Root Canal – Your Dentist or an Endodontist?

So, your dentist has told you that you need a root canal. Do you let him or her perform
the procedure or do you need an Endodontist, root canal specialist?

Before going any further, I need to let you know that I have worked for an Endodontist
for over eight years, so my advice will be biased toward Endodontists. But I have my
reasons, as I will explain.

What created the need for Endodontists in the first place?

1. A toothache is an emergency that can be caused by a broken tooth or abscess.
This patient will need treatment immediately to control the pain, but your dentist has a
lot of patients and books a full schedule every day. He can refer this patient to an
Endodontist who schedule is usually more accommodating and know that the patient
will be treated correctly.

A caring dentist knows that he / she can not possibly accommodate all emergencies.
They develop a good working relationship with a local Endodontist as a way to offer
their patients immediate care. An Endodontist can also be a back-up source for the
dentist for vacation days, etc.

2. Root canals can take a lot of time for a dentist. This is a big point so listen
carefully. An Endodontist does a lot of root canals and has the procedure down pat.
For most patients, the less time spent in the dental chair, the better. My Endodontist
can do a molar root canal from start to finish in less than an hour for a normal tooth.

3. Note, I said 'normal'? Teeth can have some funky configurations. Roots can curl
around each other, canals can be calcified, or a tooth may have more canals than
normal. An Endodontist has seen enough teeth to know what to look for and handle
any abnormalities your tooth may have, and in a reasonable amount of time.
For example:

a. I have known patients that have been in their dentist's chair for hours for a root
canal. I remember one patient that claimed to be in her dentist's chair for 8 hours, and
still ended up at the Endodontist for completion of the root canal.

b. I have known many patients that were referred to an Endodontist because the
dentist accidentally perforated the root trying to do a root canal. A perforation is when
the dental file punches a hole through the outside of the root. That's not to say that
an Endodontist never makes this mistake, but it's a whole lot less likely since they
handle these files day in and day out. They also have expertise and special materials
for repair of perforations.

c. I have know many many patients that had extra canals that the general dentist did
not see or treat causing the tooth to abscess afterward creating the need for a

d. I have known patients that had two of the canals treated by their dentist only to
find the third canal calcified, and had to be referred to an Endodontist to finish the
root canal. This is frustrating for the patient, to put it mildly.

When a dentist starts a root canal and can not finish it, legally this tooth is considered
a re-treatment. Retreatments are more expensive than a regular root canal because of the specialized equipment, time and expertise required. Also, because the Endodontist
is treating a tooth that someone else has worked on, he is, in essence, accepting legal
responsibility for someone else's work.
Sometimes, that work needs to be corrected and it takes more time for a re-do than
to do the root canal in the first place. Patients do not understand this and get angry
that they have to pay, not only twice, but more for the second procedure.
And some dental insurance will not pay for a retreat immediately after the original
root canal.

These examples are not the norm, but they are seen on almost a daily basis at an
Endodontist office. Of the millions of root canals done daily, most dentists perform
beautifully with no problems. But if you see your dentist looking doubtful when he looks
at the x-ray of your problem tooth, and he recommends an Endodontist for your
treatment, please follow his advice.

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