When a patient has a small cavity on the tooth’s surface, the typical protocol is to have it filled by a general dentist. But if bacteria makes its way into the inside or “pulp” of the tooth, a root canal may be necessary to remove the infected nerves and tissue. In many cases, a dentist can perform this type of oral surgery. However, there are certain situations when an endodontist will need to be called in to save the tooth. 

Symptoms That Indicate a Root Canal is Needed 

An infection inside the tooth can cause severe pain that does not go away. A dentist might suspect a root canal is necessary if patients also experience:

• Sensitivity to hot and cold
• Red, swollen gums
• A pocket of pus containing bacterial fluid
• Tooth discoloration

The Difference Between a General Dentist and an Endodontist

Most medical doctors who treat oral conditions are trained as general dentists. A dentist goes to college for an undergraduate degree, then attends an additional four years of dental school. During that time, a dentist learns:

• Preventative treatments such as cleanings, X-rays, and sealants
• Restorative treatments such as fillings, crowns, bridges, and dental implants
• Routine endodontic procedures (having to do with the inside of the tooth, such as a root canal)
• Emergency care such as tooth extractions

After finishing dental school, dentists can choose to continue their education to specialize in specific dental issues. For instance, a periodontist learns how to treat gum disease. An orthodontist learns how to realign the bite for straight teeth and optimum function. A pedodontist only treats children’s teeth. And an endodontist attends two extra years of school to study the inner tissues of the teeth, called the pulp. 

The word “endodontic” comes from “endo” meaning inside, and “odont” meaning tooth. While all general dentists receive training to diagnose and treat root canals, endodontists focus exclusively on conditions that affect the inside of the tooth, such as:  

• Pulpitis, which is a bacterial infection in the pulp chamber
• Necrosis, which is when the nerves and tissue inside the pulp die
• Tooth abscess, or a buildup of pus that forms when bacteria gets into the tooth

Long story short, all endodontists are dentists, but not all dentists become endodontists. 

In uncomplicated cases, having a general dentist perform a root canal is more convenient since it can be done in an office you’re familiar with. But sometimes, an endodontist is better trained to address your needs.

When Does a Root Canal Require a Specialist?

In the U.S. nearly 70% of root canals are performed by general dentists, which means the majority of cases don’t require intervention by an endodontist. A typical root canal requires removing the infected pulp and nerve in the root of the tooth, cleaning the inside of the root canal, then filling and sealing the space with a crown. A general dentist can usually do all of that. 

But if a dentist believes a particular root canal will be complicated and requires specialized treatment, he or she will refer the patient to an endodontist. Such cases include:

A Failed Previous Root Canal (Also Known as Root Canal Retreatment)

The most prevalent times dentists refer root canals out are after previous root canal failures. Failed root canals can result when a crown wasn’t placed fast enough to prevent further infection. They can also happen when a patient’s saliva contaminated the procedure, when the root was exposed to new decay, or when the full tooth canal was not treated. An endodontist uses advanced knowledge and specialized equipment to figure out why the tooth is still infected, remove damaged pulp, and save the tooth. 

Premolars and Molars

A general dentist can usually perform a root canal on canines and incisors since they have only one root. But treating upper premolars and molars is more complicated because they have up to four roots. For those teeth, an endodontist is almost always referred.  

Depth and Position of the Canals

Deep tooth canals can be difficult for a general dentist to access. The same goes for teeth that are crooked or oddly positioned, or a tooth that was previously damaged. While dentists only perform one or two root canals in a week, endodontists perform up to 25. There is a good chance they have seen a similar case and know how to treat it. 

Non-Specific Pain

When a dentist can’t find the reason for a patient’s severe pain, he may refer the patient to an endodontist. Even when a general exam and X-rays don’t reveal a problem, an endodontist’s sophisticated equipment such as ultrasonic instruments and 3D X-Rays can help identify the issue. And that can sometimes end up saving a tooth before it’s too far gone. 

Additional Pain Management 

Some patients just do not respond to typical anesthetics. Because endodontists are used to working with sensitive nerves, they are experts at administering numbing medications. For patients who have trouble staying numb in a general dentist’s office, this can be a deal breaker.

Many General Dentists Can Perform Root Canals. Talk to Your Dentist About the Right Option For You.

Whether you have a deep cavity, an abscessed tooth, or have oral pain that will not go away, you should visit a general dentist. A thorough exam will reveal what type of treatment you need in order to relieve pain and if needed, save your tooth. In many cases, a dentist will be able to perform a root canal. But if your case is unique or complicated, chances are they will refer you to an endodontist. 

Whatever you do, do not put off making an appointment. Find a dentist near you with Dental Health Society’s online search tool.