Patient Education Center
Patient Education Center
Types of Cases:
How do I know if I need an endodontic procedure?
Your tooth has nerve. These nerves are housed in the canal and chamber, hence root canals and pulp chamber. When the nerve inside the tooth becomes inflamed or dies, one will experience tooth pain. Whenever you experience pain on biting and tapping on the tooth, or when you have spontaneous and lingering pain from the tooth, you should contact your dentist and have your tooth evaluated. The tooth may need a root canal treatment.
What is an endodontist and what do they do?
Endodontists are dentist specialists who are trained in providing root canal treatment. About 80% of root canal procedures are completed by general dentists. However, if tooth canal anatomy is complex, or when a root canal treated tooth needs non surgical retreatment or surgical retreatment, then the treatment may be referred to an endodontist.
In additional to root canal treatment, an endodontist also perform surgical procedure for the previously treated root canal procedure (apicoecotmy), non surgical retreatment, evaluate teeth that had been in a traumatic accident, immature root regeneration and perform internal bleaching of a darkened tooth from trauma.
Will additional radiographs be required and can I use the ones taken in my referral dentist’s office?
X-ray Radiograph is an indispensible tools for endodontics, since almost all the work done cannot be observed under the naked eye. Hence it is important that we have excellent quality digital radiograph for diagnosis, evaluation and treatment of root canal procedures. Often, the radiograph provided by other office is either dated, has unusable resolution, incorrect angulation ,or does not show the entire root. Therefore, please be prepared to take additional radiographs
Can I book a consultation and have the treatment done on the same day?
This depends on what procedure is reccommendated and how much remaining time we have after a thorough examination is completed. If the proposed treatment is a root canal treatment, or a non surgical retreatment, and if time permits, then treatment can be started. Any surgical procedure will need to be scheduled.
Can my procedure be done in one sitting?
This really depends on several factors. In general, I do not like to complete the case I one visit for the following reasons:
- When there is a large infection, swelling and pain
- Tooth with severe extreme pain
- Difficult retreatment that requires much time to disassemble and remove of previous filling material.
- Failed retreatment cases with large PA lesion and symptoms
- When spatial space infection is present
- Inflammatory apical root resorption
What is CBCT?
Cone Beam Computed Tomography (CBCT) is a new radiographic imaging technology that allows the tooth to be viewed in 3-D. It is not the same as medical CT which generates more radiation.
Historically in endodontics, we rely on a 2 dimensional radiographs when looking at a tooth for diagnosis. In order to discern whether an object is in front or behind a tooth is questions, we tried to take different angles radiographs to give us a 3-D representation of the tooth in question.
CBCT allows us to view the tooth in 3-D. Although the radiation exposure is slightly higher than taking 1-2 tradition digital radiographs, the information gleamed from this imaging technique far outweighs the risk.
Our office is also equipped with the state of the art 3-D imaging technology cone beam computed tomography ( CBCT ), it allows one to examine the area in question in three dimension view. It is an excellent tool for difficult diagnosis. Because the CBCT image allows us to “walk around the tooth”, it sheds light to historically difficult to diagnosis cases.
The followings are example s when CBCT can be very helpful in treatment planning:
- Vertical root fracture
- Trauma with horizontal fracture and alveolar fracture
- Missed canal in previous treated RCT
- Planning for endodontic surgery
- To discern lesion of non odontogenic origin
- To verify for absence of apical lesion when not observed in PA radiograph
- To search for calcified canal
- To help decide whether a case should be treated surgically or none surgically
And so on…
The other question often encountered from our patients is concern of the radiation dosages. CBCT unlike medical CT produce much less radiation. We often compare this to amount of background radiation you are exposed to when walking in a sunny day in the South Bay. 1 digital PA radiograph is equivalent to 1 day of background radiation. 1 small focus view CBCT depending on which area in the mouth the CBCT is taken ranges from 1-6 days.
However, we are not belittling the concern of radiation exposure. Before a CBCT is ordered, we often weight the risk benefit having a CBCT scan. If the benefits of having a CBCT scan can help us treatment planning the case outweighs the risk, then I will highly recommend the scan.
Having said this we adhere to the ALARA (as low as reasonably acceptable) principal.
I have included a comparison table for your reference.
The Sievert is the preferred term for effective dose.
Rem: obsolete unit of radiation dose equivalent.
Sievert (Sv): 1uSv= .0001 rem= .10mrem
1 day backgeound radiation: 6-7 uSv
Yearly background radiation : 2400uSv
Common Dosages of Ionizing Radiation
|Dose uSv||Effective dose, days equivalent|
|Airport body scanner||0.02||.003|
|Kodak CBCT Max. Ant. Focused view||4.7||.71|
|Kodak CBCT Max. Post. Focused view||18.8||2.8|
|Kodak CBCT Mand. Ant. Focused view||22||3.1|
|Kodak CBCT Mand. Post. Focused view||38||5.8|
|4BW digital radiographs||38||5.8|
|1 day of background radiation||6.5||1|
|Chest Xray (PA and Lat)||170||25|
|1year of background radiation||2400||364|
|Flight from Newark to Hong Kong||63||9.5|
|Solar Flare while flying||600||92|
|Federal Occupational Safety Limit/ year (Adult)||50000||7692|