1. Endodontics (see Chapter 7)

An endodontist completes at least 2 years of postdoctoral education specializing in endodontics. This area of dentistry includes treatment of teeth with diseased pulp tissue (FIG. 2.1). The inside of a tooth, called the dental pulp, is often referred to as the nerve. The pulp includes nerve tissue, blood vessels, connective tissue, and tooth regenerative cells.

FIG. 2.1 The two upper front teeth were injured in an accident. Their pulps (nerves) have died, and thus, require root canal therapy. Usually, such teeth are discolored and require crowns (caps) later.

Tooth pulp can be injured in numerous ways, such as a blow to the tooth, trauma of any type, an incorrect occlusion (bite), deep dental decay (caries), and inadvertent abusive dentistry. When a dental pulp is injured, it usually responds in only one way: pain. The toothache that occurs when a dental pulp is injured causes extreme pain that demands therapy to allow the patient to return to normal activity.

Pain relief is provided by having the general dentist or endodontist perform root canal therapy. Teeth usually contain one to four (and occasionally more) root canals (FIG. 2.2). A small hole is made through the top of the tooth or crown (cap) into the dental pulp, and the diseased pulp is removed. A piece of rubberlike material called gutta-percha is inserted in place of the pulp. It is cemented into the tooth with a sealant to medicate the tissue at the deepest end of the dental pulp, where it exits from the tooth into the jawbone. Other types of materials may be used to fill root canals, including various pastes and metallic or plastic reinforcements.

FIG. 2.2 The gray internal chambers in each tooth are root canals that house the dental pulp.

(From Cohen S, Burns RC: Pathways of the pulp, ed 6, St Louis, 1994, Mosby.)

After the dental pulp has been removed and the remaining root canal filled, a metallic, ceramic, carbon, or fiber post (FIG. 2.3) may be cemented into the tooth to connect the weakened top portion (crown) of the tooth with the now hollow root.

FIG. 2.3 Often, posts of various types are placed into root canal–treated teeth. These connect the weakened top part of the tooth to the root.

Root canal therapy is successful in more than 95% of cases but occasionally, root canal–treated teeth are still painful. This problem is discussed in detail in Chapter 7.

Occasionally the tooth root end, deep in the bone, becomes infected in a root canal–treated tooth and requires further therapy, called an apicoectomy. In this situation a small incision is made in the gum over the root end of the tooth. Any diseased tissue is removed, and a filling is placed in the root end. The site is sutured for proper healing (see discussion of apicoectomy in Chapter 7, on p. 41). In addition to a post, a root canal–treated tooth may require a crown (cap) for adequate strength (FIG. 2.4).

FIG. 2.4 A and B, Three of these upper front teeth required root canals, posts, and ceramic crowns (caps) after root canal therapy.

2. Oral and Maxillofacial Surgery (see Chapter 12)

A person specializing in this area is an oral surgeon or oral and maxillofacial surgeon. These practitioners are dentists, or dentists with both D.D.S. and M.D. degrees, who have completed postdoctoral education in oral and maxillofacial surgery. Most of the simple oral surgical procedures (FIG. 2.5), including routine extraction of teeth (exodontia), are accomplished by general dentists. More complex surgery or treatment of oral-facial trauma is usually accomplished by oral surgeons. Oral and maxillofacial surgeons accomplish routine extraction of teeth; complicated extraction of teeth, including impacted (nonerupted) teeth; removal of oral tumors (growths); surgical movement of jaws to compensate for malformations, poor bite, or inadequate facial esthetics; and other complex oral surgery and facial plastic surgery. These specialists also treat seriously ill patients with oral surgical needs.

FIG. 2.5 A to C, Minor oral surgery such as this is accomplished by most general dentists.

(From McGowan DA: An atlas of minor oral surgery, ed 2, London, 1999, Martin Dunitz Ltd. Copyright 1999 by DA McGowan.)

This field of expertise commonly overlaps with that of ear, nose, and throat (ENT) specialists and some plastic surgeons. When considering complex surgery around the face or jaws, it is advisable to consult with practitioners in all the overlapping specialty areas.

3. Oral and Maxillofacial Radiology (X-Ray)

All dentists and dental hygienists, as well as most dental assistants, have sufficient background to accomplish typical dental radiography. However, sophisticated radiographs require special expertise, such as those that show various characteristics of the skull, the temporomandibular joint, all of the teeth in one view, and many others. A few dentists limit themselves to this specialty, which requires 2 years of postdoctoral education. Numerous radiographic laboratories are staffed with well-educated technicians and/or dentists. Almost without exception these laboratories provide high-quality dental radiographic services.

4. Oral Pathology (see Chapter 12)

Oral pathologists are dentists who are involved with microscopic identification of the condition of oral tissue that has been removed surgically. These dentists, who have 2 or more years of postdoctoral education, are usually found in dental schools and hospitals. If you were to consult your dentist or dental specialist with a suspicious-looking area in your mouth, your dentist would take a biopsy (removal of a small piece of tissue, p. 91) of that area and send it to an oral pathologist for microscopic identification.

A very simple diagnostic tool is also available for superficial oral lesions. A stiff brush is rubbed over the lesion, taking some of the cells with it. This material can be observed microscopically to provide a tentative diagnosis of the suspicious lesion.

5. Orthodontics (see Chapter 13)

Many general dentists and pediatric dentists (children’s dentists) perform tooth-movement procedures, but those specializing in orthodontics have completed at least 2 postdoctoral years of education in orthodontics. The/>