Endodontics

You’ve probably used the expression yourself. Someone asks you to do something that sounds awful, and you sarcastically reply: “I’d rather have a root canal!” Because of the ineffectiveness of older methods of anesthesia (which aren’t used anymore), this idea of a root canal as the ultimate terrible thing still floats around in popular culture. But it’s completely untrue. Endodontists — the specialists who deals with root canals and diseases of the pulp — are in the business of saving teeth, and with today’s advanced anesthetic techniques, most of the procedures are painless.

Endodontics Basics

Endodontists deal with what’s inside your teeth (“endo” is from the Greek for inside). Teeth are hard on the outside, thanks to enamel and dentin (a hard surface like bone). But inside, they’re gushy, filled with soft connective tissue, called pulp. The pulp is also called the tooth’s nerve. When the pulp is alive, it’s a living structure, says William T. Johnson, DDS, chair of the department of endodontics at the University of Iowa College of Dentistry. Endodontists deal with diseases of the pulp. General dentists handle pulp problems too, but endodontists are called in for more severe or complicated cases.

The real problem is that the pulp/nerve is vulnerable. Bacteria like to attack it, and when that happens, it becomes inflamed (your body’s natural response). But it’s totally encased inside the tooth (picture a hollow log). “There’s no way for the pulp to expand. It can’t swell, so it just creates pressure,” Dr. Johnson says. It also starts to lose its blood supply, which means that it can’t heal itself. It slowly starts to die (you’ve probably heard the term “dying nerve”) and as it does that, it starts to leak out the tiny hole where the blood vessel once came in.

This rouge tissue can eat away at the bone (which weakens the tooth), and cause a nasty infection that leads to an abscess tooth. That’s where the pain comes in. Symptoms of nerve problems include regular dental sensitivity to heat or cold, tenderness of teeth to the touch or pain when chewing, and facial and oral swelling. However, Dr. Johnson says, sometimes there are no symptoms and no pain, and it’s only discovered during a routine dental exam. The good news is that endodontic procedures — such as a root canal — can fix the problem and save the tooth (the alternative is tooth extraction). Most patients who have had a root canal performed by an endodontist say the procedure was virtually painless.

Is Tooth Pulp That Special?

Why is there is an entire specialty that deals solely with the stuff going on inside the tooth? Because it can get dicey very quickly, and general dentists have limited training in more complicated diseases of the pulp. The American Dental Association recognizes endodontics as one of the nine specialties. After four years of dental school, endodontists complete two more years of specialized training in endodontics. Unlike general dentists, they only deal with endodontic issues. Root canal therapy is the most common, but there are other procedures beyond that (if the root canal wasn’t successful or if there are other complications). “We are also specialists in the treatment of traumatic injuries, such as cracked teeth,” Dr. Johnson says. Endodontists are expert diagnosticians as well.

Endodontists partner closely with general dentists. They’re rarely the first stop in someone’s dental journey. In fact, usually a patient is referred to an endodontist by their general dentist. “We partner with general dentists and work very closely with them,” Dr. Johnson says. It’s not an either/or situation: it’s a continuum of care, and everyone’s goal for the patient is the same: to ensure good quality of life and overall oral health.

Endodontic Costs

The cost of endodontic procedures varies greatly according to where you live. Root canals are generally more expensive on the coasts and in the larger population centers. For example, the average cost for a root canal is around $1,000 in the central part of the country (for a root canal on a molar), and closer to $1,500 on the east coast or west coast, Dr. Johnson says. Dental insurance also varies: some plans cover 50 percent (or less) and some 80 percent. Dental benefits haven’t increased in the last 30 years (the $1,500 benefit has been the standard since 1974, Dr. Johnson says), but many endodontist offices will work out payment plans with you.