If you have pain of any sort you are best advised to consult a general dentist first. The dentist will trace the source of the pain and will refer you to a specialist if necessary. Worth knowing - Injuries to the tooth enamel and dentin, the two outer layers of the tooth, are usually be handled by any dentist. However, if the internal tissue of the tooth, known as the pulp, is displaying morbid changes, then this is best handled by a specialist.
The commonest disease of tooth pulp is pulpitis, inflammation of the dental nerve. This arises through irritations, for example during tooth treatment not carried out properly. Bacteria penetrating into the interior of the tooth through damage to the tooth enamel or caries within the tooth can also in some circumstances cause inflammation. This generally begins on quite a small scale but if there is no treatment it will keep on extending and spreading. Especially where pulpitis has not been recognized over a lengthy period, that is when chronic inflammation sets in with consequences which are irreversible.
Other morbid changes in the tooth interior are:
- pulp gangrene - germs destroy the pulp tissue which then dissolves.
- denticles - calcifications inside the teeth which generally go unnoticed.
- apical parodontitis - inflammations at the tip of the root
- odontogenic infections - abscesses which have no connection to the oral cavity or jaw bones
First, an endodontologist will question you thoroughly about your pain and sensations in the affected tooth - is the tooth painful mainly when there is pressure on it? Or is the tooth painful mainly at night? Also, a sensitivity test, determining the mobility of the tooth or palpating it can give indications of the cause of the pain. No less important is the use of imaging techniques such as X-ray diagnosis. If the endodontologist is still not sure which disease profile is present here he will go through a process of elimination using medicinal inserts or local anesthesia.
If the inflammation is an acute response which has not yet caused any lasting damage to tissue, sometimes treatment of the tooth with medication will be enough. However, if the morbid change has lasted longer and has led to tooth enamel dying, patients will generally not be able to avoid root canal treatment. This is the most commonly applied form of treatment in endodontology.
The aim of root canal treatment is to preserve the tooth, even if the tooth nerve is already partially or completely dead. Here, inflamed or dead tissue is removed from the tooth and the adjacent dentin, which is also infected, is filed down. To achieve this, a small channel must be created to maintain access to the interior of the tooth, though it is kept as small as possible. If all the inflamed tissue is removed, the endodontologist will refill the tooth. For this, a material is selected which does not break down, does not admit bacteria but which is also easy to remove again if necessary.
Endodontologists are generally dentists who have specialized in this particular field through further training. However, Germany does not yet have specialist dentistry further training in this field. That means that an endodontologist has acquired his specialist knowledge either abroad or as part of a Master's course. This is necessary because the root canals which he is treating are often narrow and on top of that also extremely crooked. This makes it necessary, firstly, to have a special tool and, secondly, to have an especially steady hand. Because many patients are afraid of having work done on their teeth, good endodontologist are also empathetic and sensitive.
If your usual dentist has tried everything and now suspects the cause of the pain to be in the interior of the tooth, you should consult an endodontologist. They have specialized in the interior life of the tooth and so are most familiar with its diseases and possible treatment techniques. The most frequently performed treatment is root canal treatment. The aim of this is to preserve the tooth, even if the majority of the tooth nerve is already dead.
