The rise of endodontics
Mark Allen discusses why the delivery of exceptional endodontics is more in demand than ever.
Will there be increased demand for endodontic treatments and retreatments as a result of the pandemic? You may have noticed more patients calling to report the sudden, worrying onset of throbbing pain, which can be an indication of irreversible pulpitis. The temporary closure of practices and slow return to anything like “normal” capacity gave oral diseases plenty of time to develop and worsen, but extraction still isn’t the only answer.
Careful assessment of the restorability of a tooth is even more of a priority. Pending diagnosis, endodontic treatment remains the best way to save it and return a patient to full health, function and comfort. Now, there is a real opportunity to drive up acceptance when a recommendation for root canal therapy is made.
The prevalence of periapical disease
The last Adult Dental Health Survey (2009, published in 2011) may be over 10 years old, but its findings that “just seven per cent of dentate adults has one or more clinical signs of endodontic infection” was likely conservative; the prevalence of periapical disease has long been underestimated. Reasons why include patients using pain relief because they have a fear or phobia of the dentist, as well as the long-standing barriers to endodontic provision within general dental services. In 1999, research around how to improve access to endodontic treatment used in-depth interviews with NHS dentists, who talked about barriers including “constraints on choice of techniques and materials”, “perceptions of patient expectations” and “anxieties arising from lack of expertise (and) inexperience”.
Twenty years on and patient expectations are perhaps even higher, as are clinicians’ concerns about an unhappy person complaining or taking legal action. General dentists, when they suspect a problem in the root canal, should refer to an endodontic specialist. When delivered by a specialist, root canal treatment is predictable and stable. Post-covid, referring out is a good use of a practice’s resources, as well as being an excellent choice for the patient. An individual who wants a result that endures, and efficient treatment that respects their natural dentition, should understand that endodontic therapy could actually be a better choice than an implant, for example. With implant therapies, longevity may be affected by peri-implant disease, with a great deal yet to be learned about the management of this destructive process.
Practical and clinical reasons to refer
Another reason to refer to an endodontic specialist is that there is often a shorter waiting time for a consultation. General practices must know when to refer then and, if you’re a specialist practice or practitioner, you need to ensure that you seek out and nurture solid, reciprocal relationships. Your selling point is that dentists will get their patients out of pain and put them back on a journey to oral health, which, with support, they can stay on for years to come. Everyone wins, so use whatever means you can to get the word out that your doors are open.
Pre-covid, you could not have attended any dental show without seeing workshops talking about how practices should market their services. Post-covid, practices that are committed to positive communication and strong, clear messaging will be able to work with the new challenges in dentistry, not find themselves fighting against them. Exceptional endodontics should be more in demand than ever because it is a high value as well as efficient treatment. A specialist will be on top of all the latest developments in the field, able to complete therapy quickly and safely, without compromise to the end result. An expert can discuss after-care in the initial consultation too, as this is crucial to treatment success. This initial stage is also likely to happen virtually, over the phone, or via video conferencing, to reduce face-to-face contact – but this can be an easy way to get to know a new patient, or a new dentist, following a referral.
A specialist has the experience to optimise both “endodontic access and instrumentation”; this conservative approach will not just cut down treatment time but also ensure “further interventions or acute symptoms are prevented or nullified”. Specialists always choose the gold-standard in tools and materials to further support good clinical outcomes, too. Coltene’s HyFlex EDM preparation files offer flexibility as often only one or two are needed to complete a treatment. Also from Coltene, the CanalPro Jeni endomotor with integrated apex locator is digital assistance for streamlined endodontic therapy.
There is often no better alternative to the “psychological, functional and aesthetic advantages of tooth retention by way of root canal treatment”. Practices must know when to refer out to a specialist and specialists must invest in the very best products to deliver a stable result, as well as ongoing training and education. Take the opportunity presented by the enforced changes to dentistry and encourage referral to an endodontic specialist; more successful endodontic therapy will raise the level of general good oral health.
References available on request.