Introduction and Scope of EndodonticsCHAPTER 1

Endo is a Greek word for “Inside” and Odont is Greek word for “Tooth”. Endodontic treatment treats inside of the tooth.

Endodontics has been practiced as early as second or third century BC. The history of endodontics begins in 17th century and since then many advances, developments and research work has been proceeded continuously.

Pre science (1776 to 1826): In this era, endodontic therapy mainly consisted of crude modalities like abscesses were being treated with poultices or leeches and pulps were being cauterized using hot cauteria.

Age of discovery (1826 to 1876): In this era there occurred the development of anesthesia, gutta-percha and barbed broaches. Also the medications were created for treating pulpal infections and the cements and pastes were discovered to fill them.

The dark age (1876 to 1926): In spite of introduction of X-rays and general anesthesia, extractions was the choice of treatment than endodontics in most of the cases of damaged teeth because theory of the focal infection was main concern at that time.

The renaissance (1926 to 1976): In this era, endodontics was established as science and therapy, forming its golden era. It showed the improvement in anesthesia and radiographs for better treatment results. The theory of focal infection was also fading out, resulting in more of endodontics being practiced and in 1943, because of growing interest in endodontics, the AAE, that is, the American Association of Endodontists was formed.2

Innovation era: It is the period from 1977 onwards in which tremendous advancements at very fast rate are being introduced in the endodontics. The better vision, better techniques of biomechanical preparations, and obturation are being developed resulting in the simpler, easier and faster endodontics with more of the successful results.

As we have seen, over the years, there has been a great improvement in the field of endodontics. Many researches have been conducted and papers are being presented regarding the advances, modifications and change in attitude regarding endodontic therapy. In the past two decades, extensive studies have been done on microbial flora of pulp and the periapical tissue. The biological changes, role of innate and acquired immunological factors are being investigated in dental pulp after it gets infected, healing of the periapical tissue after undergoing root canal therapy is also being investigated.

Scope of endodontics includes following:

Most of the patient who are given endodontic treatment, are often curious and interested in their treatment. For such patients following information should be transferred to the patient in anticipation of frequently asked questions.

Generally, all dentists receive basic education in endodontic treatment but an endodontist is preferred for endodontic therapy. General dentists often refer patients needing endodontic treatment to endodontists.

An endodontist is a dentist who undergoes a special training in diagnosing and treating the problems associated with inside of the tooth. To become specialists, they complete dental school and an additional two or more years of advanced training in endodontics. They perform routine as well as difficult and very complex endodontic procedures, including retreatment of previous root canals that have not healed completely, as well as endodontic surgery.

Endodontics is the diagnosis and treatment of inflamed and damaged pulps. Teeth are composed of protective hard covering (enamel, dentin and cementum) encasing a soft living tissue called pulp (Fig. 1.1). Pulp contains blood vessels, nerves, fibers and connective tissue. The pulp extends from the crown of the tooth to the tip of the roots where it connects to the tissues surrounding the root. The pulp is important during a tooth's growth and development. However, once a tooth is fully mature it can survive without the pulp, because the tooth continues to be nourished by the tissues surrounding it.

Number of ways which can damage the pulp include tooth decay (Figs 1.2 and 1.3), gum diseases, injury to the tooth by accident.

When pulp becomes infected, it causes increased blood flow and cellular activity, and pressure cannot be relieved from inside the tooth. This causes pain. Pulp can even die without causing significant pain.

When pulp gets inflamed, it may cause toothache on taking hot or cold, spontaneous pain, pain on biting or on lying down. on occasion a damaged pulp is noticed by drainage, swelling, and abscess at the root end (Fig. 1.4). Sometimes, however, there are no symptoms.

Because tooth will not heal by itself, the infection may spread around the tissues causing destruction of bone and supporting tissue (Fig. 1.5). This may cause tooth to fall out. Root canal treatment is done to save the damaged pulp by thorough cleaning and shaping of the root canal system and then filling it with gutta-percha (rubber like) material to prevent recontamination of the tooth. Tooth is permanently restored with crown with or without post.

If tooth is seriously damaged and its support is compromised, then extraction is only alternative.

Once the endodontic therapy is recommended, your endodontist will numb the area by injecting local anesthetic. After this a rubber sheet is placed around the tooth to isolate it. Then the opening is made in the crown of the tooth and very small sized instruments are used to clean the pulp from pulp chamber and root canals (Fig. 1.6). After thorough cleaning and shaping of root canals (Fig. 1.7), they are filled with rubber like material called gutta-percha, which will prevent the bacteria from entering this space again (Figs 1.8 and 1.9).

It has been seen that more than 95 percent cases of endodontic therapy are successful. However sometimes because of unnoticed canal malformations, instrument errors a root canal therapy may fail.

Since unrestored tooth is more prone to fracture so you should not chew hard until it has been completely restored, otherwise you should continue your regular oral hygiene routine including brushing, flossing and regular check-up.

Nowadays most of the treatment can be completed in 1–2 visits. But treatment time can vary according to condition of the tooth.

Nowadays with better techniques, and better understanding of anesthesia most of the patients feel comfortable during the treatment. But for first few days after therapy, you might feel sensation especially if pain and infection was present prior to the procedure. This pain can be relieved by medication. If continuous severe pain or pressure remains, consult your endodontist.6

No, since tooth is supplied by blood vessels present in periodontal ligament. It continues to receive the nutrition and remains healthy.

You should not chew or bite on the treated tooth until you have had it restored by your dentist. The unrestored tooth is susceptible to fracture, so you should visit your dentist for a full restoration as soon as possible. Otherwise, you need only practice good oral hygiene, including brushing, flossing, and regular check-ups and cleanings.

Most of the teeth can be treated endodontically. But sometimes when root canals are not accessible, root is severely fractured, tooth cannot be restored or tooth doesn't have sufficient bone support, it becomes difficult to treat the tooth endodontically. However, advances in endodontics are making it possible to save the teeth that even a few years ago would have been lost.