Endodontics is the branch of dentistry concerned with the prevention, diagnosis, and treatment of diseases and injuries of the tooth root, and the tissues inside and surrounding the roots.

Endodontic treatment is a dental procedure usually performed when:

• The nerves and blood vessels inside of the tooth root(s) (known as the “pulp”) are dying, dead or have doubtful health.
• There is an infection inside the tooth root(s).
• There is infection-related inflammation of the tissues around the tooth root(s).
• The above may have occurred due to tooth decay, dental trauma, or stress cracks in teeth.

Examples of endodontic treatment include:

• Pulp protection procedures
• Root canal treatment
• Surgical endodontics (e.g. apical surgery)

To control infection inside of a tooth and thus allow the tissues around the tooth to heal and/or stay healthy so that the tooth can be retained.

Root canal treatment involves cleaning the infected “tunnels” (known as 'root canals') inside of the tooth, and then sealing the space left with a root filling to prevent reinfection.

The procedure involves:

• Administration of local anaesthetic
• Placement of a protective sheet (known as the ‘rubber dam’ or ‘dental dam’ around the tooth.
• Removal of all or part of the existing restorative material in the tooth.
• Shaping and cleaning the root canal(s) with fine sterile dental instruments and cleaning solutions.
• Filling the cleaned root canal(s). The root filling material is usually a rubbery material called gutta-percha.
• Taking small dental x-ray image(s).
• Filling the hole in the tooth with a semi-permanent or definitive core filling.

Root canal retreatment involves re-cleaning infected root canal(s), and then re-sealing the space left with a new root filling. The processes are similar to root canal treatment (see above); however, it can sometimes be more challenging to perform.

Apical surgery is a minor surgical procedure which involves cleaning and filling the tips of the root(s).

The procedure involves:

• Adminstration of local anaesthetic.
• Cutting and lifting of the gum
• Removal of the tip of the root.
• Cleaning and filling of the new tip of the root.
• Taking small dental x-ray image(s).
• Replacement of the gum being held in place with dissolvable stitches.

Traditionally, success means your tooth should be symptom-free and without evidence of infection after completing endodontic treatment. The probability of endodontic treatment being successful is usually high, but treatment cannot be guaranteed to be effective. Sometimes endodontic treatment has been completed to a satisfactory standard, but it is ineffective. There is a risk of persistent infection which may then require further dental treatment, including further endodontic treatment or removal of the tooth (known as 'extraction'). It should be remembered that endodontic treatment aims to control infection, and it is not currently possible to make the inside of a tooth completely free from bacteria or other microbes.

It is important that you take time to carefully consider all options available for your tooth, including the associated pros, cons, risks, likely prognoses and financial costs. The alternatives to endodontic treatment may include:

No treatment, which is not advisable as there is a risk of acute infection with pain
and swelling; OR

Removal of the tooth (known as ‘extraction’). It may be possible to restore the resulting space with a dental implant, fixed bridge or removable denture, subject to further assessment.

Usually one 60-90-minute appointment. In a small number of cases, it can take multiple appointments.

There are unwarranted horror stories about endodontic treatment. Most patients do not experience any pain during treatment with local anaesthetic. Justin wants the experience to be as pleasant as possible, and patients frequently report that the experience was not as bad as they had expected. Justin will explain what he is doing during treatment and he will let you know in advance if you are likely to feel vibrations or hear noises. Justin uses a stretchy sheet (known as the ‘dental dam’) during root canal treatment and retreatment. This sheet is secured around the tooth to ensure optimal cleaning of the root canals and provide patient comfort as it protects the throat. Justin uses an operating microscope to significantly improve vision within the tooth.

You are welcome to bring your own headphones and listen to music. A rubbery prop can be placed between your upper and lower teeth to help your mouth stay open.

Sometimes patients catch up on some sleep and take a nap.

After treatment, most patients experience mild discomfort/pain due to the work carried out. This discomfort/pain may last for several days. It may be necessary to take pain killers and avoid chewing directly on the treated tooth for a few days.

A small number of patients experience:

• Soreness in their jaw muscles due to keeping their mouth open during treatment. This soreness may last for several days. It may be necessary to eat softer foods to allow the jaw muscles time to recover.
• A bruise on their face. It may take around two weeks for the bruise to disappear.
• Severe pain and/or facial swelling due to a spreading infection. This pain and/or swelling may take many days to settle and may unfortunately disrupt daily activities. It is therefore advisable that treatment is not schedule within two weeks of an important event or travelling/flying. It may be necessary to seek emergency dental care with Justin, your general dentist or an emergency dental clinic which may involve taking stronger pain killers and possibly antibiotics.

You will remain under the care of your general dentist during and after treatment with Justin.

You may require additional dental treatment with your general dentist. This may involve:

• Aesthetic dentistry (e.g. dental whitening of the tooth).
• Protective cap (e.g. onlay or crown) to minimise the risk of the tooth cracking/splitting.
• Replacement of an existing crown.
• A bite guard for a tooth/clenching grinding habit.

Your general dentist will be able to give you further details, including the type, timing and cost of additional dental treatment. Please discuss this with your general dentist before embarking upon treatment with Justin. It is advisable that the tooth and surrounding tissues are reviewed to assess the outcome and determine whether treatment has been effective or ineffective. The review is usually carried out at least one year following the completion of treatment. Sometimes sooner or several reviews are necessary. The review appointment usually involves a clinical examination and taking a small x-ray image. The review appointment may be carried out by your general dentist or Justin.