Endodontists and Information on Endodontics

For any type of tooth pain, your family dentist is the first point of contact. They will determine the cause of the pain and, if necessary, refer the patient to a specialist. As a general rule, any dentist can treat changes to the enamel and dentin—the two outer layers of the tooth.

However, if the tissue inside the tooth—the pulp—is affected by a pathological condition, patients should be treated by an endodontist if their dentist lacks experience in this area.

Endodontists are also specialists in treating damage to teeth resulting from dental accidents (dental traumatology, traumatic dental injuries), such as those caused by a sports injury, a fall, or a blow.

The most common condition affecting the dental pulp is pulpitis, an inflammation of the pulp. This is caused by irritation, such as that resulting from dental treatment performed improperly.

Bacteria that enter the interior of the tooth through damage to the enamel or tooth decay can also cause inflammation there. This inflammation usually starts out quite minor but, if left untreated, continues to spread. Especially if pulpitis goes undetected for a long time, it can develop into chronic inflammation, the consequences of which are irreversible.

Other pathological changes within the tooth include:

• Pulp gangrene: Bacteria destroy the pulp tissue, which then disintegrates
• Denticles: Calcifications inside the tooth that usually go unnoticed
• Apical periodontitis: Inflammation in the area of the root tip
• Odontogenic infections: Abscesses that are not connected to the oral cavity or jawbone

In addition to pathological changes within the tooth, endodontists also treat traumatic injuries to the teeth:

• Cracked (enamel cracks) or partially fractured teeth (crown fractures with or without pulp involvement)
• Loose or displaced teeth
• Teeth completely broken out of the mouth
• Root fractures

First, the endodontist will ask the patient detailed questions about the pain and sensations in the affected tooth: Does the tooth hurt mainly when pressure is applied? Or does the pain occur mainly at night?

A sensitivity test using cold, an assessment of tooth mobility, or palpation can also provide clues as to the cause of the pain. Last but not least, imaging techniques such as X-rays are also used.

If the endodontist is still unsure of the exact nature of the condition, they will perform a process of elimination using medicated fillings or local anesthesia.

While teeth were often extracted in the past, the goal of endodontic treatment today—in addition to treating the condition—is to preserve the tooth.

If the condition is an acute inflammatory reaction that has not yet caused permanent damage to the tissue, medication applied to the tooth may sometimes be sufficient. However, if the pathological change has been present for some time and has already resulted in pulp necrosis, patients generally have no choice but to undergo root canal treatment. This is the most commonly used form of treatment in endodontics.

The goal of root canal treatment is to preserve the tooth, even if the dental pulp is already partially or completely dead. To do this, inflamed and dead tissue is removed from the tooth, and the adjacent, infected dentin is filed away. This requires creating a small canal to gain access to the interior of the tooth, though this canal is kept as small as possible.

Once all inflamed tissue has been removed, the endodontist refills the tooth. A material is chosen that does not degrade, does not allow bacteria to pass through, but can also be easily removed if necessary. In some cases, root canal fillings must be redone, or posts or instruments must be removed (so-called revision treatments).

Other therapeutic procedures in endodontics include, for example, internal bleaching of a discolored tooth and apical resection, in which the root tip is removed if inflammation cannot be resolved through root canal treatment. An alternative to this is what is known as intentional replantation, which involves the removal of a tooth followed by its reimplantation into the jaw.

Endodontists are generally dentists who have specialized in the field of endodontics through advanced training.

Since there is currently no specific board certification program in Germany, aspiring endodontists take continuing education courses at accredited institutions, such as universities. Specialization in endodontics is available through the German Society for Endodontology and Dental Traumatology (DGET).

Upon successful completion of the training and evaluation of treatment cases, the “Certified Endodontist” seal of quality may be awarded. Since 2009, dentists have also had the option to acquire specialized knowledge in endodontics through a master’s degree program in endodontics.

If your family dentist is at a loss and suspects that the cause of your pain lies inside the tooth, you should consult an endodontist. These specialists focus on the inner workings of the tooth and are therefore highly knowledgeable about its diseases and possible treatment methods.

The most commonly performed treatment is root canal therapy. It aims to save the tooth, even if a large portion of the dental pulp has already died.