Most people know, generally, what a dentist does. But what about an endodontist? Less than 3% of dentists go on to become endodontists, so it’s not surprising that many people might not know what they do.
An endodontist is a dentist who specializes in root canal procedures and other treatments involving the pulp and nerves inside teeth. Root canals are needed when tooth decay has advanced beyond a cavity and has attacked the inner parts of a tooth. The word comes from the Greek terms “endo,” meaning “within,” and “odont,” meaning “tooth.”
Schooling for Dentists and Endodontists
The difference between dentists and endodontists starts with their education. All dental students receive training in basic endodontic treatment in dental school. Learning to perform root canal procedures is part of the curriculum.
But endodontists go on to complete an additional two to three years of advanced training focusing only on endodontic procedures. They become specialists in root canals, endodontic retreatment, endodontic surgery, dental implants, and the treatment of traumatic dental injuries.
Who Should Do Your Root Canal?
In many cases, family dentists are fully capable of performing root canal procedures. They have been trained to do them and their offices have all the necessary equipment. There are times, however, when a dentist may recommend an endodontist instead. As root canal specialists, endodontists may be better prepared to handle more serious cases.
So, while an endodontist can treat most cases needing a root canal, their advanced expertise may not be necessary for every case. It is best for a patient to consult with their dentist to see if an endodontist is needed. (If you do not currently have a dentist, use our dentist finder tool to find one in your area.)
Endodontists Are Specialists
A basic root canal includes removing damaged pulp from inside the tooth, cleaning out the empty canal, and filling it in. These are the straightforward type of procedures typically done in the dentist’s office. The complexity of a root canal procedure is usually the deciding factor in whether a dentist will refer a patient to an endodontist.
When a tooth has extensive damage, an endodontist may be better equipped to save the tooth. Serious conditions like pulpitis or dental pulp necrosis need to be addressed and fixed as soon as possible. Endodontists are also called in if a previous root canal has failed to fix the problem.
Molars can pose more of a challenge, as they contain multiple roots that branch out into several canals, whereas incisors and canine teeth only have one root. Dentists may choose to refer these cases to an endodontist.
Advantages of Endodontists for Root Canals
Endodontists are in the business of saving teeth that are at risk. While dentists spend a lot of time in the prevention of dental issues, endodontists focus on repairing damage that is already done.
Focused Experience
Endodontists concentrate all their time on this type of work. They do not fill cavities or do other procedures that general family dentists do. A typical dentist might do a few root canals a month. An endodontist might do 25 in a week.
Diagnostic Skills and Higher Success Rates
Because of their focus on pulp and nerve issues, endodontists develop keen diagnostic skills. They have the training and experience to find the patient’s problem and offer the best options for treatment. Clinical studies conducted by the Journal of Oral Surgery Oral Medicine Oral Pathology Oral Radiology and the Journal of Endodontics point to greater rates of success for endodontists (meaning fewer root canals that need to be redone) than those of general dentists.
Specialized Equipment
Endodontic practices have access to specialized equipment that a general dental practice may not have. They routinely use 3D-Xrays, surgical microscopes, and ultrasonic instruments in their procedures. Without these tools, it can take an endodontist half the time it takes a general dentist to complete a procedure.
Expert Pain Management
Many patients fear root canal procedures because of their reputation for being painful. Endodontists are experienced in anticipating and controlling pain during and after root canal procedures and other surgeries. They may also offer sedation and options to relieve anxiety.
Advantage of Dentists for Root Canals
While there’s nothing wrong with going to an endodontist for even a basic procedure, it is not always necessary. Since not all root canal cases are challenging, a dentist can be the best option.
Lower fees
Because endodontists are specialists, they typically charge more for their services. It may be more cost effective to visit a dental practice instead. Patients should ask for an estimate so they can compare prices. If they have dental insurance, they should check with them about exactly what services are covered.
Familiarity
Many patients will find it comforting to visit a familiar office. If a patient is used to a practice’s staff, scheduling procedures, billing, and insurance policies, they may feel more comfortable with the entire process.
Convenience
When a patient needs a root canal, especially in an emergency, it will be easy to find a dentist just about anywhere. Even if they don’t have a regular dentist, they will most likely be able to find one nearby who will accommodate them. Endodontists, on the other hand, may be harder to find in some areas of the country. And while a regular dentist may be chosen for being nearby, a patient may have to travel farther to visit an endodontist.
Continuity
There is some advantage to having one person doing all of a patient’s dental work. They will know the patient’s history and have access to all relevant files.
The orofacial and skeletal development associated with Down's Syndrome contribute to dental problems. It is important to be aware of the type of anatomical soft tissue and dental anomalies which are part of the typical developmental pattern of people with Down's Syndrome, which have influence on dental problems.
Dental anomalies are related to the tooth morphology in that there is.- Decreased root to crown ratio, Decreased tooth size, Hypodontia or partial anodontia and Delayed eruption.
Dental Problems:
The normal development of oral structure and function is altered leading to compromised development of suckling, swallowing, mastication and speech; and to drooling unless there is effective intervention. The degree of difficulty varies from person to person:
Preventive measures and therapy are needed to ameliorate the problems found in swallowing and mastication. Here an integrated approach can be adopted with the Speech and Language Therapist.
Dental Disease:
People with Down's Syndrome are prone to the same degree of dental disease as the general population. Periodontal disease: People with Down's Syndrome develop more severe forms of periodontal disease than the general population. This may be related to immunological deficiency factors. This disease is most rampant in young people between 16 and 20 years old. The progression of the disease gives rise to periods of acute infection and pain, which may result in changes in behaviour, refusal to eat or swallowing food whole.
Caries:
Various studies have shown a reduced incidence of caries in children and young adults with Down's Syndrome. This may be due to the fact that many of these children are under supervision in regard to their diet in order to prevent their tendency to obesity. This is where the dentist and the dietician can work together to make sure the food being consumed is working towards oral and general health improvement.
Risk associated with infection is raised in people with Down's Syndrome as the incidence of congenital cardiac disease is increased in this group (3% to 40%), resulting in a serious risk of endocarditis.
The gag reflex can occur even in the anterior portion of the oral cavity. Any further back than the premolars a gag reflex may be accompanied by a gastro-oesophegal reflux. Children find this most uncomfortable.
Bruxism occurs in people with Down's Syndrome and may be triggered by a state of chronic anxiety, dental malocclusion, temporo mandibular joint dysfunction due to laxity of the supporting ligaments, and/or underdeveloped nervous control.
Dental trauma is frequently experienced due to lack of motor development. Fracture or luxation of the anterior teeth is frequent and often involves loss of tooth vitality.
Treatment and prevention: Good oral hygiene and supervised tooth brushing programmes, Education, e.g. via videotapes, Diet, communication and use of oral muscles. This requires an integrated approach to care, as it involves a team of professionals and carers. Management of any malocclusion requires a multi-disciplinary team to carry out diagnoses and treatment planning (e.g. Orthodontist, Restorative and Oral Maxillo-Facial Surgeons).
Losing teeth can do more than affect the ability to delight in a fresh, crunchy apple or flash a healthy smile. New research study suggests that tooth loss– a marker for gum (gum) disease– might forecast rheumatoid arthritis and its intensity. The more teeth lost, the greater the danger of RA, one research found.
In the study of 636 patients with early arthritis, provided at the 2012 European Congress of Rheumatology in Berlin, 24.2 percent had 10 or fewer teeth, 16.1 percent had 11 to 20, 36.3 percent had 21 to 27 teeth, and 23.3 percent had 28 or more teeth. (A full set of adult teeth, consisting of wisdom teeth, numbers 32.)
At six months’ follow-up, 52 percent had a great reaction to treatment, 32 percent had a moderate reaction and 16 had no reaction. The worst diagnosis was for those with the fewest teeth. Individuals with 10 or fewer teeth had more severe arthritis– evidenced by a considerably greater erythrocyte sedimentation rate, higher tender and swollen joint counts, and a higher Disease Activity Score– than those with more than 10 teeth.
In a separate study provided at the exact same meeting, Italian scientists reported that tooth loss was connected with joint symptoms in a group of 366 first-degree relatives of people with RA, which put them at enhanced risk of RA themselves.
Rheumatoid Arthritis and Gum/Dental Disease
Individuals with one or more inflamed joints had approximately 26 teeth, compared to an average of 29 teeth for those with no inflamed joints. The less the teeth participants had the higher their danger for joint inflammation, the researchers found. Patients with less than 20 teeth had 8 times the risk of having at least one swollen joint compared with those with all 32 original teeth.
The Mouth-Joint Connection Problems
The 2 studies are simply the latest in a growing body of research study linking periodontal disease and rheumatoid arthritis. In a research of 6,616 men and women who underwent 4 medical exams in between 1987 and 1998 and an assessment for gum disease between 1996 and 1998, those who had moderate to severe periodontitis had more than two times the danger of RA as compared to those with moderate or no periodontitis, says study author Jerry A. Molitor, MD, PhD, associate professor in the rheumatic and autoimmune disease division of the department of medicine at the University of Minnesota, Minneapolis.
Such research study grew from earlier observations that individuals with rheumatoid arthritis had the tendency to have more periodontal disease and individuals with gum disease had the tendency to have more rheumatoid arthritis.
Medical professionals presumed that periodontal disease was a result of RA itself (stiff, uncomfortable hands made oral hygiene difficult) or the medications to treat it (drugs that reduced the body immune system inhibited the body’s capability to eliminate hazardous bacteria in the mouth), states Dr. Molitor. In addition, Sjögren’s syndrome with RA lessened production of the mouth’s protective saliva, leaving it vulnerable to disease.
A separate research study out of India, which was published this year in the Annals of the Rheumatic Diseases, discovered two times as many cases of gum disease in 91 patients with RA compared to 93 patients without RA. Since none of individuals with arthritis had actually taken disease-modifying antirheumatic drugs (DMARDs), the drugs’ suppression of the immune system might not be blamed for the disparity.
Researchers studying the RA and Dental Problems connection have found similarities in the joint and oral tissues, as well as in the inflammatory procedures that influence them.
If oral bacteria are involved in the development or development of RA, or inflammation in the mouth somehow fuels swelling in the joints, one may reason that clearing up the gum disease would likewise assist avoid or deal with RA.
Dr. Bingham says more research study is needed to better identify whether treating gum disease enhances or and if efforts to avoid periodontal disease may also assist prevent RA. In the meantime, he says, there is factor for individuals with RA and their doctors to pay certain focus on oral health.
5 Oral Health Consequences If Your Teeth Don’t Line Up Correctly
May is National Smile Month, but people with significant bite issues aren’t always eager to show off their pearly whites. More important, though, is that bite issues can affect your health. Maybe it’s crooked teeth that have thrown your bite out of whack. Maybe you suffered an injury, or perhaps the cause is dental work that wasn’t quite right. Whatever the reason, overall dental health is affected. Here are a few of the long-term consequences when teeth don’t line up quite right:
1.-Tooth pain: A bite that is off by a fraction of a millimeter can cause tooth pain. Improperly adjusted dental work can irritate a nerve. Tooth pain from these factors usually happens quickly and is usually the result of trauma or dental work. It’s important to have the eventual position of the tooth corrected to prevent long-term issues.
2.-Jaw joint pain (temporomandibular joint, TMJ): The jaw joint is made up of two bony parts: the temporal bone in the skull and the lower jaw (the mandible). Put the temporal bone and the mandible together, and you get the temporomandibular joint (TMJ). Occasionally trauma to the joint can create a crackling or popping sound when you open or close your jaw. For most people, that’s no big deal. But, if you have a hard time opening your jaw, can’t open it at all, or have significant pain during jaw movement, you should be evaluated for TMJ problems.
3.-Muscular pain: Muscular pain is the most common finding in people with jaw-joint problems and is largely responsible for the pain associated with many headaches.
4.-Tooth wear: Your teeth function as a chewing machine. And, just as with any other machine, the parts need to fit together properly to prevent premature wear. Over time, teeth can wear so that the inside part of the tooth becomes exposed. Once tooth wear progresses to a certain point, significant dental work and orthodontics are necessary to correct the problem. Preventing significant tooth wear before it happens is the best approach.
5.-Gum wear: Not only will teeth that aren’t aligned correctly begin to wear prematurely, the gums and supporting bone will, too. Notching of the teeth near the gum line and wearing away of the gum tissue are common in people over 30 whose bite is off. Gum recession and tooth notching can be painful as well as difficult and expensive to fix. Again, prevention by correcting your bite early is the best option.
Some people’s bad bites catch up with them when they are in their 20s. For others those bad bites won’t create significant problems until they are in their 60s. But eventually your bite will catch up with you. Dealing with bite issues proactively is much less painful, less labor intensive, and less expensive than dealing with bite problems later.”
Dr. Lee earned her dental degree from the University of California at Los Angeles and completed her residency in Hospital Dentistry at University Medical Center in Fresno. She has also completed more than 600 hours of postgraduate continuing education. Dr. Lee believes that having a solid education is critical to ensuring the highest level of patient care.
Dr. Treva Diane Lee grew up in the Central San Joaquin Valley and is a Bullard High School graduate. She attended UC Berkeley and received her Bachelor's degree with Honors in the Food, Nutrition, and Dietetics major.
To Dr. Lee, the community is very important. You may not know that her drive to become a dentist originally sprang from her desire to help her friends and neighbors from Fresno and Madera counties.
As a dentist, Dr. Lee focuses on providing top-notch, personalized attention to her patients. To give back to her community, Dr. Lee provides complimentary screenings at local schools during Children’s Dental Health Month, gives care to the less fortunate in Ocoroni, Mexico through LIGA, participates in TeamSmile, combining major sporting events and children's dental care, Give Kids A Smile, fundraising for local Alzheimer's organizations with the Senior Living Network, and local charities with Parker's Team/Central Valley Charitable Cycling Association.
Dr. Lee is an active member of many notable professional organizations, including achieving a Mastership in the Academy of General Dentistry,and International Congress of Oral Implantologists (ICOI) (of which she is a Fellow), the American Dental Association, International Association for Orthodontics, the Dental Organization for Conscious Sedation, the American Association of Women Dentists, the California Dental Association, and the Fresno Madera Dental Society. Dr. Lee is also active with the Clovis Chamber of Commerce and the Fresno Women's Network.
She is also a gifted speaker, having lectured at high schools in the area, and is a certified instructor at San Joaquin Valley College.
Serving the area around Clovis and Fresno, dentist Treva Lee, D.D.S., has the skill, expertise, and training necessary to provide high-quality, easy-care dental services that can really make a difference in her patients' lives.
She knows that to give the best care to her patients from Fresno and Madera counties, she must be a dentist with more than just good technique. This is why she is also committed to better understanding and getting to know her patients personally, thereby knowing the best ways to help them.
It’s quite common and expected that when you have a tooth filled or extracted, the dentist will use medications to numb the area and ensure you’re comfortable throughout the procedure. If you’ve never had a procedure that required numbing, you may be nervous because you don’t know what to expect. Fortunately, with a better understanding of how numbing medications make you feel, you can feel more at ease about any impending procedures.
Things to keep in mind
Knowing that you need a filling, extraction or other dental procedure that requires numbing can be stressful, but the purpose of numbing is so that you don’t feel anything during the procedure. Every patient is different so numbing may affect you more or less than other people, and this doesn’t mean that there’s anything to worry about. The medication given during certain dental treatments may cause numbness in both your face and head, but this isn’t cause for concern. Other elements to be aware of during numbing include:
There’s less numbness for upper tooth extraction than lower tooth extraction
The dentist can numb upper teeth individually, so there’s less overall numbness
The dentist can numb upper teeth in blocks or sections for larger treatment areas
For lower teeth numbing, half of your lip and tongue on the side of treatment will go numb
It’s common and normal to experience numbness in your nose, cheek and the side of your head during a dental procedure because of how all the nerves in your face and head are connected. For a tooth extraction, it’s common for the entire side of your head to feel numb, and this doesn’t indicate a problem. The dentist wants to make sure that you’re comfortable and pain-free when removing a tooth.
When numbing wears off
Dental numbing usually wears off within a few hours. The length of time numbing lasts depends on what anesthetics the dentist used and where treatment occurred in the mouth. Generally speaking, though, feeling should return within 2-4 hours. You may have trouble speaking normally, eating or drinking while numb, but once sensation routines, you will be fine. If you don’t think numbing will be enough to calm your nervousness or you have dental anxiety, ask your dentists about sedation dentistry.
At Creative Dental, we encourage you to discuss any concerns you have about numbing and other aspects of dental treatments. We want you to feel as comfortable as possible during all procedures, and we put your oral health needs first.
Keeping a Healthy Smile Despite MS and Dental Issues
One of the biggest concerns that dental care providers have for patients with MS is the difficulty that they have managing adequate oral hygiene due to tremors or muscle impairment.
Even without compromised tooth brushing, oral hygiene may be poor with increased bacteria levels that can predispose someone with MS to complicated dental problems later on.
Dry Mouth
Xerostomia (dry mouth) is a side effect of MS or the medications taken for it. When the mouth is too dry, teeth decay at a much quicker rate. Keeping the mouth lubricated with moisturizing drops and drinking plenty of water can help to an extent.
Get Creative with Your Oral Hygiene Aids
Adding a Xylitol spray to your daily routine can decrease the plaque buildup in your mouth. The molecular makeup of Xylitol prevents plaque from clinging to the teeth (causing weak enamel). Getting 5 exposures of Xylitol each day from a spray, gum, or other source has been shown to be as effective as tooth brushing in regard to the amount of plaque in a person’s mouth.
Using an electric toothbrush and water flosser will allow the equipment to do the work for you, as long as you’re able to minimize the mess and place them where they need to be. Angling the electric brush along the gumlines and brushing for at least 2 minutes can drastically improve your oral health and reduce gingivitis symptoms.
Prescription Fluoride Is a Must
Topical prescription fluoride gels are able to accommodate the remineralization of enamel that has demineralized or is in the earliest stages of tooth decay. For best results, first brush thoroughly and then apply the fluoride gel immediately before bedtime without rinsing, eating, or drinking afterward.
At the Dental Office
Unfortunately, complications from MS such as facial paralysis or pain may make some dental problems difficult to diagnose. A detailed, comprehensive examination is needed to pinpoint any type of diagnosis in a patient with MS.
In very rare circumstances, pain from MS can be experienced as tooth pain due to nerve damage. Be sure to find a dentist that understands how MS can affect their patients, and if you’re not happy with your dentist it’s fine to shop around.
Schedule your appointments first thing in the morning, and either set up multiple short appointments, or a longer appointment with multiple 5 to 10 minute breaks every half hour. It can be difficult to sit for long periods of time, so getting up and moving around will help. Adding a mouth prop can also make it easier to have your mouth open and muscles relaxed as your dentist cares for you.
The most important consideration for your mouth is a good preventive care plan. Losing teeth due to decay or gum disease can jeopardize the well-being of a person with MS, because large removable prosthetics such as dentures typically do not work very well for them. If you’ve lost teeth due to the difficulty of caring for them, a fixed implant or implant-supported-prosthesis is a wonderful option.
University Dental Group was established in 1997 by Dr. Richard Morales, a Miami native and a graduate of the University of Florida College of Dentistry, on Miracle Mile in downtown Coral Gables. As the practice grew, he relocated to South Miami and in 2009 back to the City Beautiful and to the current state-of-the art facility. Dr. Rebeca Garcia joined the practice in 2009 and Dr. Lauren Triana in 2014.
Richard D. Morales, DMD, is a product of Jesuit education, having graduated from Belen Jesuit Preparatory School in Miami. He then attended the University of Miami where he received his Bachelor's in Science majoring in Biology and minoring in Chemistry. He graduated from University of Florida in Gainesville with a Doctorate in Dental Medicine in 1995, and then went on to complete a one year General Practice Residency at Mount Sinai Medical Center in Miami Beach.
In practice now for nearly 20 years, he has been in his current location for almost four years after spending seven years in South Miami and five years on Miracle Mile. Since graduating from his GPR program, Dr. Morales has kept up to date on the latest procedures and studies by immersing himself in continuing education courses, averaging over 150 hours yearly, ensuring that his patients receive the most comprehensive and advanced dental care.
Born and raised in South Florida, Dr. Morales maintains close ties to the community, and is active in youth sports programs and in his church. He and his wife Cecilia and their four young children live, work and play in and around Coral Gables.
REBECA M GARCIA
Rebeca M. Garcia, DMD joined the team at University Dental Group in October 2009. Prior to working with us, she was the sole dentist working out of the Pankey Institute in Key Biscayne, where she practiced comprehensive dental care using the techniques taught at the world-renowned advanced-learning facility.
Born and raised in Miami, Dr. Garcia received her undergraduate education at the University of Miami. She then attended Nova Southeastern University College of Dental Medicine and graduated in 2004. Since completing a residency at the Veterans Administration and Jackson Memorial Hospital in 2005, she has been in private practice.
Dr. Garcia prides herself on providing gentle and comprehensive dentistry to all her patients, making her a perfect fit for our team.
Pain is the body’s way of conveying that something wrong is happening and needs attention. Pain is never really straightforward and is caused due to inflammation. It can be physical, emotional or physiological and helps in eliminating the foreign bodies or infections by activating the immune system. But if chronic, the inflamed areas will take longer time to heal causing chronic pain.
Some people suffer from chronic neck pain or back pain while others suffer occasionally but not everyone knows that tooth related problems can also cause headache or backache. If there is chronic back pain but cannot determine the reason then the underlying cause can be a dental problem. This is known as referred pain i.e. pain perceived at an area other than the site of origin. The more stressed and inflamed the body becomes, the longer it will prevail and take time to heal.
Teeth contains interconnecting sensory nerve fibers and nerve endings which help in sending signals up and down the spinal cord. So, when there is toothache or cavities, it can affect the structures below like the neck, back, etc causing pain and can radiate to the entire face or skull.
Referred pain can also be due to the muscle interaction with one another. A common example is jaw disorder (TMJ) and back pain. Patients with TMJ problems often complain of backache because when the jaw is out of alignment it causes the muscles of the neck, shoulders and back to stress by exerting extra force but when these muscles wear, the surrounding areas can pain.
The jaws are to be aligned correctly to achieve proper phonation and masticatory function but in case of malocclusion, these functions get compromised and can change the position of the skull. Realignment of the dental arches is required to solve the dental problems and reduce the stress on the neck and back muscles thereby restoring the overall health.
If the body is not properly aligned and the head moves forward in front of the shoulder joint like when staring at a computer, the jaw, neck and shoulder muscles overstress to hold the head upright and can result in pain, locking, stiffness and over time temporomandibular joint dysfunction or TMD. So, maintaining a good posture is required to prevent back pain.
Back pain can also be from poor diet, poor dental health, incorrect breathing patterns, etc. So, eating organic food, maintaining good oral care, breathing correctly (nasal breathing), etc can reduce the amount of stress and inflammation leading to back pain. Besides, moving and stretching body, visiting a chiropractor or acupuncturist or physiotherapist, etc can also help in healing back pain.
As mouth (tooth) is in close proximity to the brain, in case of tooth infections the infection need not travel too far to affect the brain. Tooth infection is not to be taken lightly and is better treated than leaving untreated. Besides, it is important to identify the cause of pain and help in making proper diagnoses. Mostly, a toothache means time to visit a dentist but it is always better to know what else it can be.
Dr. James G. Monaco DMD has been providing excellent dental care in Fayetteville for over 25 years. Skill and compassion go hand in hand when providing exceptional patient care. As a dental professional, I stay up to date on the latest advancements in dentistry in order to provide the most current treatment options for my patients.
As a doctor, I recognize that my patients are unique individuals who have placed a great deal of trust in me and my team. That is just one reason why I value each and every patient relationship.
I appreciate the time you’ve taken to visit our site and find out more about this dental practice, my team, and the many services we can provide to help you achieve optimum oral health.
Dr. Monaco is an active member of the following Dental Associations:
American Dental Association (ADA) New York State Dental Association (NYSDA) New York State 5th District Dental Society Onondaga County Dental Society American College of Prosthodontists (ACP)
At Dr. Monaco's we ONLY do Restorations of Dental Implants
