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Mary Chien DDS MS

Hacienda Heights, CA

Mary Chien DDS MS


What is an Endodontist and what do they do?

Endodontists are dentists who specialize in maintaining teeth through endodontic therapy involving the soft inner tissue of the teeth, called the pulp.  The word "endodontic" comes from "endo", in Greek, meaning inside and "odont" meaning tooth.  An endodontist usually has undergone a minimum of 2 years of extra postgraduate specialty training after dental school.  They study pulp biology and pathology, microbiology and root canal techniques and procedures in greater depth, for diagnosis and treatment of more difficult cases. For this reason, many dentists choose to refer their patients to endodontists.  The specialist training allows an endodontist to:

  1. deal with disease of the dental pulp and supporting structure;
  2. diagnose facial pain and related problems.

All dentists are trained in diagnosis and endodontic therapy, however, some teeth can be especially difficult to diagnose and treat.  That’s why you may have been referred to an endodontic specialist.

What Happens During Endodontic Treatment? What is a Root Canal?

A local anesthetic will be given.  A sheet of latex called the "rubber dam" (we've got non-latex ones too) will be placed around the tooth to isolate it; this also helps to prevent the irrigant and water from going down your throat during the procedure.  The endodontist removes the inflamed or infected pulp, carefully shapes and disinfects the canal system and then seals the prepared spaces with biocompatible materials.  Treatment may require more than one visit.  Once treatment is completed, you will be instructed to return to your general dentist for permanent restoration.

Root canal treatment or endodontic therapy has a very high degree of success, up to 95%.  However, the amount of remaining sound tooth structure and the quality of the permanent restoration also play important roles in determining the long-term succes rate.  We will discuss with you the chances of success before any endodontic procedure to help you make an informed decision.  If a root canal or endodontic therapy is unsuccessful or fails, you may still have options such as retreatment and/or apico surgery before condemning the tooth to extraction. 

Signs and Symptoms

Indications for endodontic therapy include prolonged sensitivity or pain to cold or heat, discoloration of the tooth, swelling or tenderness of the tooth or adjacent gums.  The offending tooth may or may not be tender when you chew.  Sometimes there are no symptoms at all.  You may also notice recurring pus ball or gum boils next to the tooth over a period of time. 

Orofacial Pain Diagnosis and Treament

Oral pain such as toothaches or cracked / fractured teeth can often be difficult to pinpoint.  Because of the vast network of nerves in the mouth, the pain of a damaged or diseased tooth often is felt in another tooth and/or in the head, neck, or ear.  TMJ pain, muscle pain of the head and neck, as well as sinusitis can also have similar clinical presentations as toothaches.  An endodontist is a specialist in diagnosing and treating this type of pain.

Traumatic Injuries

Pulp damage is sometimes caused by a blow to the mouth, and the endodontist specializes in treating these traumatic injuries. For example, a blow to a child's permanent tooth that is not fully developed can cause the root to stop growing. A procedure called apexification stimulates bone to be deposited at the end of the root which makes it possible to then save the tooth through a root canal procedure. An endodontist is specially trained in procedures for replanting teeth that have been knocked out of their sockets.

Will I need to return to your office for Additional Visits?

Once endodontic therapy is completed your tooth should be examined periodically, usually every 6 - 12 months.  This allows us to make sure the tooth has healed or is healing properly.  You will be sent a notice in the mail when we feel it is appropriate to reevaluate the area.  Since an abscess may take 2 years to heal, our office will reevaluate the tooth for at least 2 years.

Retreatment and Apico Surgery

Occasionally a tooth that has undergone endodontic treatment fails to heal or pain continues despite therapy.  Although rare, sometimes a tooth initially responds to root canal therapy but becomes painful or diseased months or years later. When either of these situations occur, the tooth often can be maintained with a second-round of endodontic treatment.