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ENDODONTICS AND PROSTHODONTICS SPECIALITIES OF DENTISTRY


ENDODONTICS:

Endodontics is a specialty of dentistry, that deals with the tooth pulp and tissues surrounding the root of a tooth. The pulp (containing nerves, arterioles and venules as well as lymphatic tissue and fibrous tissue) can become diseased or injured and thus is unable to repair itself. The pulp then dies and endodontic treatment is required. The word comes from the Greek words endo meaning inside and odons meaning tooth. Literally taken, it means study of that which is "inside the tooth".

Endodontists are dentists who have specialized in this field. Typically they have completed an additional 2-3 years of training following dental school. Many endodontic residents do original research and earn a Master's degree as well as a specialty certificate. They specialize and limit their practice to root canal therapy and root canal surgery, and use their special training and experience in treating difficult cases, such as teeth with narrow or blocked anals, or unusual anatomy. Endodontists may use advanced technology, such as operating microscopes, ultrasonics and digital imaging, to perform these special services, and often have great experience in successfully treating patient who present in pain. Patients requiring root canal therapy are either referred by their general dentists to the endodontist or are self referred. Root canal therapy is also a standard procedure for general dentists.

The most common procedure done in endodontics is root-canal therapy. This procedure aims to save a tooth that would otherwise be extracted (pulled) due to infection caused by decay (a cavity in the tooth), a large filling, periodontal (gum) diseases (perio-endo lesions), or trauma to the tooth. Root canal therapy involves the removal of diseased pulp tissue inside the tooth (the area inside the tooth that becomes infected due to the aforementioned reasons). The aim of treatment is to prevent or eliminate the development of inflammation outside the root (apical periodontitis) by removing the diseased/infected pulp and then sealing the root canal systems with a biocompatible material. When the pulp tissue becomes infected, caused by bacteria from inside the tooth, the infection can leak out of the tooth's root and make the surrounding bone ill and painful or cause an abscess to form. Once the diseased pulp tissues are removed, the body's defense system can then repair the damage created by disease.

Signs to look for include tooth pain, prolonged sensitivity to heat or cold, tenderness to touch and chewing, and discoloration of the tooth. Sometimes, however, there are no symptoms.

When performed by a specialist, most root canals can be performed in one appointment, depending upon the complexity of the case. Endodontists are experts at using local anesthetics to make the procedure virtually pain-free. It is considered a standard of care to use a rubber dam in order to isolate the tooth and provide a clean environment. An opening then is made on the top of the tooth. Then the pulp chamber and root canals are cleaned and shaped for filling and sealing. Often, an intra-pulpal medicament to inhibit bacterial growth is placed and the tooth is filled with a temporary restoration until the second appointment, where the temporary restoration and medicament are removed and the canal(s) are sealed with a root-filling material, usually gutta-percha, thus completing the procedure. Endodontists then refer patients back to their general dentist for placement of a permanent crown or other restoration. After restoration, the tooth continues to function like any other tooth.

Root canal-treated teeth typically last for a lifetime. According to the American Dental Association, root canals save more than 17 million teeth each year. Other treatments, such as extracting the natural tooth and placing an artificial dental implant, often cost 75 to 90 percent more than root canal treatment.

Other procedures practiced in endodontics include incision for drainage and periradicular surgery (apicoectomy). These treatments generally are needed in cases of abscesses, root fractures, and problematic tooth anatomy, but may be indicated in treating teeth that have persistent root end pathosis following root canal treatment.


PROSTHODONTICS:

Prosthodontics is one of the nine dental specialties recognized by the American Dental Association (ADA).

A prosthodontist is a dentist who specializes in prosthodontics, the specialty of implant, esthetic and reconstructive dentistry. Prosthodontists specialize in the restoration of oral function by creating prostheses and restorations (i.e. complete dentures, crowns, implant retained/supported restorations). Cosmetic dentistry, implants and joint problems all fall under the field of prosthodontics.

The American College of Prosthodontists (ACP) [1] ensures standards are maintained in the field. Becoming a prosthodontist requires an additional 3 years of specialty training after obtaining a dental degree (D.D.S. or D.M.D.) in an ADA approved program. An immense amount of time is spent in clinical and didactic study from 3000 hours over 3 years in a British program to 7000 hours over the same period in US accredited programs. Training consists of rigorous preparation in head and neck anatomy, materials science, esthetics, and occlusion (bite). Due to this extensive training, prosthodontists are frequently called upon to treat complex cosmetic cases, full mouth reconstructions, TMJ related disorders, congenital disorders, and sleep apnea by planning and fabricating various prostheses and orthotic appliances.

Maxillofacial prosthetics is a sub-specialty of prosthodontics. Maxillofacial prosthodontists treat patients who have acquired and congenital defects of the head and neck (maxillofacial) region due to surgery, trauma, and/or birth defect. It requires an additional year of training after completing an ADA approved prosthodontic training program. Artificial eyes, ears, and maxillary obturators are commonly planned and fabricated by maxillofacial prosthodontists. Other less commonly employed prostheses include mouth devices used by amputees to aid in daily activities, tracheostomy obturators, and cranial implants.

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