Do I Need an Endodontist for my Root Canal?

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 whose schedule is usually more accommodating and know that the patient will be treated correctly.

A caring dentist knows that he/she cannot 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 retreatment.

   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 cannot finish it, the Endodontist is bound legally to consider the procecure 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 retreatment immediately after the original root canal.

These examples are not the norm, but they are seen often 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.