London endodontist



Endo specialist London Root canal expert London
"A procedure may look easy but prove to be challenging, even for a specialist."
Tony Druttman
"It's vitally important that the case is assessed correctly
and you are given treatment options."
Should you seek general or specialist help
for your endodontic treatment?
There's a difference between having a root canal treatment undertaken by a general dentist or by an endodontic specialist. It has to do with the degree of expertise, the degree of difficulty and the equipment used.

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by Dr. Tony Druttman

Endodontics as a specialty
If you've reached a point where your dentist says that one of your teeth needs a root canal treatment, how do you decide whether to let him or her carry out the work or have it done by a specialist? This article helps you understand the considerations.

Endodontics was recognised as a dental specialty in the UK only in 1998. In other countries such as the USA, Sweden, Australia and Israel, this field has been established for many years. Specialty training in Endodontics (Root Canal Treatment) requires three years of formal postgraduate education and goes far beyond the basic endodontics training given to general dentists.

Since all dentists are taught endodontics as part of their undergraduate education, any newly qualified graduate should be capable of carrying out a root canal treatment on any tooth in the mouth. In addition, few endodontists work in the public sector so patients usually pay for their treatment privately. So you may ask yourself: "If I have to pay for my root canal treatment why not let my regular dentists do the work?"

A question of expertise
Some dentists refuse to do any root canals, recognising that the specialist will do a better job. Others will do only the easier cases and there are those that will ‘have a go’ at anything and either refer when they experience difficulties or tell the patient that an extraction would be the better option. There are also general practitioners who have developed greater skills in this area. It all comes down to personal experience and expertise.

The complexity of dental roots

Fig. 1 X-ray of a tooth with very
curved roots buried in the bone
Some teeth have complex anatomy and generally molar or back teeth have more root canals than front teeth. But in some cases a molar is easier to treat than a front tooth. Assessing the case is not always easy. One cannot always be guided by a pre-treatment x-ray. It may show that the tooth has curved roots (Fig.1) or very small canals that will be difficult to locate. It may look an easy procedure but prove to be challenging in practice, even for a specialist.

Four reasons for referring to an endodontist
1. Diagnosis - The challenge is when multiple large fillings or crowns in a dentition obscure the source of pain and make it difficult to locate. Care must be taken in identifying the correct tooth.

Fig.2 Lower tooth with
three canals where only
one would be expected
2. Difficult teeth - Reaching the full length of a curved canal can be very tricky, even when using special instruments. Age, decay or restorations (fillings, crowns etc) can all reduce the size of root canal. Even when using magnification such as loupe or microscope, a root canal can be hard to find (see Fig.2)

3. Re-treatments - A significant number of root treatments carried out in general practice are unsuccessful over time, causing discomfort or even pain because of bacteria in the root canal system. Either this was never fully removed or it was reintroduced because of decay or leakage under existing fillings.

When a root canal treatment has to be repeated (called 're-treatment' - see Fig.3a and b) it is usually done by an endodontic specialist. This is especially the case if there has been a procedural error (a mishap occurring during treatment), or if the tooth has a post, or part of a dental file is left in the tooth. It is always vitally important that the case is assessed correctly and that you are given options of alternatives such as extraction and implants.

Fig.3a Failed root treatment of lower molar
tooth. The infection is shown in black
between the two roots

Fig. 3b The same tooth has been re-root
treated and the infection has healed. The
bone between the two roots has grown back

4. Patient management issues - Some patients are very anxious about dental treatment and particularly about root canals. The access to back teeth can be very challenging. These people can be put at ease by dental specialists with the greatest experience, expertise and access to the best equipment.

Are endodontists more successful?
Generally, yes. The chances of success are very high under the best circumstances, over 95%, but there are no guarantees. Each case must be judged on its own merits. Evidence-based studies suggest that endodontists achieve greater successes due to their experience, expertise and equipment. Most specialists use operating microscopes (Fig. 4) that give very high magnification and therefore allow work to be carried out with a very high degree of accuracy.

Fig. 4 Root canal treatment carried out with the aid of an operating microscope

Getting a second opinion
Having assessed your endangered tooth, your dentist may well offer to refer you to an endodontic specialist. If not, suggest that it may be wise to consult a specialist before agreeing to have your tooth extracted and perhaps replaced with an implant.

You don't need to wait for a dentist's referral. You can 'go direct' by reviewing the list of endodontic specialists on the General Dental Council Website - select 'specialist list' and then 'Endodontics'.

About Dr Tony Druttman
Dr. Tony Druttman, MSc. B.SC. B.Ch.D, is an Endodontics consultant with two practices in Central London. He teaches Endodontics at the Eastman Dental Institute for Oral Healthcare Sciences. He has lectured in the UK and at international congresses on wide-ranging topics dealing with root canal treatment.

Dr Tony Druttman
London Endo Ltd
38 Devonshire Street
London W1G 6QB

Tel: 020 7935 9943
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