If you’re in need of a root canal, you may be debating between a dentist and an endodontist for treatment. What is the difference in these two professionals? To find out more about endodontists and what they do, 1Dental’s Kayla Holiday had the privilege of speaking with Dr. Jason Hales, an endodontic specialist at Superstition Springs Endodontics in Arizona, and founding author of The Endo Blog.
1. Tell us a little bit about your background.
I went to dental school in West Virginia where I had a general dentist residency for a year and then two years of endodontic residency from a master’s program. I finished in 2002 and have been practicing for 10 years. I work at an Arizona private practice and have been writing a blog for about five years.
2. What exactly does an endodontist do?
Endodontists treat everything associated with the root of the tooth. We are a dental specialist that focuses on and has high training with root canals. A general dentist typically performs an average of about two root canals a week while an endodontist does closer to 25 root canals a week. When a general dentist gets out of dental school, he has done anywhere from five to 10 root canals on real live patients. When an endodontist finishes the program, he or she has done 200-300 root canals on live patients. So as you can see, the amount of training an endodontist has in root canals is significantly higher than that of a general dentist. Specialists are typically the ones who are assigned to do the most difficult cases and deal with any complications. In my opinion, if you’re going to have a root canal done, I would always go to a specialist.
Another thing that makes a specialist different from a general dentist is the use of microscopes during a root canal. Endodontics is the only specialty in dentistry where microscopes are used, which allows us to look into the root of the tooth to find the canals and see things that wouldn’t be seen otherwise. Having a root canal done with a microscope is completely different than having one done without magnification.
3. Why did you decide to pursue endodontics over general dentistry?
I like focusing on one specific area of dentistry. I like getting from the start to finish very quickly. I like detail; endodontics is a very detail oriented specialty and most endodontists are very detail focused. I also like the technology. We were trained to use the microscopes and specialized equipment in dental school.
4. What technologies do you incorporate in your work?
We use digital radiography, which allows us to produce the radiation quicker than having film developed. Right now microscopes are, in my opinion, the standard of care for an endodontist. The microscope allows us to take images and video of the inside of the tooth, and that’s very helpful to the patients because it allows them to see what’s going on inside their tooth, as well as increases the communication between the patient and their general dentist. I believe that in 10 or 15 years, cone beam CT will also be a standard of care. This new technology, cone beam computed tomography, is essentially a CT scan for teeth. We’re able to now take a three dimensional image of the tooth and look it from any angle or direction. We can see things that we could never see before. We can see abscesses earlier than we would be able to detect them with an x-ray, how many canals are on the tooth, how much curvature a root has—we can literally look at the root before we ever go into it. That’s a new technology that we’ve been using for about two years now and is far ahead of the curve of even most endodontists. I believe this will revolutionize dentistry and endodontics.
5. Explain your research in endodontic sealers.
The goal of root canal treatment is to remove bacteria that has gotten inside the root. When we remove that tissue, we disinfect the space where the nerve tissue used to live and fill it with a root canal filling. The root canal filling is made up of two parts: one is a sealer like cement that coats the walls of the canal. The other is a filler, typically a rubber-like material, called gutta-percha, that seals up the space of the canal. Those two materials are what the root canal filling is made out of.
When I got my master’s degree, I was looking up resin sealers and the effect that they had on bacteria. They potentially had the ability to cause antibiotic resistance. I found that most endodontic sealers are pretty antimicrobial themselves. So they don’t form a resistance to bacteria because they kill bacteria.
6. Are root canals as scary as they’re made out to be?
They get a bad rap in the media, but modern endodontic therapy can literally be comfortable and painless. Most patients who have had root canals by an endodontist report that the procedure is very comfortable. In fact, I even have patients who fall asleep during treatment! There are certain situations where patients have infections, and so when they come to the endodontist, they are already in pain. I try to help people understand that if you have a problem in your tooth and it is causing you pain, a root canal is the solution to that pain, not the cause of that pain.
7. What advice would you give to a patient who is in need of root canal therapy but is afraid to have the treatment done?
First of all, I would recommend that the patient see a specialist. Specialists are trained not only to manage difficult cases, but they can do the treatment much quicker than a general dentist. They are also, from experience, used to working with patients that are anxious. When I do 1000 root canals every year, you can imagine that I’m comfortable working with patients that are anxious.
It’s also important that patients become educated about the procedure. If they pick the right practitioner, then the endodontic treatment can be painless. I think a lot of patients don’t understand that a general dentist is sometimes a gate keeper. Many patients are not aware that there are specialists who do just root canals. In other words, patients may be told that they need a root canal but the only time they’re referred for the root canal is when the general dentist decides to send them to an endodontist. But patients have the choice. If they want to see a specialist, they can request for a referral to see a specialist from the general dentist. Cases are particularly difficult for root canals on a molar or on a tooth that has a crown or bridge already. For a general dentist without a microscope, there is more chance of complications occurring.
If you have a root canal done and there is a complication, your general dentist will then send you to an endodontist to perform a retreatment under a microscope, and you’ll pay for that root canal a second time.
In no way am I saying that a general dentist shouldn’t do root canals, but general dentists should carefully choose which root canals they can do effectively and adequately. Molars, premolars, and teeth with crowns on them are exceptionally difficult to treat. Those are the ones that should really be treated with a microscope.
8. Any final thoughts?
There’s a lot of marketing going on right now about dental implants that contains misinformation about root canals and root canal retreatments. In my opinion, there is nothing as good as a natural tooth. Dental implants are a great way to replace a missing tooth, but nothing is as good as a natural tooth, and saving the natural tooth is much more cost effective than replacing it with an implant. That’s why I think endodontics is such an important specialty- we help patients to save their natural teeth.
Thank you, Dr. Hales, for taking the time to talk to us about the practice of endodontics and root canals. To learn more, be sure to visit his Endo Blog.