Endodontists are dentists who have received additional training to provide the highest level of care for the soft inner tissue of teeth called the dental pulp.

The word "endodontic" comes from greek root words "endo" meaning inside and "odont" meaning tooth.  All dentists receive training in endodontic therapy;  however, some teeth can be difficult to treat and some pain can be difficult to diagnose.  This is why your dentist has elected to refer you to an endodontic specialist, to ensure your tooth receives specialized care.

In addition to four years of dental school, endodontists receive two or more years of advanced education and have practices that are focused on this type of treatment only.  Endodontists work closely with your general dentist throughout the process to ensure seamless dental care for you.

The narrow channels inside the roots are known as "root canals".  Within the root canal, there is a unique and soft tissue known as the dental pulp.  The dental pulp contains tiny nerves that are commonly responsible for toothache pain.  Occasionally, the tissue can become injured and bacteria can contaminate the root canal spaces.  The result is a painful infection that will not resolve until this tissue is removed.  Root canal treatment is directed at the inside spaces of the tooth and is designed to eliminate infection, remove diseased tissue, and prevent re-contamination.

A common misconception is that the roots of the tooth are removed during root canal treatment.  This is not true; your tooth will remain intact and healthy after treatment.  It is only the inside spaces that are treated and sealed.

The Illustration below shows the stages of treatment, including completion with a permanent crown once root canal therapy is complete.

Priority number 1 is to always ensure your comfort during treatment.

A small amount of local anesthetic will be given to gently numb the area around the tooth.  The tooth is isolated with a latex sheet called the "rubber dam"  (non-latex rubber dams are also available for those with a latex allergy).  The rubber dam is placed around the tooth to keep all the dental materials from getting into your mouth, as well as isolating the tooth from saliva (which contains bacteria).  

Once you are completely numb and the tooth is isolated, the diseased pulp is gently removed from the tooth, and the spaces are cleaned and disinfected with various irrigating solutions.  Once the tooth is cleaned and dried, the canals are sealed and a temporary filling is placed in the small hole in the tooth.

Sometimes root canal therapy requires 2 visits to complete.  Every case is different, and your doctor will discuss the specifics about your case with you prior to treatment.  Some reasons that the tooth may need to be completed in 2 visits may include:

• Extreme calcification or curvature of the canals.  
• Presence of infection (which may or may not be accompanied by swelling)
• Severe inflammation that prohibits drying the tooth properly
• Teeth that are difficult to numb

This is a complex question.  Not only do teeth have a pulp on the inside of the tooth, but each tooth also has a small ligament (called the periodontal ligament) that is on the outside of the tooth.  This ligament has an abundance of nerve endings, and can become inflamed or sore due to the inflammation in the pulp of the tooth.  In time, this pain usually subsides with rest and anti-inflammatory medications such as ibuprofen (talk with your doctor before starting any over the counter pain medication).  Some patients have a history of clenching or grinding their teeth, which will most certainly cause an increase in pain to biting or chewing.  

The diagram below illustrates the difference between an infected pulp with abscess formation and an inflamed pulp with ligament inflammation.  

Brushing our teeth removes food particles, plaque, and bacteria from all tooth surfaces, except in between the teeth.  Unfortunately, our toothbrush can’t reach these areas that are highly susceptible to decay and periodontal (gum) disease.

Daily flossing is the best way to clean between the teeth and under the gumline.  Flossing not only helps clean these spaces, it disrupts plaque colonies from building up, preventing damage to the gums, teeth, and bone.

Plaque is a sticky, almost invisible film that forms on the teeth.  It is a growing colony of living bacteria, food debris, and saliva.  The bacteria produce toxins (acids) that cause cavities and irritate and inflame the gums.  Also, when plaque is not removed above and below the gumline, it hardens and turns into calculus (tartar).  This will further irritate and inflame the gums and also slowly destroy the bone.  This is the beginning of periodontal disease.

How to floss properly:

• Take 12-16 inches (30-40cm) of dental floss and wrap it around your middle fingers, leaving about 2 inches (5cm) of floss between the hands.
• Using your thumbs and forefingers to guide the floss, gently insert the floss between teeth using a sawing motion.
• Curve the floss into a “C” shape around each tooth and under the gumline.  Gently move the floss up and down, cleaning the side of each tooth.

Floss holders are recommended if you have difficulty using conventional floss.

Daily flossing will help you keep a healthy, beautiful smile for life!

If you’re feeling somewhat self-conscious about your teeth, or just want to improve your smile, cosmetic dental treatments may be the answer to a more beautiful, confident smile.

Cosmetic dentistry has become very popular in the last several years, not only due to the many advances in cosmetic dental procedures and materials available today, but also because patients are becoming more and more focused on improving their overall health.  This includes dental prevention and having a healthier, whiter, more radiant smile.

There are many cosmetic dental procedures available to improve your teeth and enhance your smile.  Depending on your particular needs, cosmetic dental treatments can change your smile dramatically, from restoring a single tooth to having a full mouth make-over.  Ask your dentist how you can improve the health and beauty of your smile with cosmetic dentistry.

Cosmetic Procedures:

Teeth Whitening: Bleaching lightens teeth that have been stained or discolored by age, food, drink, and smoking.  Teeth darkened as a result of injury or taking certain medications can also be bleached, but the effectiveness depends on the degree of staining present.

Composite (tooth-colored) Fillings: Also known as “bonding”, composite fillings are now widely used instead of amalgam (silver) fillings to repair teeth with cavities, and also to replace old defective fillings.  Tooth-colored fillings are also used to repair chipped, broken, or discolored teeth.  This type of filling is also very useful to fill in gaps and to protect sensitive, exposed root surfaces caused by gum recession.

Porcelain Veneers: Veneers are thin custom-made, tooth-colored shells that are bonded onto the fronts of teeth to create a beautiful individual smile.  They can help restore or camouflage damaged, discolored, poorly shaped, or misaligned teeth.  Unlike crowns, veneers require minimal tooth structure to be removed from the surface of the tooth.

Porcelain Crowns (caps): A crown is a tooth-colored, custom-made covering that encases the entire tooth surface restoring it to its original shape and size.  Crowns protect and strengthen teeth that cannot be restored with fillings or other types of restorations.  They are ideal for teeth that have large, fractured or broken fillings and also for those that are badly decayed.

Dental Implants: Dental implants are artificial roots that are surgically placed into the jaw to replace one or more missing teeth.  Porcelain crowns, bridges, and dentures can be made specifically to fit and attach to implants, giving a patient a strong, stable, and durable solution to removable dental appliances.

Orthodontics: Less visible and more effective brackets and wires are making straightening teeth with orthodontics much more appealing to adult patients.  Also, in some cases, teeth may be straightened with custom-made, clear, removable aligners that require no braces.

Thanks to the advances in modern dentistry, cosmetic treatments can make a difference in making your smile shine!

Porcelain veneers are very thin shells of tooth-shaped porcelain that are individually crafted to cover the fronts of teeth.  They are very durable and will not stain, making them a very popular solution for those seeking to restore or enhance the beauty of their smile.

Veneers may be used to restore or correct the following dental conditions:

• Severely discolored or stained teeth
• Unwanted or uneven spaces
• Worn or chipped teeth
• Slight tooth crowding
• Misshapen teeth
• Teeth that are too small or large

Getting veneers usually requires two visits.  Veneers are created from an impression (mold) of your teeth that is then sent to a professional dental laboratory where each veneer is custom-made (for shape and color) for your individual smile.

With little or no anesthesia, teeth are prepared by lightly buffing and shaping the front surface of the teeth to allow for the small thickness of veneers.  The veneers are carefully fitted and bonded onto the tooth surface with special bonding cements and occasionally a specialized light may be used to harden and set the bond.

Veneers are an excellent dental treatment that can dramatically improve your teeth and give you a natural, beautiful smile.

Since teeth whitening has now become the number one aesthetic concern of many patients, there are many products and methods available to achieve a brighter smile.

Professional teeth whitening (or bleaching) is a simple, non-invasive dental treatment used to change the color of natural tooth enamel, and is an ideal way to enhance the beauty of your smile.  Over-the-counter products are also available, but they are much less effective than professional treatments and may not be approved by the American Dental Association (ADA).

As we age, the outer layer of tooth enamel wears away, eventually revealing a darker or yellow shade.  The color of our teeth also comes from the inside of the tooth, which may become darker over time.  Smoking, drinking coffee, tea, and wine may also contribute to tooth discoloration, making our teeth yellow and dull.  Sometimes, teeth can become discolored from taking certain medications as a child, such as tetracycline.  Excessive fluoridation (fluorosis) during tooth development can also cause teeth to become discolored.

It’s important to have your teeth evaluated by your dentist to determine if you’re a good candidate for bleaching.  Occasionally, tetracycline and fluorosis stains are difficult to bleach and your dentist may offer other options, such as veneers or crowns to cover up such stains.  Since teeth whitening only works on natural tooth enamel, it is also important to evaluate replacement of any old fillings, crowns, etc. before bleaching begins.  Once the bleaching is done, your dentist can match the new restorations to the shade of the newly whitened teeth.

Since teeth whitening is not permanent, a touch-up may be needed every several years to keep your smile looking bright.

The most widely used professional teeth whitening systems:

Home teeth whitening systems: At-home products usually come in a gel form that is placed in a custom-fitted mouthguard (tray), created from a mold of your teeth.  The trays are worn either twice a day for approximately 30 minutes, or overnight while you sleep.  It usually takes several weeks to achieve the desired results depending on the degree of staining and the desired level of whitening.

In office teeth whitening: This treatment is done in the dental office and you will see results immediately.  It may require more than one visit, with each visit lasting 30 to 60 minutes.  While your gums are protected, a bleaching solution is applied to the teeth.  A special light may be used to enhance the action of the agent while the teeth are whitened.

Some patients may experience tooth sensitivity after having their teeth whitened.  This sensation is temporary and subsides shortly after you complete the bleaching process, usually within a few days to one week.