HELPFUL LINKS

• American Association of Endodontists - national organization representing the specialty of endodontics or root canal treatment.

• American Dental Association - ADA Online - access to news, publications, and products and services related to dental health.

• American Medical Association - another useful site with links to consumer health information, vast AIDS information center, searchable database of more than 650,000 physicians.

• EndoWeb - provides the most up-to-date information of endodontic interest.

• MedicineNet - Content-rich commercial site includes interactive groups, ask-the-doctor feature, medical dictionary, comprehensive drug information, medical news, disease-specific information, and links.

• Medscape - Searchable commercial collection of full-text articles from such useful sources as the National Institutes of Health and the Centers for Disease Control and Prevention.

• Nevada Dental Association

• ParentsPlace.com - Not health-only, but this commercial site contains many pages of sophisticated, reader friendly information on children's health issues.

• Medical Matrix - Physician maintained commercial database of annotated health links. Oriented toward medical professionals, but accessible to an educated lay person. A keyword search gets you to a subject index, from which you navigate to the links you want.

• WebDental - American based dental database

ENDODONTIC PROCEDURES

As an endodontic patient, what should I expect?

A comprehensive examination is done to diagnose orofacial pain and pulpal injury and to determine if the tooth is a good candidate for endodontic therapy. The purpose of non-surgical treatment is to eliminate the diseased pulp. This injured pulp is removed and the root canal system is thoroughly cleaned and sealed. Under certain circumstances, microsurgery may be indicated. We are experts in performing this procedure, and utilize sophisticated equipment to ensure the best result. Please choose from the procedures in the menu below for more information about your treatment needs.

FREQUENTLY ASKED QUESTIONS

What is endodontics?

Endodontics is a branch of dentistry recognized by the American Dental Association involving treatment of the pulp (root canal) and surrounding tissues of the tooth. When you look at your tooth in the mirror, what you see is the crown. The rest of the tooth, the portion hidden beneath the gum line, is called the root. Though the outer portion of the root is a hard tissue called dentin, the inside channel or "root canal" contains a pulp of soft tissue, blood vessels and nerves. Bacteria that are introduced into the pulp as a result of tooth decay, periodontal disease, tooth fracture or other problems, can severely damage the pulp. When that happens, an endodontic specialist removes the diseased pulp to save the tooth and prevent further infection and inflammation. After successful endodontic treatment, the tooth continues to perform normally.

I'm worried about x-rays. Should I be?

No. While x-rays will be necessary during your endodontics treatment, we use an advanced non-film computerized system, called digital radiography, that produces radiation levels up to 90 percent lower than those of already low dose conventional dental x-ray machinery. These digital images can be optimized, archived, printed and sent to doctors via e-mail or diskette. For more information contact Schick Technologies, Inc.

What about infection?

Again, there's no need for concern. We adhere to the most rigorous standards of infection control advocated by OSHA, the Centers for Disease Control and the American Dental Association. We utilize autoclave sterilization and barrier techniques to eliminate any risk of infection. Our dental unit waterlines have been tested by an independent laboratory and are in compliance with CDC guidelines.

What happens after treatment?

When your root canal therapy has been completed, a record of your treatment will be sent to your restorative dentist. You should contact his/her office for a follow-up restoration within a few weeks of completion at our office. Your restorative dentist will decide on what type of restoration is necessary to protect your tooth. It is rare for endodontic patients to experience complications after routine endodontic treatment or microsurgery. If a problem does occur please call our office at 876-5800.

What new technologies are being used?

Please review our New Technologies page for more information about technology used at Las Vegas Endodontics.

NON-SURGICAL ROOT CANAL

What is a root canal? A root canal is one of the most common dental procedures performed, well over 14 million every year. This intricate treatment can save your natural teeth and prevent the need of dental implants or bridges.

At the center of your tooth is pulp. Pulp is a collection of blood vessels that helps to build the surrounding tooth. Infection or inflammation of the pulp can be caused by trauma to the tooth, deep decay, cracks and chips, or repeated dental procedures. Symptoms of the infection can be identified as visible injury or swelling of the tooth, sensitivity to chewing, temperature, or pain in the tooth and gums.

How is a root canal performed? If you experience any of these symptoms, your dentist will most likely recommend non-surgical treatment to eliminate the diseased pulp. This injured pulp is removed and the root canal system is thoroughly cleaned and sealed. This therapy usually involves local anesthesia and usually is completed in one or more visits depending on the treatment required. Success for this type of treatment occurs in about 90% of cases. If your tooth is not amenable to endodontic treatment or the chance of success is unfavorable, you will be informed at the time of consultation or when a complication becomes evident during or after treatment. We use local anesthesia to eliminate discomfort. However if you are very anxious, oral sedation can be provided. This would have to be arranged prior to your treatment visit and you would not be able to drive to or from the appointment.

What happens after treatment? When your root canal therapy has been completed, a record of your treatment will be sent to your restorative dentist. You should contact their office for a follow-up restoration within a few weeks of completion at our office. Your restorative dentist will decide on what type of restoration is necessary to protect your tooth. It is rare for endodontic patients to experience complications after routine endodontic treatment or microsurgery. If a problem does occur, please call our office at 876-5800. To prevent further decay, continue to practice good dental hygiene.

How much will it cost? The cost associated with this procedure can vary depending on factors such as the severity of damage to the affected tooth and which tooth is affected. In general, endodontic treatment is much less expensive than tooth removal and replacement with an artificial tooth.

ENDODONTIC RETREATMENT

With the appropriate care, your teeth that have had endodontic treatment will last as long as other natural teeth. Yet, a tooth that has received treatment may fail to heal or pain may continue to exist. Sometimes, the pain may occur months or years after treatment. If so, Endodontic Retreatment may be needed.

Improper healing may be caused by:

Curved or narrow canals that were not treated during the initial treatment.

Complicated canals that went undetected during the initial treatment.

The crown or restoration was not placed within the appropriate amount of time following the procedure.

The crown or restoration did not prevent saliva from contaminating the inside of the tooth.

In some cases, new problems can influence a tooth that was successfully treated:

New decay can expose a root canal filling material, causing infection.

A cracked or loose filling or crown can expose the tooth to new infectio

Once revisionary treatment has been selected as a solution to your problem, the doctor will reopen your tooth to gain access to the root canal filling material. This restorative material will be removed to enable access to the root canal. The doctors will now clean your canals and carefully examine the inside of the problematic tooth. Once cleaned, the doctors will fill and seal the canals and place a temporary filling in the tooth. At this point, you will need to return to your dentist as soon as possible in order to have a new crown or restoration placed on the tooth to restore full functionality.

APICOECTOMY

Occasionally, a non-surgical (root canal) procedure will not be sufficient to heal the tooth and your endodontist will recommend surgery. Endodontic surgery can be used to locate fractures or hidden canals that do not appear on x-rays but still manifest pain in the tooth. Damaged root surfaces or the surrounding bone may also be treated with this procedure. The most common surgery used to save damaged teeth is an apicoectomy or root-end resection.

What is an Apicoectomy?

The above diagram illustrates this simple procedure. An incision is made in the gum tissue to expose the bone and surrounding inflamed tissue. The damaged tissue is removed along with the end of the root tip. A root-end filling is usually placed to prevent reinfection of the root and the gum is sutured. The bone naturally heals around the root over a period of months restoring full function. Following the procedure, there may be some discomfort or slight swelling or bruising while the incision heals. This is normal for any surgical procedure. To alleviate any discomfort, an appropriate pain medication will be recommended.

CRACKED TEETH

Cracked teeth demonstrate many types of symptoms, including pain when chewing, temperature sensitivities, or even pain on the release of biting pressure. It is also common for pain to come and go, making it difficult to diagnose the cause of discomfort.

Chewing can cause movement of the cracked pieces of your tooth, and the pulp within the tooth becomes irritated. At the same time, when biting pressure is released, the crack can close quickly, resulting in sharp pain. Eventually, the pulp will become damaged and tooth will consistently hurt, even when you are not chewing. It is possible that cracks can lead to infection of the pulp tissue, which can spread to the bone and gum surrounding the problematic tooth.

Types of Cracks:

Craze lines

These are tiny cracks that only affect the outer enamel of the tooth. These cracks are more common in adults. These types of cracks are superficial and are usually of no concern.

Fractured Cusp

When a cusp becomes weakened, a fracture may result. The cusp may break off or be removed by a dentist. A fractured cusp rarely damages the pulp, so a root canal is not necessary. Your dentist will usually restore the tooth with a full crown.

Cracked Tooth

This type of crack extends from the chewing surface of the tooth and vertically migrates towards the root. In some cases, the crack may extend below the gum line. It is possible for the crack to extend further into the root. Damage to the pulp is commonplace. In this case, root canal treatment is usually necessary. A cracked tooth that is not treated will worsen, resulting in the loss of the tooth. Therefore, early detection is essential.

Split Tooth

A split tooth is usually the result of an untreated cracked tooth. It can be identified by a crack with distinct segments. This type of tooth can never be saved intact. Yet, the position and extent of the problem will dictate whether any portion of the tooth can be saved. Sometimes, endodontic retreatment by the doctors and restoration by your dentist can be used to save a portion of the tooth.

Vertical Root Fracture

A vertical root fracture begins at the root and extends towards the chewing surface of the tooth. Unfortunately, they show minimal symptoms and may go unnoticed. Treatment involves endodontic surgery if a portion of the tooth can be saved by removal of the fractured root. Otherwise the tooth will have to be extracted.

TRAUMATIC INJURIES

Injuries to the mouth can cause teeth to be pushed back into their sockets. Your endodontist or general dentist may reposition and stabilize your tooth. Root canal treatment is usually started within a few weeks of the injury and a medication, such as calcium hydroxide, will be placed inside the tooth. Eventually, a permanent root canal filling will be implanted.

Sometimes a tooth may be pushed partially out of the socket. Again, your endodontist or general dentist may reposition and stabilize your tooth. If the pulp remains healthy, then no other treatment is necessary. Yet, if the pulp becomes damaged or infected, root canal treatment will be required.

If an injury causes a tooth to be completely knocked out of your mouth, it is important that you are treated immediately! If this happens to you, keep the tooth moist. If possible, put it back into the socket. A tooth can be saved if it remains moist. You can even put the tooth in milk or a glass of water (add a pinch of salt.) Your Endodontist may start root canal treatment based upon the stage of root development. The length of time the tooth was out of your mouth (the first 1-2 hours are critical) and the way the tooth was stored, may influence the type of treatment you receive.

INJURIES IN CHILDREN

An injured immature tooth may need one of the following procedures to improve the chances of saving the tooth:

Apexogenesis
This procedure encourages the root to continue development as the pulp is healed. Soft tissue is covered with medication to encourage growth. The tip of the root (apex) will continue to close as the child gets older. In turn, the walls of the root canal will thicken. If the pulp heals, no additional treatment will be necessary. The more mature the root becomes, the better the chance to save the tooth.

Apexification
In this case, the unhealthy pulp is removed. The Doctors place medication into the root to help a hard tissue form near the root tip. This hardened tissue provides a barrier for the root canal filling. At this point, the root canal walls will not continue to develop, making the tooth susceptible to fractures. So it is important to have the tooth properly restored by your dentist.