The slogan for the Endodontics Masterclass I chaired in 2014 was “Listen, learn and Implement”. We had a fantastic audience who definitely listened and learned. I wonder what they took back and implemented in their practices?

We had outstanding endodontists in the line-up of speakers: Ghassan Yared, Arnaldo Castelluci, Liviu Steier and Martin Trope all pictured above. Each one espoused his own technique and theories in a very detailed and well  argued presentation. All had different canal preparation systems.

Then we had question time when audience members could put their queries to the panel. One dentist confessed to being confused by the different points of view. Having listened to some of the best  known speakers in the world, it was difficult to decide which system to invest in. Another dentist asked: “Bearing in mind how long endodontics has been a field of dentistry, why isn’t there some kind of consensus for this?”

We all agreed it was a sad commentary on the state of research – the problem being that you could not get ethical approval for an RCT  which would involve treating one cohort of patients in a less than satisfactory way. What we need is for all endodontists to work together and for peer-reviewed journals to insist on research which involves hundreds of patients, not just small groups.
And my advice to the delegates at the Endo Masterclass? Read the literature and follow best advice. As dentists you have the professionalism, experience and judgement to decide which system will work best for you and your patients.one cohort of patients in a way which you thought less than satisfactory. What we need is for all endodontists to work together and for peer-reviewed journals to insist on research  which involves hundreds of patients, not just small groups.

Regnerative endodontics has recently entered the topical mainstream. I predict that we are going to hear a lot more about this procedure which allows healthy pulp tissue to regenerate, thus avoiding definitive endodontic treatment.

In addition to the press release we have disseminated, there have been no fewer than two articles in the Daily Mail. The most recent was by David Hurst who interviewed the mother of a young patient of mine.

The previous one was much earlier in 2013 with the headline:” New op to dodge dreaded root canal treatment. I am delighted that Roger Dobson, the article’s author, picked up on the issue although for many patients, root canal treatment is no longer “dreaded” thanks to new techniques and advanced pain relief.

However, in his rush to praise regenerative endodontics, Dobson failed to emphasise it is only for young children.  But The Daily Mail at least introduced the subject of regenerative endodontics and parents  have started asking about it for their children.

It can be completed in only 2 visits, spaced 4-6 weeks apart. It stimulates root end closure over time but, more importantly, root development continues to occur which narrows down the root canal space, maintaining the natural strength of the tooth. David Hurst explained this well in his article in the Daily Mail.

The aspect of the procedure which captures the imagination, I believe,  is that regenerative endodontics harnesses the body’s natural healing mechanisms. How exciting that the re-growth of healthy pulp can lead to the normal and healthy development of the damaged teeth of our young patients without the need for root canal treatment.

I frequently find myself being asked for a second opinion. The patient comes to see me saying their dentist believes the problem with their tooth is sensitivity. But the patient suspects that the nagging discomfort is in fact a more deep-rooted problem – forgive the pun – and they wind up in my chair.

Today, dentists take a minimally invasive approach. They don’t want to open up a tooth or even carry out an x-ray unless it is necessary, which is of course correct. The trouble is, that the “minimally invasive”, “wait and see” approach does not always provide a solution.  Very often, the patient with toothache finds the absence of a clear diagnosis and a solution  frustrating because it does not signal an end to the problem.

I have several tests I undertake depending on the state of the tooth and the suspected problem. First I use the aspirator to blow cold air. This helps me zone in on a tooth or teeth that are symptom producing.  Then I percuss gently, tapping with the back of a mirror handle to see if I get a reaction. I might test all the teeth in the quadrant to make sure the patient is correctly identifying the source of the discomfort.

If the tooth has a minimum restoration and I suspect a crack, I use an LED light. Healthy teeth transmit light whereas a fracture line stops the light. For a tooth which is heavily restored, I use a bite stick or Tooth Slooth.

This is followed by cold and hot testing of the pulp of the affected tooth.  The final and definitive test is the electric pulp tester. From the above tests a preliminary  diagnosis of the pulp status can be made – reversible pulpitis or irreversible pulpitis.  Finally a radiograph is taken.

To the dentist in practice, wanting to deal with a worried and frustrated patient, I would always recommend a Tooth Slooth and/or  LED light investigation followed by an electric pulp test. By this time, the patient is reassured and happy that the cause of their toothache has been fully investigated and a solution may be on the horizon.

Stand-up comedians would struggle to find humour in a root canal treatment. Nevertheless, my colleague Trevor Lamb got a mention on stage from one of the UK’s best known stand-ups. The comedian, who must remain nameless, came to see Trevor  needing to be got out of pain so he could perform live that very night. Trevor duly delivered and was rewarded with a mention in the comedian’s set later in the day. It’s gratifying to think that thanks to Trevor, who takes his job very seriously, and the very uncomical root canal procedure he performed, many hundreds of people were able to go out for an evening of hilarity.

The extent of decay in this lower left molar makes this one of the more extreme cases dealt with here. The patient was in pain and had swelling and an extraction was a distinct possibility. Our policy is always to save teeth if we possibly can and that is what we set out to do for this patient. Follow the pictures left to right and you can chart the progress.

In the first picture, you can see the pale (radiolucent) areas around the bottom of the root and this shows that there is infection in the bone (apical periodontitis).  The old filling and all the decay were removed and the tooth was root treated in a single visit.

The tooth was rebuilt with a post and core followed by a crown by the referring dentist. The final picture shows the tooth at the 2 year review. The infection had healed. The tooth is maintained and the patient was very happy!