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Endodontic treatment of teeth is one of the most complex procedures that falls under the umbrella of general dentistry. Understanding when it is appropriate to refer to a specialist could save the general dentistry office serious time, money and stress in the long run.
“Most root canals can be performed [by an endodontist] in one visit under an hour at the highest possible level” says Dr. Rico Short of Apex Enododontics in Smyrna, GA
Teeth with periapical pathology and root canal involvement have always been a thorn in the side of general dentists. On one hand, treating the compromised tooth might create revenue for the office and grow the patient’s loyalty towards their successful practitioner. But on the other hand, a failed procedure could leave the patient with pain and result in a lower level of trust between in their dentist.
According to a web-based survey conducted by de Gregorio et al. for the Journal of the American Dental Association, endodontists are more likely to use methods that are up to date for their root canal therapy procedures, whereas general dentists utilize skills learned in dental school, such as protocols on irrigation adjuncts.
Dr. Rico Short, owner of Apex Endodontics in Smyrna, GA and a clinical professor at Medical College of Georgia and Meharry Medical College, thinks patients are better off seeking the care of a specialist for root canal procedures. “An endodontist has at least 2 years in specialized training after dental school in root canal therapy” Short said. He referenced a study published in the Journal of Endodontics in May 2016 that compared outcomes of root canal treatment for endodontists versus other providers. The results suggested that, “there was a significantly higher success rate for root canals performed by endodontists versus general dentists at year 5 for molars and year 10 for all tooth types,” he said.
While it may be difficult to refer a patient with legitimately needed treatment, there is strong reason to rely on endodontic expertise:
Increase Patient Confidence
Many clients in the office are loyal to their team of dental providers and may be hesitant to go elsewhere for care. However, reassurance and a positive referral can increase a patient’s respect for the expertise and judgement of their general dentist. An endodontist will have state-of-the-art equipment specifically designed for treating root canal therapies that may not be present in the general office, such as specialized microscopes and cone beam computed tomography (CBCT) imaging systems. Even patients with little dental knowledge will pick up on these advances and feel more confident with their prescribed treatment. “Most root canals can be performed in one visit under an hour at the highest possible level” Short explained, adding that a positive endodontic experience usually correlates with overall patient satisfaction and a reduction in fear of future treatments.
Reduce the Possibility of Lost Chairside Time
Most general dentists will allocate one to two hours towards a root canal procedure to allow for proper excavation, radiographic updates and the subsequent temporary restoration. In the event of a procedure failure, the patient will either need to undergo an extraction, possibly by an oral surgeon, or require an endodontic referral on an emergency basis. In Short’s experience, most case failures “are usually due to missed canals, inadequate cleaning and shaping of canals, or procedural errors such as perforations”. An incomplete procedure does not generate income for the office, and it takes significant practitioner time and office resources. Getting in front of the issue by initially referring to a specialist can mitigate some of these office emergencies and reduce the possibility of disruption to both the office’s and patient’s schedules.
Increase the Likelihood of Providing the Proper Dental Restoration
While sending away a root canal may seem like a loss of income, a patient’s treatment does not end at the endo office. That patient will need to return to their general dentist for outstanding restorative treatments that need rendering, as well as proper monitoring and follow-up. Such appointments will generate revenue for the office, especially when treating a complex molar case. Following a smooth chain of treatment from the specialist to the general dentist will reaffirm the patient’s confidence in their chosen practitioner.
Minimize the Risk of Losing Patients
A dentist’s office can be a scary place for many patients, so they often look for an “out,” or some reason to abandon their prescribed treatments and maintenance. Experiencing a traumatic tooth loss as a result of a botched root canal therapy can be just the thing that brings those fears to life for a patient, and pushes them away for good. While the primary dentist overseeing their health cannot reverse periapical pathology, steering the patient towards the proper course of treatment with the highest likelihood of success will help them maintain their dedication as a reliable client, and make them feel good about coming back to your office.
It is important to treat every case of endodontic involvement individually to conclude the correct course of action for the patient. While some single-canaled anterior teeth may prove to be a seamless procedure for the general dentist, the infection of several canals may be better suited for a specialist. An unwavering focus on patient wellbeing should drive the decision-making process and will help determine if the time and resources are worth the economic risk. It is up to the individual practitioner to decide if their skillset, equipment, staff and the patient are suitable for in-office treatment or an endodontic referral.
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