What is Endodontics?
odonto- relating to tooth. [Greek odont ‘tooth’]
-logy (ology) denoting a subject of study [Greek logia]
Endodontics is the branch of dentistry that is concerned with the management of the hollow space inside the tooth, commonly known as the ‘root canal’. This space contains the nerves and blood supply of the tooth, called the ‘dental pulp’, which helps to nourish a healthy tooth. The dental pulp also helps to protect a diseased tooth.
Endodontology is the study of the pulp in health and disease. It concerns all aspects of dentistry that may directly or indirectly affect the pulp.
The tooth is divided into the Crown and the Root. The crown is the ‘white biting surface’ that you can see on the tooth. The root (or roots) of a tooth holds the tooth in the jawbone, which is surrounded by ‘gums’.
The hard outer surface of the crown is the Enamel. Beneath this is the hard Dentine, which can transmit sensations to the Pulp. The pulp, containing nerves & blood vessels, extends into the roots of the tooth. These nerve & blood vessels exit the tooth through openings at the tip of the root into the jawbone, where they join a larger blood & nerve supply from the body.
There are approximately 500 different species of bacteria that can normally be found in the mouth. These bacteria, when given the opportunity, are responsible for causing the dental diseases such as caries (‘decay’), periodontal (‘gum & bone’) disease and endodontic (‘root canal’) infections. The pulp can get inflamed or, in the worst cases infected, when the tooth’s natural defences (the hard enamel and reparative pulp-dentine) are breached. The usual causes of such breaches are deep decay, repeated dental procedures on the tooth, or trauma to the tooth.
The pulp is a delicate organ and very often does not survive multiple injuries by bacteria, heat or chemical irritation (usually from filling materials). With mild irritation the pulp may just become inflamed and if managed early enough, the inflammation can be reversed. However, when the pulp ‘dies’, the resulting infection becomes established inside the root canal and may lead to an abscess in the bone.
At this point, the tooth may either be extracted or saved by carrying out root canal treatment (Endodontic treatment).
Signs of pulp damage include pain, prolonged sensitivity to heat and cold, discolouration of the tooth, and swelling and tenderness in the nearby gums. Occasionally there are no symptoms and you may be completely unaware that there is a low-grade underlying infection in the tooth.
Conventional endodontic treatment is a highly skilled procedure that involves gaining access to the pulp chamber and root canals of the tooth. The fine root canals need to be enlarged to allow cleaning solutions and medicaments to be placed in the canal space. A suitable rubber-based filling material can then be placed in the prepared root canal. This filling material provides a seal, preventing bacteria re-entering the tooth to cause another infection.
Root canal treatment is usually carried out in a single 90-120 minute appointment. Occasionally further visits may be required in complicated cases.
All dentists are trained to carry out simple root canal treatment during their undergraduate dental training. Some dentists develop a special interest in endodontics and gain further training to manage the more complex cases.
An Endodontist is a specialist that has undergone a formal training period leading to a post-graduate qualification in Endodontics. Specialists in Endodontics usually limit their practice to endodontics and are registered on the General Dental Council’s list of Dental Specialists in the UK
Many general dental practitioners refer to specialists either for advice or because the case is so complicated that it requires specialist skills for a more predictable outcome. Indeed, studies have shown that success rates for first time endodontic treatment can be 85-96% in the hands of a specialist.
The majority of cases that are referred to a specialist are those where previous attempts at root canal treatment have failed. Success rates for such re-treatment cases are usually in the region of 80%, in the hands of a specialist.
You have been referred to Dr Ayub because your dentist cares about you!
By referring to a specialist, He/She wants to give you the opportunity to have the best chance of laying a good foundation for your tooth.
In addition to root canal treatment or re-treatment, you may also be referred to see a specialist in Endodontics for the following:
- Differential diagnosis and treatment of oro-facial pain of dental origin
- Prevention of pulpal disease and vital pulp therapy
- Surgical endodontics
- Bleaching of endodontically treated teeth
- Treatment procedures related to the restoration of teeth such as post/core preparations, crown lengthening and forced eruption
- The treatment of traumatised teeth (teeth that have fractured or knocked out of alignment).
With modern techniques and anaesthetics, most patients report that they are comfortable during the procedure. You will be surprised to find that Dr Ayub has the ability to help you relax to the extent that many patients actually fall asleep at some point during the procedure!
For the first few days after treatment the tooth may feel sensitive or ‘bruised’, especially if there was pain or infection before the procedure. This discomfort can be relieved with over-the-counter analgesics (such as Ibuprofen or Paracetamol) or prescription medications.
If you have severe pain that starts after three to four days of mild discomfort following root canal treatment, contact Dr Ayub immediately.
There is a common misconception that root canal treatment is very painful. There are certain situations, for example when a nerve is inflamed, that require a different approach to treatment. Dr Ayub has the skill and expertise to manage such situations with minimal discomfort.
You should avoid biting on the root treated tooth until you have it restored back to function by your dentist. The un-restored tooth is susceptible to fracture so you should see your dentist as soon as possible following the completion of root canal treatment.
A root treated tooth should last as long as a natural tooth, provided that the root filling and the crown of the tooth are well maintained. Occasionally the tooth may become painful or re-infected (new decay or trauma) months to years after successful treatment. When this is the case, the root filling may be revised.
In a few cases, a tooth that has undergone endodontic treatment fails to heal or the pain continues. Such cases require additional endodontic treatment (such as endodontic surgery) to save the tooth.
Most teeth can be root treated, provided there is enough tooth structure for the tooth to be restored. Occasionally root canals may not be accessible which could render root canal treatment impossible. However, such cases may be managed by surgical endodontics.
When a root canal cannot be treated in the usual manner, a surgical approach may be adopted. This involves getting access to the roots of the teeth from the bone by lifting up the gum around the tooth, removing a little bone to gain access to the roots of the tooth and removing the part of the root that is diseased.
There are four main surgical procedures that may be carried out:
- Incision & Drainage- making a hole in the gum or bone to ‘drain’ a large infection
- Apicectomy- removal of the root tip.
- Root Resection- removal of one root in a tooth with multiple roots.
- Tooth Resection- removal of roots and part of the crown in multi-rooted teeth (cutting the tooth in half).
The only alternative to endodontic treatment is to have the tooth extracted. The remaining space must be restored with a denture, a bridge or an implant. These procedures can be far more costly and time consuming than endodontic treatment and the restoration of your natural tooth.
No matter how effective modern tooth replacements are – and they can be very effective – nothing is as good as your natural tooth.
Consultations
A basic consultation with Dr Ayub costs £100.
Consultations for extensive examinations and treatment plans cost £300.
Treatments
Root canal treatments cost £900 per tooth. This fee applies to any tooth.
There may be an additional cost of £300 for various extra works if required, as prescribed by your referring dentist.
It is important to bear in mind that most root treated teeth require new or replacement crowns by your general dentist, the cost of which ranges between £350-£800+ depending on your general dentist.
Endodontic surgery
Incision, trephination & drainage- £150
Other surgical endodontic procedures- £1,000
Payment methods
We accept cheques (made payable to ‘Ayub Endodontics’) and all major credit cards.
Visa/Delta, Maestro, Mastercard, Solo, Commercial Cards and JCB.
Payment terms and conditions
Practice policy is to receive payments for services rendered at the time of treatment.
Cancellations
We require 48hr notice to cancel an appointment in order to avoid a cancellation charge of £100 or half of the treatment cost – at the practice’s discretion.
If you are any fears, anxiety or nervousness, please let us know. We will endeavour to do our best to accommodate your request.