An Endodontist is a dentist who has undergone a minimum of 2 years postgraduate training after completing dental school. Specialist training allows an Endodontist to:

1. deal with diseases of the dental pulp and supporting structures

2. 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.

A Board-Certified Endodontist has further passed a written, cased-based and oral examination and shown exemplary knowledge of the specialty.  Dr. Pannkuk became a Diplomate of the American Board of Endodontics in 1988 and in addition to a full-time clinical practice continues to perform research studies and scholarly projects within the academic community.

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 adult tooth. The tooth continues to be nourished by the tissues surrounding it even after the pulp is removed.

Endodontic treatment is necessary when the pulp becomes inflamed and/or infected. The most common reasons for inflammation or infection are deep caries (decay), repeated dental procedures, cracks or chips. Trauma can also cause inflammation and often shows up as discoloration of the tooth. If pulp inflammation or infection is left untreated, it can cause pain or lead to an abscess.
Indications for treatment include prolonged sensitivity to heat or cold, discoloration of the tooth, swelling or tenderness of the tooth or adjacent gums. Sometimes there are no symptoms and the area of infection is noted by radiographic (x-ray) examination.

The endodontist removes the inflamed or infected pulp, carefully cleans and shapes the canal system and then seals the prepared space in the roots. Often treatment requires an additional visit to insure that adequate time is spent completely cleaning complex root anatomical space before placing the final root filling.  If the tooth is abscessed the second visit is routinely delayed a month or even longer to insure that initial healing has begun.  Multiple visits depend upon the tooth so that the placed medication in the root space has time to thoroughly disinfect the tooth.

Once root canal treatment is completed, you may be instructed to return to your dentist for a permanent restoration (crown or bonded filling) of the top of the tooth. The restoration of the tooth is an important part of treatment because it seals the root canal filling from the oral environment, protects the tooth from fracture and restores it to function.

An ideally treated root, has the internal space completely cleaned and shaped so that all the complex areas are cleared of remaining tissue and debris before it is sealed and restored.

Detailed technical aspects can be found on Dr. Pannkuk's Pure Dental Learning website: www.puredentallearning.com

Toothache pain is the main reason for patients seeking 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 sensitivity to biting pressure, especially if there was pain or infection before the procedure. If there are no contra-indications, 600mg of ibuprofen combined with 1000mg acetaminophen (3 tablets of Advil + 2 tablets of Extra Strength Tylenol) every 8 hours is recommended for 24 to 48 hours after the procedure. The typical inflammatory response peaks at 48 hours then subsides. Do not be alarmed if you feel your tooth a little more two days later. Your endodontist can prescribe other medications but they are rarely required.

Always use caution when taking even over-the-counter medications.  Note that Nonsteroidal Anti-inflammatory medications like ibuprofen (Advil) should be avoided if you have kidney or ulcer problems.  Acetaminophen (Tylenol) should be avoided if you have any liver disease.