Who Performs Root Canal Treatment Procedures?

By Brian J. Gray, DDS, MAGD, FICOI

All dental school graduates have basic education and training in the diagnosis and treatment of diseases of the dental pulp and are licensed to perform root canal procedures.

What Is an Endodontist?

An endodontist is a dentist who has completed an additional two- to three-year course of study in an accredited endodontic postdoctoral residency program. In addition to performing routine root canal procedures, the endodontic specialist has extensive training and experience in the diagnosis and treatment of a wide variety of conditions, such as:

• The differential diagnosis of painful oral and facial conditions in which the origin of the pain is uncertain. In these cases, the endodontist is part of a team, which may include other specialists in dentistry as well as medical colleagues, when appropriate.
• Endodontic treatment of teeth involved in cases of oral-facial trauma.
• Endodontic treatment for patients who are medically compromised.
• Endodontic treatment of complex root canal cases, such as teeth that exhibit calcified canals, curved canals, or very long roots.
• Non-surgical retreatment of teeth that have had previous root canals.
• Surgical treatment of endodontic disease that can be treated in no other way.

There are ethical guidelines that determine what an endodontist can and cannot do. As an example, an endodontist would not place crowns, dentures, or perform orthodontic procedures.

Following the completion of root canal treatment, a patient is usually referred back to the general dentist. At times, however, in a complex situation it may be necessary for the endodontist to refer a patient to another specialist before the patient returns to their general dentist.

Why Are Patients Referred From One Dentist to Another?

Patients are referred from one dentist to another because a dental problem may be so complex that its successful diagnosis and treatment require considering a multitude of complex factors. A "multidisciplinary" approach allows the patient to have expert opinions from different generalists and specialists so that the best of science, art, and technology can be utilized in a particular set of circumstances.

Oftentimes, an individual dentist is more interested and experienced in some areas of dentistry than in others. Dentists may choose not to do certain procedures because:

• They do not have the equipment, instruments, or training necessary to do the procedures.
• The time involved to do the procedure well is more than they wish to spend.
• Particular teeth may exhibit complex treatment challenges.
• The patient may have medical or other complicating factors.

In short, the primary consideration for referral is that the patient has the opportunity to have the best diagnosis and the best care available. A patient may be referred from one dentist to another to make certain that this goal is attained.