If you have pain in your teeth of any kind, your family dentist is the right first port of call. They will determine the cause of the pain and refer the patient to a specialist if necessary. The following applies: changes to the enamel and dentin, the two outer layers of the tooth, are usually treated by any dentist.
However, if the tissue inside the tooth, i.e. the pulp, is affected by pathological conditions, patients should be treated by a specialist in endodontology if the dentist lacks experience.
Endodontists are also specialists for damage to the teeth after dental accidents (dental traumatology, traumatic dental injuries), for example after a sports accident, after a fall or after a blow.
The most common disease of the dental pulp is pulpitis, an inflammation of the dental pulp. This is caused by irritation, for example in the course of improperly performed dental treatment.
Bacteria that enter the inside of the tooth due to damage to the enamel or tooth decay can also cause inflammation. These usually start out quite small, but will continue to spread if no treatment is carried out. Especially if pulpitis is not recognized for a long time, a chronic inflammation develops, the consequences of which are irreversible.
Other pathological changes to the inside of the tooth are
- Pulp gangrene: Germs destroy the pulp tissue, which then dissolves
- Denticles: Calcifications inside the tooth that usually go unnoticed
- Apical periodontitis: inflammation in the area of the root tip
- Odontogenic infections: Abscesses that have no connection to the oral cavity or jawbone
In addition to pathological changes to the inside of the tooth, endodontists also treat traumatic injuries to the teeth:
- Cracked (enamel cracks) or partially broken teeth (crown fractures without or with pulp involvement)
- Loosened or displaced teeth
- Teeth completely broken out of the mouth
- Root fractures
First, the endodontist will ask the patient in detail about the pain and sensation of the affected tooth: Does the tooth hurt mainly when it is loaded? Or does the pain occur mainly at night?
A sensitivity test with cold, determination of tooth mobility or palpation can also provide clues as to the cause of the pain. Last but not least, imaging procedures such as X-ray diagnostics are also used.
If the endodontist is still not sure exactly which clinical picture is present, he or she will carry out an exclusion procedure with the help of medication or local anesthesia.
While teeth were often extracted in the past, the aim of endodontic treatment today is to preserve teeth in addition to treating the disease.
If it is an acute inflammatory reaction that has not yet permanently damaged the tissue, it is sometimes sufficient to treat the tooth with medication. However, if the pathological change has been present for some time and the pulp has already died as a result, patients usually cannot avoid root canal treatment(root canal treatment). This is the most frequently used form of therapy in endodontology.
The aim of root canal treatment is to preserve the tooth, even if the tooth nerve is already partially or completely dead. To do this, inflamed and dead tissue is removed from the tooth and the adjacent dentin, which is also infected, is filed away. To do this, a small canal must be created to gain access to the inside of the tooth, but this is kept as small as possible.
Once all the infected tissue has been removed, the endodontist fills the tooth again. A material is chosen for this that does not decompose, does not allow bacteria to pass through, but is also easy to remove if necessary. In some cases, root canal fillings have to be repeated or posts or instruments removed (so-called revision treatments).
Other therapeutic procedures in endodontology include internal bleaching of a discolored tooth and root tip resection, in which the root tip is removed if an inflammation cannot be eliminated by root canal treatment. Alternatively, there is the so-called intentional replantation, i.e. the removal of a tooth with subsequent replanting into the jaw.
Endodontists are usually dentists who have specialized in the field of endodontology through further training.
As there is currently no special specialist training in Germany, the prospective endodontist attends further training courses at authorized institutions such as universities. Specialization in endodontology is possible through the German Society for Endodontology and Dental Traumatology (DGET).
The quality seal "Certified Endodontist" can also be awarded following successful completion of further training and assessment of treatment cases. Since 2009, dentists have also had the opportunity to acquire specialist endodontic knowledge as part of a master's degree in endodontology.
If your family dentist is at a loss and suspects the cause of your pain is inside your tooth, you should consult an endodontist. They specialize in the inner workings of the tooth and are therefore very familiar with its diseases and possible treatment methods.
The most common treatment is root canal therapy. It aims to preserve the tooth, even if a large part of the tooth nerve has already died.
