“Endo” is the Greek word for “inside” and “odont” is the Greek word for “tooth.”  Endodontic treatment, commonly called a “root canal,” treats the inside of the tooth.  The inside or “pulp” of the tooth contains blood vessels, nerves and connective tissue and is surrounded by the hard white outer tissues of the tooth.  The pulp is the living tissue inside the tooth.  It sometimes becomes inflamed or infected.  It may eventually die, leaving a space inside the tooth that is prone to infection.  In endodontic treatment, the inside tissues of the tooth are removed and the space inside is thoroughly cleaned and disinfected, and replaced with a material that will allow the tooth to heal.

Root canal treatment doesn’t cause pain, it relieves it.  Most patients see their endodontist when they have a severe toothache.  The toothache can be caused by damaged tissues in the tooth. The tissues may be damaged when they become inflamed or infected due to deep decay.  Or the damage may occur as a result of trauma.   Root canal treatment removes this damaged tissue from the tooth, thereby relieving the pain you feel.  The perception of root canals being painful began decades ago when root canal treatment was painful.  But with the latest technologies and anesthetics, root canal treatment today is no more uncomfortable than having a filling placed.  In fact, a recent survey showed that patients who have experienced root canal treatment are six times more likely to describe it as painless as patients who have not had root canal treatment. 

Dr. Behrend strives to make endodontic treatment as pain-free as possible.  However, if you are really nervous, oral sedation is a good option.  Oral sedation with Ativan, sometimes combined with nitrous oxide, can prevent dental anxiety.  You will be sleepy but not unconscious and you probably will not remember the procedure. 
It takes a separate appointment to set up oral sedation.  See “Oral Sedation for Endodontic Treatment.”

Saving your natural tooth should always be your first choice when dental care is needed.  Nothing, not even the most advanced bridges and implants, can truly replace your natural tooth.  Tooth replacements may cause you to avoid chewing certain foods on that side and could affect the rest of your teeth or your overall nutrition.  Dental implant procedures can be complex, costly, and time-consuming.  Do everything possible to save your teeth before considering extraction.  Nothing is as good as your natural tooth!  Endodontic treatment has a very high success rate.  Many teeth that have been treated by root canal last a lifetime.

All dentists receive basic training in root canal treatment in dental school.  Although some general dentists perform root canal procedures, many refer their patients to endodontists.  See “Why see a specialist?”.  Endodontists have two or three years of specialized training beyond dental school in root canal treatment.  Many have performed thousands of procedures and are familiar with all the potential complications that may arise.  They have specialized training in the latest technology, including the use of the ultrasonic, apex locator, digital imaging, and the operating microscope. Endodontics is one of the nine specialties recognized by the American Dental Association.  Because they limit their practice to endodontics, endodontists have lots of experience in handling difficult cases, such as teeth with narrow or blocked canals or unusual anatomy. 

Signs to look for include pain, prolonged sensitivity to heat or cold, tenderness to touch and chewing, discoloration of the tooth, and swelling, drainage and tenderness in the nearby tissues.  Sometimes, however, there are no symptoms.  At times, there are indications on the dental X-rays that the tissues around the roots are being affected by the tissues inside the tooth.  The endodontist is specially trained to evaluate pain of the teeth and face. 

Please call the office at 866-1989 and speak to the receptionist or office manager to discuss the cost of endodontic treatment.  The cost varies according to the complexity of the procedure.  The cost for oral sedation is separate from the cost of the procedure itself.  Generally, dental insurance plans provide coverage for endodontic treatment.  If you have specific questions about your coverage, you should speak to your insurance company directly.  We will be happy to assist you with information about the specific fees and dental procedure codes so that you will be able to get accurate information from the insurance company.  Usually, endodontic treatment and restoration of the natural tooth is less expensive than the alternative of extraction followed by replacement with a bridge or implant and crown.

You should not chew or bite on the treated tooth until you have had it restored by your dentist.  The unrestored tooth is susceptible to breakage and the temporary filling will last only a few weeks, so you should see your dentist for full restoration as soon as possible.  Once it has been restored with a permanent filling or crown, you need only practice good oral hygiene, including brushing, flossing, and regular checkups and cleanings.

Retreatment, whether surgical or non-surgical, can be more challenging than first-time treatment, and many dentists refer patients needing retreatment to endodontists. 
Most endodontically treated teeth last as long as other natural teeth.  In a few cases, a tooth that has undergone endodontic treatment does not heal.  Occasionally, a treated tooth may become painful or diseased months or even years after successful treatment.  This might occur because the canals were not cleaned completely, or a small accessory canal might have been overlooked.  Also, it may be that the root canal treatment was successful, but later the tooth became cracked or decayed, allowing bacteria to re-enter the inside of the tooth.  Re-doing the endodontic procedure may be able to save the tooth.  Endodontists use their specialized training and experience to perform endodontic retreatment. A consultation appointment is required before retreatment, so that Dr. Behrend can evaluate your problem and advise you on the need for retreatment.  He will inform you of the likelihood of success with the procedure and describe the procedure.  Retreatment is done in two appointments, approximately one week apart.

The most common surgical procedure that can be performed to save a tooth is called apicoectomy, or root end resection.  When inflammation or infection persists in the bony area around the end of your tooth after a root canal procedure, your endodontist may need to do apicoectomy.  In this procedure, the endodontist opens the gum tissue to see the underlying bone and to remove any inflamed or infected tissue.  The very end of the root is also removed.  Sometimes, tissue is removed that should be examined by an oral pathologist.  If a biopsy is done, the tissue will be sent to UNC School of Dentistry Oral Pathology Department for analysis.  A separate biopsy fee is charged in order to cover the oral pathologist’s services. 
Sometimes calcium deposits make a canal too narrow for the instruments used in non-surgical root canal treatment to reach the end of the root.  If your tooth has this “calcification” your endodontist may perform endodontic surgery to clean and seal the remainder of the canal.

Dr. Behrend recommends oral sedation for patients undergoing endodontic surgery.  You will take a pill one hour before your appointment.  You will be sleepy during the procedure and for several hours. You may not remember the surgery or the few hours after the procedure.   You must have someone to drive you to the appointment and to drive you home.  You should not plan to go out again the day of your surgery.  Resting with your head elevated for a few hours helps to minimize swelling and discomfort.  You should be able to resume normal activities the next day.

If your general dentist has told you that you definitely need a root canal, and you have never had a root canal on that tooth before, you should schedule an appointment for treatment.  The treatment will last about an hour, so plan on being here in the office about an hour and 20-30 minutes, allowing time for filling out forms.  Some of our forms may be downloaded from the website and may be filled out before your appointment to save time.  If you are unsure about having root canal treatment, please let the receptionist know before scheduling your treatment appointment.  She may be able to answer questions that will resolve the problem.
Dr. Behrend will always evaluate the need for treatment with X-rays and testing before proceeding with treatment to make sure treatment is necessary and to confirm that your symptoms are being caused by the specific tooth that has been identified by your general dentist.  If it turns out that you do not need a root canal, or that root canal treatment will be unlikely to save your tooth, then you will be charged for a consultation appointment.  If Dr. Behrend starts treatment and finds that the tooth cannot be saved, he will charge a reduced fee for incomplete endodontic treatment. 
If you are experiencing severe pain and/or facial swelling, we will make every effort to see you the same day that you call.  When a tooth is highly inflamed or infected, we will see you for emergency treatment to open the tooth and allow the inflammation and infection to subside.  You will then return in one week to complete the treatment. 
If your general dentist is unsure whether your discomfort is coming from the inside of your tooth, it may be better to schedule a shorter consultation appointment.  Dr. Behrend is specially trained in the diagnosis of dental pain.  A consultation appointment should also be scheduled if you would like to have oral sedation for your root canal treatment, or if you need retreatment or endodontic surgery.

The office is open Mondays through Friday.  On Wednesday and Friday, the office closes early, at 1:00 pm.  During office hours, please call the office at 866-1989 with your questions or problems.  We will give Dr. Behrend the message when he is finished seeing patients.  You should have a reply in most cases within a few hours.  After hours, Dr. Behrend’s cell phone number will be on the office recorded message.