Seven year-old referred to endodontist

My 7 year old daughter was told that we had to take her to an endodontist. I don't fully understand the procedure used in this. My daughter is very scared, and I can't help her because I don't understand it myself. Can you explain it to me?

Question:

Dear Marilyn,

An endodontist is a root canal specialist. A general dentist might refer a patient to an endodontist for several reasons. Even though general dentists are trained in the techniques for completing root canals, some general dentists simply do not like to perform root canal therapy. Some general dentists may do root canals on some teeth, but not others. For example, root canals on molars can be somewhat more complicated than root canals on anterior teeth as molars have several canals and are more difficult to access. General dentists may also refer patients to an endodontist if diagnosis is difficult. It is not always easy to determine the cause of an aching tooth or even which tooth may be causing pain. Endodontists can be extremely helpful in determining proper diagnosis and, therefore, proper treatment.

First, I would advise you to discuss this referral with your daughter's dentist to find out exactly why your general dentist feels that the referral to the endodontist is necessary. If your daughter needs treatment for a primary tooth, treatment by the endodontist may not be necessary. Generally, "baby" root canals (also known as a pulpotomy or pulpectomy) for primary teeth are fairly simple and can be done by a general dentist or a pedodontist. If your daughter needs root canal treatment for a permanent tooth, her dentist may feel more comfortable having the endodontist perform the treatment, especially if the root of the tooth is not fully formed yet.

Root canals are successful about 90-95% of the time, and the procedure generally goes smoothly. The occasional stories you encounter about the tough root canals are actually more the exception than the rule. The endodontist will first anesthetize the tooth with local anesthetic. He or she will then place a rubber dam over the tooth. The rubber dam is a square piece of rubber with a hole punched in it to isolate the tooth. The rubber dam serves two important purposes: 1) to prevent instruments and medications from entering the throat of the patient, and 2) to keep the tooth clean and dry. A small hole, either in the back of an anterior tooth or the chewing surface of a posterior tooth, will then be made with the highspeed or slowspeed handpiece. This hole will allow access to the pulp chamber of the tooth. The pulp chamber contains the nerve and blood vessels of the tooth. Very small instruments called files will then be used to remove the pulp tissue from the canal(s) in the root of the tooth. If the root of the tooth is not fully formed, a medication which will promote complete formation of the root will then be placed. Once root formation is complete, a compound called gutta percha (an inert plastic material) will be placed in the empty canal(s) to prevent bacteria from growing in them and causing infection. This will complete the root canal procedure. After the root canal is complete, a filling and/or crown may be necessary to restore the tooth.

The procedure I described is the basic procedure. Since I have not personally examined your daughter, I am not sure of the details involved in her specific case. Please do not hesitate to discuss these details with your daughter's dentist and the endodontist. This information may help to relieve your anxiety. Marilyn, good luck and keep me posted on your daughter's progress.

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