Dental care often requires specialized expertise, leading to a division of labor among different types of dentists who focus on specific areas. General dentists provide comprehensive oversight, but particular procedures demand the advanced training of a specialist. Specialization focuses on either the internal structures of the tooth, particularly the soft pulp tissue, or the external supporting structures like the gums and bone. Understanding these specialized roles clarifies which professional is best suited for procedures like a root canal.
Who Performs a Root Canal
The procedure to save a tooth by removing infected or damaged pulp from its inner chamber is performed by a general dentist or, more commonly, by an Endodontist. Endodontics is the branch of dentistry focused on the dental pulp and the tissues surrounding the root of a tooth. Endodontists complete two to three years of additional training focused exclusively on advanced techniques for root canal procedures, root end surgeries, and diagnosing complex tooth pain.
General dentists are trained to perform routine root canals, particularly on less complex teeth like incisors and premolars. However, complex cases involving molars, curved roots, or retreatment are frequently referred to an Endodontist due to their specialized experience. Endodontists perform these treatments far more often, giving them a higher proficiency in managing complicated anatomy using advanced technology. A Periodontist typically does not perform this procedure.
The Periodontist’s Specialty Focus
The Periodontist is a dental specialist dedicated to the health of the periodontium, which includes the gums, cementum, periodontal ligament, and alveolar bone—the structures that surround and support the teeth. Their primary focus involves the prevention, diagnosis, and treatment of periodontal disease, commonly known as gum disease. This area of expertise is separate from the internal pulp chamber that is the focus of endodontic treatment.
Periodontists perform a range of procedures to manage and correct issues with supporting tissues. Non-surgical treatments often involve scaling and root planing, a deep-cleaning technique to remove plaque and calculus from the tooth root surfaces below the gum line. For advanced cases, they may perform surgical procedures such as osseous surgery, where the gum tissue is folded back to remove disease-causing bacteria and smooth irregular bone surfaces.
Other common procedures involve regenerative techniques and soft tissue management. Gum graft surgery, for example, is performed to cover exposed tooth roots caused by gum recession. Periodontists are also experts in placing dental implants, which are artificial tooth roots used to support replacement teeth. The goal of all these treatments is to establish and maintain a stable, disease-free foundation for the teeth.
When Dental Specialties Interact
While the Periodontist and the Endodontist focus on different parts of the tooth, there are specific situations where the two specialties must work together to treat a single tooth. This collaboration often occurs with a complex condition known as a combined periodontic-endodontic lesion, or “perio-endo lesion”. This type of lesion involves an infection that has spread to affect both the dental pulp inside the tooth and the surrounding gum and bone tissue.
The communication between the inside and outside of the tooth is possible because of accessory canals that connect the pulp to the periodontium, or through a fracture. In these combined cases, a coordinated treatment protocol is necessary for successful healing. The Endodontist addresses the internal infection with root canal therapy first, as eliminating the pulpal infection is a prerequisite for successful periodontal healing.
Following the root canal, the Periodontist then manages the external issue, performing procedures like scaling and root planing or surgical therapy. This sequential approach emphasizes that specialists refer to one another rather than substituting roles.