normally.

Will I feel pain during or after the procedure?
Tooth pain can be a primary reason patients seek treatment. Fortunately, modern anesthetics can make the procedure pain-free in most cases. Seeking treatment early makes the procedure more comfortable, so don't wait. When caught early, treatment should feel no different than having a regular filling.

For the first few days after treatment, there may be some discomfort and/or sensitivity to biting pressure, especially if there was pain or infection before the procedure. Sometimes it takes several days for the inflammation to subside. If needed, over-the-counter anti-inflammatory medications like ibuprofen or acetaminophen are recommended.

What happens during endodontic treatment?
First, you will meet Dr. Yamauchi or Dr. Nogueira to discuss your case and answer any questions you may have. Generally, the treatment process involves several steps. First, a local anesthetic will usually be administered for comfort. Next, a sheet of latex called a "rubber dam" (we have non-latex ones too) will be placed around the tooth to isolate it, and keep it clean and dry during treatment. Then the endodontic treatment is performed, followed by placing either a permanent or temporary filling. Afterwards, you will be referred back to your general dentist to continue your care.

The number of office visits will depend on your particular case. Some treatments require two visits, but many are just a single visit. Occasionally, however, up to three appointments are needed. The number of required visits depends on the level of infection and inflammation, and the degree of treatment difficulty. 

There are, of course, no guarantees when it comes to dental treatments. But endodontic therapy has a high degree of success when treated properly. We will discuss with you the chances of success and other options available before beginning any endodontic procedure to help you make an informed decision about your tooth.

What is a “retreatment”?
Occasionally, when a tooth has undergone endodontic treatment it fails to heal or pain continues despite therapy. Sometimes there are missed or untreated canals inside the tooth that allows bacteria to remain and cause continued infection (Fig. 1). Sometimes a tooth initially responds to root canal therapy but becomes painful or diseased months or years later if a new cavity forms under the restoration and bacteria get back in (Fig 2). When either of these situations occur, the tooth often can be maintained with a second endodontic treatment. Basically, the old root canal fillings are taken out, all the root canal spaces are cleaned/re-cleaned, and then refilled and sealed.

What is endodontic surgery?
Teeth with persistent infection that can't be retreated, or don't heal despite retreatment, can be treated through endodontic surgery. This is a minor dental surgery and involves making a small incision in the gums to directly access and clean out the infection around the root end. After the infection is cleaned, the root end is sealed. Endodontic surgery has a high success rate if treated properly. Drs. Yamauchi and Nogueira perform all surgeries using a dental operating microscope for high precision and technique. 

Do you treat traumatic injuries?
An endodontist is specially trained in diagnosing and treating traumatic dental injuries. Many times after facial and dental trauma, the teeth and supporting tissues can be damaged. This can lead to pain and/or infection which often require endodontic treatment.  

Can my tooth always be saved?
Sometimes teeth just cannot be predictably saved. Depending on the health of the tooth and supporting tissues, teeth may have an unfavorable prognosis. Sometimes the tooth can develop a crack. Depending on the extent of the crack, the tooth may not have a good prognosis. If the crack or fracture extends on the root of the tooth, the prognosis is unfavorable. Or if the tooth and root canal have been too damaged from previous treatments, this can lead to an unfavorable prognosis because the tooth is too weak. In these cases, extraction of the tooth may be needed. If extraction is necessary, the space that is left can be replaced by dental implant treatment, bridges, or removable appliances.

Will I need to return to your office for additional visits?
Once endodontic therapy is completed your tooth should be examined periodically, usually every six to 12 months. This allows us to make sure the tooth is healing properly.






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