Some patients are afraid of endo … so are some dentists. Neither should be. If a patient says, “That wasn’t bad at all” after treatment and the tooth is comfortable for many years, the patient is happy and the staff is rewarded. If done well, endo can be one of the most rewarding, predictable, and profitable treatments a dentist can do. (endodontic endo motor)


Root canal therapy has made great strides in ease, efficiency, and predictability during the last few years, with increasing levels of patient acceptance. Advances in anesthetic materials and techniques, digital radiography, apex locator accuracy when teeth aren’t perfectly dry or filling-free, rotary files that take most of the physical finger work out of the procedure, and obturation materials that are simple and effective mean there is no reason endo shouldn’t be routine in most dental offices. Certainly, it is not something to loathe.
1. Methodical diagnosis

It’s really satisfying to do great endo, and it’s a real bonus if you do it on the correct tooth! Working on the wrong tooth is no practice builder. Therefore, it is imperative to our patients’ well-being, our practice reputations, and the practitioners’ peace of mind that we diagnose accurately and have confidence in our decisions.

Often the diseased tooth is obvious, but other times our evaluation must involve a series of tests that are challenged and scrutinized by our own skepticism. Endodontic teacher Dr. Steven Buchanan calls the search for the correct tooth “Methodical Skepticism.” It means being sure about something that is not easily seen. One must have a system of repeatable diagnostic tests that allows checking of all teeth in a suspect quadrant, and then be diligently thorough.

The patient interview and history is the place to start. We repeat the same questions on every patient: “What makes it hurt?” “How long have you had the pain?” “Is it sharp or throbbing pain?” “Does it hurt or feel better to hot or cold?” “Do you feel pain radiating to other places?” These start the evaluation to help differentiate between pulp pathology, periodontal issues, tooth fractures, or restoration failure.

Quality digital dental x rays machine cannot be overstated. Periapical radiolucencies and opacities are still the best indicators of a diseased tooth. Poor X-ray developing, improper angles, and faulty exposure settings all contribute to incomplete and unreliable diagnosis. Digital X-rays can help remove these errors, can be manipulated in the software to increase their diagnostic contribution, and the images have almost zero wait time. Perhaps the greatest advantage of all is that the digital image is usually seen on a 15 by 20 inch monitor instead of a 2 by 3 inch film on a view box (Fig. 1). It is certainly easier to diagnose from an image that is seven times larger with sharp detail.