Endodontics

Nothing can be compared to natural teeth in function or aesthetics; this is why they are worth saving. Endodontics is the ultimate step in preserving a natural tooth from extraction.

Endodontics is a dental specialty focused on the tooth root and internal structures. The most common endodontic procedure is root canal treatment. This is why most people refer to endodontics as root canal treatment, although it encompasses many other treatments.

At Dulwich Dental Office, we understand the common belief that root canal treatment is painful; therefore, we have equipped our endodontics department with advanced tools and technologies to ensure your treatment is comfortable. Over 50 years of specialist endodontics care in London, our experts have performed countless endodontic procedures, including over 10000 root canal treatments to save natural teeth.

What is Endodontics: Anatomy of the tooth root

The tooth consists of the tooth crown, which is the visible part in the oral cavity, and the tooth root, which is embedded in the jawbone, providing support for the tooth.

At the root core lies the pulp space, which contains the blood and nerve supply. It connects to larger blood vessels and nerves through the apical foramen, a small opening at the root’s end.

The pulp translates various stimuli into pain. If a stimulus causes pulp death, it cannot regenerate, and the bacteria feeding on the dead pulp tissue will lead to pus formation and the spread of infection through the apical foramen to the surrounding bone.

Endodontics is concerned with conserving tooth vitality, treating diseases related to the pulp tissues, and treating damage if infection spreads beyond the tooth root. It represents the last attempt to save the tooth from extraction.

Endodontic solutions require visiting a specialised endodontist rather than a general dentist.

Why Choose to Visit an Endodontist Over a General Dentist

An endodontist specialises in all conditions related to the tooth pulp. While a general dentist can perform simple root canal treatments and other dental procedures, such as dental fillings.

When you experience a dental problem related to the tooth pulp, an endodontist is your best choice because:

• They receive an extra 2-3 years of tooth pulp study after finishing dental school.
• More specialised in diagnosing and dealing with all types of tooth pain
• Have deep knowledge and experience to help save severely damaged teeth from extraction
• They are well-trained to access and use recent technologies to improve the treatment outcome.
• Have deeper knowledge of pain management techniques, as their study focuses on the tooth nerves.

When Do I Need an Endodontic Visit?

A visit to our specialised endodontists is required if you experience any symptoms related to pulp inflammation, such as

• Tooth decay that approximates the pulp tissue. The pain becomes more intense than the initial caries and is initiated due to hot, cold, and sugar intake.
• A tooth abscess which is characterised by pulp death and pus formation, leading to severe pain and swelling.
• Trauma causing a tooth fracture at a level exposing the pulp tissue.
• Single tooth discoloration, even if there is no pain, as this means a dead pulp.
• If you experience pain related to a root canal-treated tooth.

Different pulp conditions and a suitable endodontic solution

• Reversible pulpitis: If you experience tooth pain with hot, cold, and sweets, this means that your pulp is still vital, but it is exposed to factors causing pain. The tooth vitality may be saved through the pulp capping technique, where the pulp tissue is stimulated to form a dentine layer to insulate it from stimuli.
• Irreversible pulpitis: The vitality of the tooth cannot be saved due to bacterial spread to the pulp tissue. This condition is often characterised by severe pain that may occur without any stimulus. The only treatment option to preserve the tooth is root canal treatment.
• Pulp necrosis: This condition occurs when the tooth pulp is dead. There is no pain at this stage, and you may notice that the tooth darkens in colour. The only treatment option is root canal treatment.
• Periapical abscess: When a tooth with necrotic pulp goes untreated for a prolonged period, bacteria can escape from the apical foramen, damaging the tissues surrounding the tooth root and causing pus formation. This condition is marked by severe pain that does not improve with painkillers and may be accompanied by facial swelling. An emergency visit is necessary to alleviate the pain through drainage of the accumulated pus, followed by root canal treatment. Some cases may require endodontic surgery to remove the tooth apex with the surrounding abscess.

Endodontics at Dulwich Dental Office

Dulwich Dental Office is a world-class dental facility in London offering top-rated endodontic solutions. Our experienced team of endodontists is dedicated to saving your tooth from extraction while ensuring a positive and comfortable treatment experience.

Our dental facility adheres to the highest standards of patient care. It is equipped with state-of-the-art technology for diagnosis and treatment to maintain our history of success in endodontic treatments.

The essential step for endodontic treatments is the accurate diagnosis to determine whether the tooth vitality can be saved. Our endodontic diagnostic steps involve:

1. Visual examinationAn initial visual examination is essential to determine the reason, such as a large decay or a broken tooth.
2. Digital X-rayRadiographic examination is invaluable for investigating what is not visible in the oral cavity. It is essential for determining the extent of decay or fractures and assessing whether the structures surrounding the tooth apex are affected. At Dulwich Dental Office, we utilise the latest digital X-ray technology to minimise radiation exposure while providing high-quality images for accurate diagnosis.
3. Tooth vitality testsTooth vitality tests can provide valuable information if the tooth pulp is still vital to be saved. Tooth vitality tests include applying hot or cold swabs in contact with the affected tooth to check if the pulp is still vital.
4. Percussion testA percussion test is when the back of a mirror is used to tap over the intended tooth. If there is pain during percussion, this indicates that the infection has spread to the periapical tissues.

   Reaching an accurate diagnosis will help our experts choose the suitable endodontic treatment to help maintain your tooth.

Endodontics Root Canal Treatment

Root canal treatment is the most common endodontic treatment, this is why most people mistake the endodontic treatment to only involve root canal treatment.

Root canal treatment is a dental procedure that involves removing the affected tooth pulp. Next, the canal is cleaned and shaped with specialised instruments to ensure a sterile environment before filling. The last step involves using a thermoplastic material to fill the canal space, sealing the root canal to prevent reinfection.

Following root canal treatment, the crown access is sealed using dental filling material. In some cases, additional support is required through inserting a post inside the root canal and a final crown to avoid tooth fracture.

Dulwich Dental Office endodontic experts utilise the most recent tools and technologies to ensure a successful root canal treatment, including:

• Ni-Ti instruments: These are valuable tools for cleaning curved root canals because they are flexible.
• Apex locator: A device that can help determine the root canal length to avoid overfilling, which may cause periapical inflammation, or underfilling that leaves behind an uncleaned area.
• Magnifying loops: They provide a clear vision of the operating field and are particularly valuable for detecting accessory root canals.

Other Endodontic Treatments

1. Pulp cappingPulp capping is an endodontic procedure aiming to maintain the vitality of a tooth with exposed pulp tissue. When the tooth pulp is accidentally exposed during cavity preparation, the vitality can be saved because the field is sterile, which increases the chances of success.

   Pulp capping may be performed directly on exposed pulp tissue or indirectly in deep cavities where only a thin dentin bridge prevents pulp exposure.

   It involves applying a biomaterial that stimulates dentine formation, such as calcium hydroxide and MTA, to separate the cavity floor from the pulp. The cavity is then filled with a long-term temporary material such as glass ionomer until the pulp is healed, and the final restoration is placed.

   The success of the pulp capping procedure to maintain pulp vitality depends on the cavity conditions and the operator’s experience. This is why it is better performed by a specialised endodontist.

2. Root canal retreatmentIn some cases, root canal treatment fails and requires retreatment. Root canals may fail due to many reasons, such as incomplete removal of bacteria, improper canal shaping, missed canals, improper sealing of the root filling, or the final restoration.

   Choosing an experienced endodontist for root canal treatment is essential to avoid failure.

   Root canal retreatment involves removing the old filling, thoroughly cleaning, and disinfecting the root canal, and ensuring proper sealing during filling.

3. ApixectomySome cases of chronic periapical abscess may require minor endodontic surgery to remove the abscess along with the root apex. This procedure aims to eliminate the source of infection and ensure proper healing to prevent re-infection and root canal failure.

   It requires a skilled, professional endodontist to conservatively remove the affected tissue and guarantee perfect root sealing after removing the root apex.

4. ApexificationThe root formation continues after tooth eruption. The root end of newly erupted teeth is wide and gradually closes to form the root apex. If the pulp is dead before root closure, it will be difficult to have a successful root canal treatment because it is hard to get root seal. Apexification is an endodontic solution where a biomaterial is placed to stimulate the formation of a calcific barrier to close the tooth root.