Endodontists are dentists with at least two additional years of advanced specialty education in diagnosis and root canal treatment.
Because they limit their practices to endodontics, they treat these types of problems every day. They use their special training and experience in treating difficult cases, such as teeth with narrow or blocked canals, or unusual anatomy.
Endodontists may use advanced technology, such as operating microscopes, ultrasonics and digital imaging, to perform these special services.
Symptom: Momentary sensitivity to hot or cold foods.
Possible problem: If this discomfort lasts only moments, sensitivity to hot and cold foods generally does not signal a serious problem. The sensitivity may be caused by a small decay, a loose filling or by minimal gum recession that exposes small areas of the root surface.
What to do: Try using toothpastes made for sensitive teeth. Brush up and down with a soft brush; brushing sideways wears away exposed root surfaces. If this is unsuccessful, see your general dentist. If the sensitivity is coming from a decay you should see your general dentist.
Symptom: Sensitivity to hot or cold foods after dental treatment.
Possible problem: Dental work may inflame the pulp inside the tooth causing temporary sensitivity.
What to do: Wait two to four weeks. If the pain persists or worsens, see your general dentist.
Symptom: Sharp pain when biting down on food.
Possible problem: There are several possible causes of this type of pain: decay, a loose filling or crack in the tooth. There may also be damage to the pulp tissue inside the tooth.
What to do: See a dentist for evaluation. If the problem is pulp tissue damage, your dentist may send you to an endodontist. Endodontists are dentists who specialize in pulp-related procedures. Your endodontist will perform a procedure that cleans out the damaged pulp and fills and seals the remaining space. This procedure is commonly called a â€œroot canal.â€
Symptom: Lingering pain after eating hot or cold foods.
Possible problem: This probably means the pulp has been damaged by deep decay or physical trauma.
What to do: See your dentist or endodontist to save the tooth with root canal treatment.
Symptom: Constant and severe pain and pressure, swelling of gum and sensitivity to touch.
Possible problem: A tooth may have become abscessed, causing an infection in the surrounding gingival tissue and bone.
What to do: See your endodontist for evaluation and treatment to relieve the pain and save the tooth.
Symptom: Dull ache and pressure in upper teeth and jaw.
Possible problem: The pain of a sinus headache is often felt in the face and teeth. Grinding of teeth, a condition known as bruxism, can also cause this type of ache.
What to do: For sinus headache, see your physician. For bruxism, consult your dentist. If pain is severe and chronic, see your endodontist for evaluation.
Myth #1 - Root canal treatment is painful.
Truth - Root canal treatment doesn't cause pain, it relieves it.
The perception of root canals being painful began decades ago but with the latest technologies and anesthetics, root canal treatment today is no more uncomfortable than having a filling placed. In fact, a recent survey showed that patients who have experienced root canal treatment are six times more likely to describe it as "painless" than patients who have not had root canal treatment.
Most patients see their dentist or endodontist when they have a severe toothache. The toothache can be caused by damaged tissues in the tooth. Root canal treatment removes this damaged tissue from the tooth, thereby relieving the pain you feel. (See more about root canal procedures.)
Myth #2â€”Root canal treatment causes illness.
The myth: Patients searching the Internet for information on root canals may find sites claiming that teeth receiving root canal (endodontic) treatment contribute to the occurrence of illness and disease in the body. This claim is based on long-debunked and poorly designed research performed in the 1920s by Dr. Weston A. Price. Dr. Price stated that bacteria trapped in the teeth during root canal treatment could â€œleakâ€ and cause almost any type of disease, including arthritis, heart disease, kidney disease and others. This was before medicine understood the causes of these illnesses. At the time, Dr. Price recommended tooth extraction instead of endodontic treatment.
The truth: There is no valid, scientific evidence linking root canal-treated teeth and disease elsewhere in the body. In fact, by the early 1930s, a number of well-designed studies discredited Dr. Priceâ€™s research, and no subsequent research has supported Dr. Priceâ€™s findings. In 1951, the Journal of the American Dental Association devoted an entire issue to a review of the scientific literature and concluded that there was no evidence supporting Dr. Priceâ€™s theory and that his research techniques from the 1920s lacked many aspects of modern scientific research. The ADA recommended endodontic treatment as the standard of practice for teeth that could be saved. Recent research continues to support the safety of dental treatment as it relates to overall health.
The presence of bacteria in teeth and the mouth has been an accepted fact for many years. But the presence of bacteria does not constitute "infection" and is not necessarily a threat to a person's health. Bacteria are present in the mouth and teeth at all times, even in teeth that have never had a cavity or other trauma. Research shows that the healthy immune system takes care of bacteria in a matter of minutes. When a severe infection in a tooth requires endodontic treatment, that treatment is designed to eliminate bacteria from the infected root canal and prevent re-infection of the tooth.
Tooth extraction is a potentially traumatic procedure and is known to cause a significantly higher incidence of bacteria entering the bloodstream; endodontic treatment confined to the root canal system produces much less trauma and a much lower incidence and magnitude of bacteria entering the blood stream.
There is no adequate replacement for the natural tooth - it should be saved whenever possible. Endodontic treatment, along with appropriate restoration, is a cost effective way to treat infected teeth because it is usually less expensive than extraction and placement of an implant. In most cases, endodontic treatment allows patients to keep their natural teeth for a lifetime.
Myth #3 - A good alternative to root canal treatment is extraction (pulling the tooth).
Truth - Saving your natural teeth, if possible, is the very best option.
Nothing can completely replace your natural tooth. An artificial tooth can sometimes cause you to avoid certain foods. Keeping your own teeth is important so that you can continue to enjoy the wide variety of foods necessary to maintain the proper nutrient balance in your diet.
Endodontic treatment, along with appropriate restoration, is a cost-effective way to treat teeth with damaged pulp and is usually less expensive than extraction and placement of a bridge or an implant.
Endodontic treatment also has a very high success rate. Many root canal-treated teeth last a lifetime.
Placement of a bridge or an implant will require significantly more time in treatment and may result in further procedures to adjacent teeth and supporting tissues.
Millions of healthy endodontically treated teeth serve patients all over the world, years and years after treatment. Those healthy teeth are helping patients chew efficiently, maintain the natural appearance of their smiles and enhance their enjoyment of life. Through endodontic treatment, endodontists and dentists worldwide enable patients to keep their natural teeth for a lifetime.
Causes of a Root Canal
Root canals are necessary when a cavity that has been left untreated becomes larger. Once the cavity reaches the pulp of the tooth, an infection forms at the base of the root canal, causing an abscess. This abscess is generally painful and will need to be removed.
The doctors at Heartland Endodontics & Periodontics know that serious tooth decay can often lead to a root canal. A root canal may be needed if the decay has reached the tooth's nerve. Essentially, a root canal involves cleaning out a tooth's infected root, then filling and sealing the canal.
Root Canal Procedure:
1) An opening is made through the crown of the tooth into the pulp chamber.
2) The pulp is removed, and the root canals are cleaned, enlarged and shaped.
3) The infected area is medicated.
4) The root canals are filled.
5) The crown opening is filled with a temporary.
If you are experiencing severe tooth pain, you may need a root canal. The only sure way to know is to call our Sebring, FL dental office at (863) 382-9947 and setup an appointment with Dr. Obermayr.
Sometimes the infection persists even after root canal therapy. In these cases, an apicoectomy, or root end resection can be performed to remove diseased tissue.
1) An incision is made to allow access to the base of the tooth. The inflamed or infected pulp is treated and the canals are carefully cleaned and shaped.
2) A small filling may be placed in the remaining tip of the tooth to seal the root canal. The gum tissue is stitched back into place.
3) A crown is placed to protect the tooth.
As occasionally happens with any dental or medical procedure, a tooth may not heal as expected after initial treatment for a variety of reasons:
Narrow or curved canals were not treated during the initial procedure.
Complicated canal anatomy went undetected in the first procedure.
The placement of the crown or other restoration was delayed following the endodontic treatment.
The restoration did not prevent salivary contamination to the inside of the tooth. In other cases, a new problem can jeopardize a tooth that was successfully treated.
New decay can expose the root canal filling material to bacteria, causing a new infection in the tooth.
A loose, cracked or broken crown or filling can expose the tooth to new infection.
What will happen during retreatment?
First, the endodontist will discuss your treatment options. If you and your endodontist choose retreatment, the endodontist will reopen your tooth to gain access to the root canal filling material. In many cases, complex restorative materialsâ€”crown, post and core materialâ€”must be disassembled and removed to permit access to the root canals.
After removing the canal filling, the endodontist can clean the canals and carefully examine the inside of your tooth using magnification and illumination, searching for any additional canals or unusual anatomy that requires treatment.
After cleaning the canals, the endodontist will fill and seal the canals and place a temporary filling in the tooth. If the canals are unusually narrow or blocked, your endodontist may recommend endodontic surgery. This surgery involves making an incision to allow the other end of the root to be sealed.
After your endodontist completes retreatment, you will need to return to your dentist as soon as possible to have a new crown or other restoration placed on the tooth to protect and restore it to its full function.
Is retreatment the best choice for me?
Whenever possible, it is best to save your natural tooth. Retreated teeth can function well for years, even for a lifetime.
Advances in technology are constantly changing the way root canal treatment is performed, so your endodontist may use new techniques that were not available when you had your first procedure. Your endodontist may be able to resolve your problem with retreatment.
As with any dental or medical procedure, there are no guarantees. Your endodontist will discuss your options and the chances of success before beginning retreatment.
There are many types of cracked teeth. The treatment and outcome for your tooth depends on the type, location and severity of the crack.
Unlike a broken bone, a fracture in a cracked tooth will never heal. Early diagnosis is important, even with high magnification and special lighting, it is sometimes difficult to determine the extent of a crack.
A crown will bind and protect the cracked tooth. When a crack reaches the tooth root, root canal treatment is frequently needed to treat the injured pulp. A cracked tooth that is not treated will progressively worsen, eventually resulting in the loss of the tooth.
How will my injury be treated?
Chipped teeth account for the majority of all dental injuries. Dislodged or knocked-out teeth are examples of less frequent, but more severe injuries. Treatment depends on the type, location and severity of each injury. Any dental injury, even if apparently mild, requires examination by a dentist or an endodontist immediately. Sometimes, neighboring teeth suffer an additional, unnoticed injury that will only be detected by a thorough dental exam.
Chipped or Fractured Teeth
Most chipped or fractured tooth crowns can be repaired either by reattaching the broken piece or by placing a tooth-colored filling. If a significant portion of the tooth crown is broken off, an artificial crown or â€œcapâ€ may be needed to restore the tooth.
If the pulp is exposed or damaged after a crown fracture, root canal treatment may be needed. These injuries require special attention. If breathing through your mouth or drinking cold fluids is painful, bite on clean, moist gauze or cloth to help relieve symptoms until reaching your dentistâ€™s office. Never use topical oral pain medications (such as AnbesolÂ®) or ointments, or place aspirin on the affected areas to eliminate pain symptoms.
Injuries in the back teeth often include fractured cusps, cracked teeth and the more serious split tooth. If cracks extend into the root, root canal treatment and a full coverage crown may be needed to restore function to the tooth. Split teeth may require extraction.
Dislodged (Luxated) Teeth
During an injury, a tooth may be pushed sideways, out of or into its socket. Your endodontist or general dentist will reposition and stabilize your tooth. Root canal treatment is usually needed for permanent teeth that have been dislodged and should be started a few days following the injury. Medication such as calcium hydroxide may be put inside the tooth as part of the root canal treatment. A permanent root canal filling will be placed at a later date.
Children between seven and 12 years old may not need root canal treatment since their teeth are still developing. For those patients, an endodontist or dentist will monitor the healing carefully and intervene immediately if any unfavorable changes appear. Therefore, multiple follow-up appointments are likely to be needed. New research indicates that stem cells present in the pulps of young people can be stimulated to complete root growth and heal the pulp following injuries or infection.
Knocked-Out (Avulsed) Teeth
If a tooth is completely knocked out of your mouth, time is of the essence. The tooth should be handled very gently, avoiding touching the root surface itself. If it is dirty, quickly and gently rinse it in water. Do not use soap or any other cleaning agent, and never scrape or brush the tooth. If possible, the tooth should be placed back into its socket as soon as possible. The less time the tooth is out of its socket, the better the chance for saving it. Call a dentist immediately!
If you cannot put the tooth back in its socket, it needs to be kept moist in special solutions that are available at many local drugstores (such as Save-A-Tooth). If those solutions are unavailable, you should put the tooth in milk. Doing this will keep the root cells in your tooth moist and alive for a few hours. Another option is to simply put the tooth in your mouth between your gum and cheek. Do not place the tooth in regular tap water because the root surface cells do not tolerate it.
Once the tooth has been put back in its socket, your dentist will evaluate it and will check for any other dental and facial injuries. If the tooth has not been placed back into its socket, your dentist will clean it carefully and replace it. A stabilizing splint will be placed for a few weeks. Depending on the stage of root development, your dentist or endodontist may start root canal treatment a week or two later. A medication may be placed inside the tooth followed by a permanent root canal filling at a later date.
The length of time the tooth was out of the mouth and the way the tooth was stored before reaching the dentist influence the chances of saving the tooth. Again, immediate treatment is essential. Taking all these factors into account, your dentist or endodontist may discuss other treatment options with you.
A traumatic injury to the tooth may also result in a horizontal root fracture. The location of the fracture determines the long-term health of the tooth. If the fracture is close to the root tip, the chances for success are much better. However, the closer the fracture is to the gum line, the poorer the long-term success rate. Sometimes, stabilization with a splint is required for a period of time.
Do traumatic dental injuries differ in children?
Chipped primary (or â€œbabyâ€) teeth can be esthetically restored. Dislodged primary teeth can, in rare cases, be repositioned. However, primary teeth that have been knocked out typically should not be replanted. This is because the replantation of a knocked-out primary tooth may cause further and permanent damage to the underlying permanent tooth that is growing inside the bone.
Childrenâ€™s permanent teeth that are not fully developed at the time of the injury need special attention and careful follow up, but not all of them will need root canal treatment. In an immature permanent tooth, the blood supply to the tooth and the presence of stem cells in the region may enable your dentist or endodontist to stimulate continued root growth.
Endodontists have the knowledge and skill to treat incompletely formed roots in children so that, in some instances, the roots can continue to develop. Endodontists will do all that is possible to save the natural tooth. These specialists are the logical source of information and expertise for children who are victims of dental trauma.
Will the tooth need any special care or additional treatment?
The nature of the injury, the length of time from injury to treatment, how your tooth was cared for after the injury and your bodyâ€™s response all affect the long-term health of the tooth. Timely treatment is particularly important with dislodged or knocked-out teeth in order to prevent root resorption.
Resorption occurs when your body, through its own defense mechanisms, begins to reject your own tooth in response to the traumatic injury. Following the injury, you should return to your dentist or endodontist to have the tooth examined and/or treated at regular intervals for up to five years to ensure that root resorption is not occurring and that surrounding tissues continue to heal. It has to be noted that some types of resorption are untreatable.
TMJ and TMD Symptoms and Treatment Overview
Do you ever experience a clicking or popping sound when opening or closing your mouth? Have you been suffering from headaches or migraines and no one seems to be able to help you? Have you been taking pain medicine for years and would like to get off of it? Do you feel any clogging or congestion in one or both of your ears? These are just a few of many symptoms that might be associated with TMD, or Temporomandibular Dysfunction, a common condition affecting the jaw joint or Temporomandibular Joint (TMJ).
TMJ dysfunction, often referred to as TMD, is a disharmony between the way the jaw joint works in an unstrained position and the way the teeth and bite work during those movements. Possible causes of this disharmony include tooth loss, accidents (like whiplash), mal-positioned and/or underdeveloped cranial or jawbones, and perhaps habits like clenching or teeth grinding. Many people go through life suffering from headaches and a variety of facial and neck pains without knowing the ultimate cause, which in many cases is TMJ disorder.
Define TMJ and TMD
They are the two joints which connect the lower jaw to the temporal bone at the side of the head. If you place your fingers just in front of your ears and open your mouth, you can feel the joint on each side of the head. Because these joints are flexible, the jaw can move smoothly up and down and side to side, enabling us to talk, chew and yawn. When the TMJ is not functioning normally and it is not within its physiological limits, it creates a condition called TMD, or Temporomandibular Dysfunction.
TMD is a group of conditions resulting from not having a normal function or "comfortable" positioning of the TMJ, and will present as a cycle of pain, muscle spasms and jaw problems. When teeth are missing, out of alignment, crowded or misshaped, chewing and biting cannot be achieved in a balanced way, so the TMJ and the muscles of chewing try to compensate for this unbalanced movement which results in symptoms that will confirm the presence of TMD.
Temporomandibular Joint Disorder (TMD) is not just a disorder, but a group of conditions, often painful, that affect the jaw joint or Temporomandibular Joint (TMJ) and the muscles that control chewing.
- Myofascial pain, the most common form of TMD, which is discomfort or pain in the muscles that control jaw functions and the neck and shoulder muscles.
- Internal derangement of the joint meaning a dislocated or displaced disc or injury to the condyle (the rounded part at the end of the jaw bone).
- Degenerative joint disease such as Osteoarthritis or Rheumatoid Arthritis in the jaw joint. Causes of TMJ/TMD
- Unbalanced occlusion or "Bad Bite"
- Stress (emotional or work/school related)
- Injury or trauma (this could have been an injury as obvious as a blow to the jaw with a fist or something as subtle as a whiplash injury with direct trauma to the head or jaw.
- Teeth grinding or Bruxism
- Missing teeth
- Crowded or "crooked" teeth
- Worn down teeth
- Old crowns and bridges
- Unbalanced dentures
When teeth are missing, or out of alignment, it causes the jaw to shift positions and the muscles to work harder to chew, swallow, bite...etc and eventually will cause: muscle spasms, tension and pain.
Muscle tension and misplaced TMJ could cause the TMJ disc to be pulled out of place which will result in pain, clicking and popping in the TMJ.
If the disc is displaced for a long time, the bones will start rubbing against each other and some damage will happen to the bone, this is called Osteoorthrosis.
If there is inflammation in other joints or bones of the body, it is called Osteoarthritis (Arthritis) which may involve the jaw bone and the TMJ. Some damage to the bone may be evident on the x-rays.
- Headaches, Migraines or tension headaches
- Worn or loose teeth
- Painful muscles in the neck and shoulders (muscle spasms)
- Pain behind the eyes.
- Clicking and popping of the jaw joint (TMJ)
- Locked jaw or restriction in opening or closing the mouth
- Earaches or a clogging feeling in the ears
- Tingling or numbness in the hands and the fingertips
While recognizing TMJ problems is within the ability of most physicians and dentists, not all practitioners are qualified to diagnose it properly and treat it right. It is imperative that a trained practitioner in Craniofacial pain or Neuromuscular Dentistry give the final and definitive diagnosis, and suggest the most suitable treatment plan.
There is a lot of skepticism about TMJ treatment in the medical society and that is simply due to the fact that physicians didn't receive the dental training and didn't acquire the knowledge required for such complicated diagnosis and treatment. Furthermore, many dentists rush into treating TMJ thinking that they can cure these problems, only to find that they lack the skill and experience to get the job done.
We have training and experience in the treatment of these problems with outstanding success rates. With highly advanced equipment and a high level of knowledge, we address your concerns and provide the best diagnosis for the optimal treatment.
Many patients who suffer from TMD symptoms, were never told that it is related to their TMJ problem, and were not aware that treating their TMJ could easily relieve their suffering. To explain this further...
Headaches and Migraines
If you suffer from headaches or migraines, TMJ dysfunction, could be the major and most likely cause of your suffering. Your doctors, including neurologists, have simply not received the dental training required to relate your migraine or headache pain to your TMJ problems. Once you rule out any brain tumors or aneurysms, TMJ should be checked and TMD should be treated to relieve the headaches and migraines.
Due to the proximity of the TMJ to the ears, it is very common to feel ears congestion, or to have ringing in the ears when the TMJ bones move or dislocate from their place. In this case ENT's (ear doctors) won't find anything wrong with the ears, yet the patients keep complaining about their ears. Once the TMJ is put back into its natural position, the pressure put on the ears will be relieved and the congestion disappears.
Tingling or Numbness in the Fingers
When the TMJ is not in a balanced position, it affects the general posture of the body. When the posture is not straight and upright, the nerves coming out from the spine could be irritated, which could cause the numbness or tingling feeling in the fingertips.
We use a state-of-the-art jaw tracking system that helps diagnose TMJ Dysfunction (TMD) by tracking the jaw movement. Research shows that there are certain jaw movements which show very specific types of TMJ dysfunction. For example, limited opening and closing or locking, jaw opening deviations and deflections, and restricted side-to-side jaw movements. All of these indications are widely accepted and published criteria for diagnosing TMD.
Joint Vibration Analysis (JVA)
The Joint Vibration Analysis (or JVA) has been accepted by the American Dental Association to help provide a fast, non-invasive method to accurately diagnose TMJ function and demonstrate the severity level of the problem.
Electromyographic Analysis (EMG)
We use an Electromyographic Analysis (or EMG) to measure muscle activity on head and neck muscles both at rest and in function. This is done by placing computerized sensors on the skin allowing us to accurately monitor muscle activity. Hyperactive muscles are common for patients experiencing pain symptoms associated with TMJ problems. Imbalances between right and left sides of the same sets of muscles are also typical. The EMG system is a safe and comfortable method do help detect such issues and getting to the root of a TMJ issue.
Neuromuscular TMJ Treatment
TMJ/TMD is treatable most of the time. Simple cases of TMJ can be treated with anti-inflammatory medications and a hot/moist compress.
Treatment for more complex cases usually consist of two phases:
Generally speaking, it includes the fabrication of an orthotic. An orthotic is an acrylic device that is worn on the lower teeth 24 hours a day. The orthotic is designed to reposition the jaw to the correct neuromuscular position. We analyze the bite, decide which muscles are causing the pain, and where the current position of the bone is and the disc. All this is done with the aid of advanced equipment like the TENS unit, K7 jaw tracking, Sonography, EMG's and advanced x-rays like Tomography, CT Scans and MRI's of the TMJ. This will help us determine the best and most comfortable position of the TMJ and the muscles. Once that position is determined, we place the orthotic on the lower teeth to keep the TMJ in that position. Orthotics usually are worn for 4-6 months or until most of the symptoms are relieved. Once an orthotic is in use, the symptoms start gradually disappearing until we reach a point that both the doctor and the patient are satisfied with. This concludes Phase I of the treatment.
After 4-6 months of relief and when the patient is no longer suffering from any TMD symptoms, Phase II will be considered. Phase II includes any of the following:
- Wearing a long term removable orthotic, full time or part time.
- Replace missing teeth.
- Orthodontic treatment (Braces).
- Restore all the lower and/or upper teeth with crowns and veneers to preserve the optimal occlusion (bite) that was achieved with the orthotic in phase I.
Most of the time, any of the above could be considered and chosen, depending on the patients' preferences and financial capability. If you are currently suffering from TMD, it is too early to think of phase II at this time, since it is important to get you out of your pain and symptoms.
Treating TMJ/TMD Caused by Dentures:
Many patients complain that when they received dentures, they noticed pain in the jaw, headaches, ear problems and other symptoms. Sometimes taking the dentures out will relieve those symptoms. If your dentures are not made to the correct bite, or vertical dimension, it will most likely cause these symptoms. Simple adjustments could get rid of these symptoms, but sometimes a whole new set of dentures need to be made according to the neuromuscular principles, to get rid of your headaches or jaw pain.
Orthotics or Bite Splints
An orthotic is an acrylic device that is worn on the lower teeth 24 hours a day. It is designed to reposition the jaw to the correct neuromuscular position.
An orthotic, sometimes called a Bite Splint, is a very effective method in relieving TMD symptoms. It provides an acrylic platform to bite against, sometimes moving the mandible to a new position that is more comfortable.