Endodontic consultations in our office include a thorough medical history review, as well as history of the endodontic problem. We collaborate with your family dentist to gather all the relevant information. During the consultation, radiographs and possibly CBCT (3D radiographs) are obtained, a microscope inspection and clinical tests are performed to indentify the problem. After the examination, Dr. Nesari discusses all the possible treatment options, risks and benefits of each options, and timelines for any necessary treatment. This consultation is essential to both diagnose endodontic problems and to help determine how to best proceed with respect to the overall treatment plan provided by your family dentist. Often times, endodontic treatment may not be necessary; the consultation is essential to determine if this is the case. 

Endodontic treatment is necessary when the pulp (internal soft tissue of the tooth) becomes inflamed or infected. The most common reasons for inflammation or infection are deep cavities (caries), repeated dental procedures, cracks or fractures in a tooth. Trauma can also cause inflammation and often shows up as discoloration of the tooth. If pulp inflammation or infection is left untreated, it can cause pain or lead to an abscess.

In order to understand endodontic treatment, it helps to know something about the anatomy of a tooth. Teeth have several layers. The outside layer of the tooth is composed of a hard layer called enamel. Enamel is supported by an inner layer called dentin, which has at its center a soft tissue known as the pulp.

The pulp contains blood vessels, nerves, and connective tissue that are responsible for forming the surrounding dentin and enamel during tooth development. The pulp receives its nourishment supply from vessels which enter the end of the root. Although the pulp is important during development of the tooth, it is not necessary for function of the tooth. The tooth continues to be nourished by the tissues surrounding it even after the pulp is removed.

The endodontist removes the inflamed or infected pulp, carefully cleans and shapes the canal system and then seals the root of the tooth. Once treatment is completed, you will return to your dentist for a permanent restoration (dental filling and possible crown). The restoration of the tooth is an important part of treatment because it seals the cleaned canals from the oral environment, protects the tooth, and restores it to function.

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 occurs, the tooth often can be maintained with a second endodontic treatment (retreatment).

Occasionally a tooth has undergone multiple endodontic treatments and has still not responded favorably to the treatment. In these occasions, a surgical approach is more appropriate, especially when further treatment is not feasible or may risk weakening the tooth and lowering its long-term survival. Dr. Nesari is well-trained in not only understanding when this procedure is indicated, but also in meticulously planning and performing the procedure using the latest 3D imaging technology (CBCT), advanced bioceramic materials, and modern microsurgical instrumentation.

There are occasions, although rare, that teeth that have had root canal treatment begin to darken over time. These teeth are usually functional, but not esthetic. Careful endodontic consultation, examination, and review of the treatment history, allows us to determine if internal bleaching can return the tooth to its natural shade. The microscope is essential for this purpose, as it allows careful internal cleaning and stain removal, without removing too much tooth structure. Most of the time, internal bleaching can return the tooth to its natural shade without the need for crowns or veneers. Best of all - no numbing!

There are scenarios where teeth have deep cavities (caries), very close to the pulp. If these teeth are asymptomatic and responds normally to endodontic testing, then they may not necessarily need endodontic treatment. There are newer materials that can be placed in the tooth that can promote regeneration (bioceramics) and other conservative options to avoid endodontic treatment.