I was keen to be in the Healthcare sector and enjoyed working with my hands. Dentistry seemed like a natural choice. Choosing endodontics as a specialty was not my initial choice, but borne about as I was seeing a lot of patients in pain which needed such treatment during my early years right after graduation. Seeing how this treatment brings not just immense relief to the patient, but also enabling them to keep their natural teeth secured my belief that this was the field I wished to focus on.

More often than not, patients see an endodontist as a referral from their usual general dentist after being diagnosed. However, there are many early tell-tale signs of tooth pulp inflammation that they can also seek first contact with an endodontist. For example, hyper sensitivity to cold/hot; or dull aching radiating pain that comes on and off, with or without a related meal – these are all classical signs that your tooth is undergoing inflammation and will likely require intervention. By the time one notices a swelling or a pimple near the tooth/teeth, it is quite likely the affected tooth/teeth is in bad condition and requires root canal treatment.

Like all specialists, it is important to keep current not only with advances in my own field of endodontics but also in all aspects of clinical dentistry as well. This pursuit is commonly obtained both locally, but more often than not, in international conferences and workshops in North America and Europe as these are the leading centres of endodontics research and development. Being on the key opinion leader (KOL) panel of a few dental products and equipment and teaching regularly, also pushes me to not just be up to date but also to explore the boundaries of cutting edge endodontics.

Managing and treating patients in the kindest, gentlest and most efficient way to empower the patients to maintain their natural teeth in a painless healthy manner for as long as they can.

Every patient that benefits from having a painful tooth episode relieved, and brought back into healthy function is a “success story” for me. It is particularly gratifying when I am able to bring an initially fearful or sceptical patient seeking root canal treatment, to eventually becoming a total convert and even recommending their family and friends when they require similar treatment. Over the years I have learnt to manage the patient as a person, and not focussed just on the tooth or teeth as many younger dentists commonly do. There is never “a one size fit all” treatment philosophy even for a specialised field like endodontics.

Endodontics or root canal treatment have a traditional poor reputation amongst lay people due to legacy information and prior experiences done many years ago. Primarily these are the common misconceptions:

1. Root canal treatment is always painful:
This was likely true decades ago but with modern technology and anaesthetics, you are unlikely to experience anymore discomfort than having a cavity filled. In addition, endodontists are experts in pain management and most cases can be treated quickly and comfortably.

2. Root canal treatment causes illness:
Information you may find on the Internet or elsewhere, claiming that if you receive a root canal treatment that you’re more likely to become ill or contract a systemic disease in the future simply isn’t true. This false claim was based on long-debunked and poorly designed research conducted nearly a century ago, long before modern medicine understood the actual causes of many diseases. There is no valid, scientific evidence linking root canal treatment to cancer or disease elsewhere in the body. In fact, modern research has shown that patients with multiple endodontic treatments had a 45% reduced risk of cancer.

3. It is better to extract the tooth and place an implant than have root canal treatment:
Saving your natural teeth, if possible, is always the best option. Nothing artificial can replace the look or function of a natural tooth so it’s important to always consider root canal treatment as an option. Endodontic treatment has a high success rate and many root canal-treated teeth last a lifetime. Replacing an extracted tooth with a bridge or implant requires more time in treatment and may result in further procedures to neighbouring teeth and supporting tissue.
It is also untrue that implant supported teeth last long than natural teeth treated with root canal treatment. Large scale research and studies have shown that they have similar lifespans.

4. If my tooth does not hurt or is not too painful, there is no need for root canal treatment:
While a throbbing toothache typically is a telltale sign of a need for root canal treatment, there are times a tooth can require root canal treatment when there is no pain present. I often remind patients that the severity of pain and discomfort in the mouth, usually does not coincide with severity of disease or pathology involved. Endodontists are specially trained to test a tooth to see if the pulp has been infected or damaged. If this is the case, a root canal would be necessary to save the tooth. And remember, when it comes to teeth, there is no pain that is “normal”, so be sure to see an endodontist if you have a toothache.

I do not believe we can truly “ensure” patient has a complete understanding of their treatment choices. However, I will take care to:

a. Describe the relevant objectives and outcome of the intended treatment.
b. Detail the main aspects of the procedure and the known complications if any.
c. Present alternatives to this treatment.

With modern ease of internet searches for information and the prevalence of social media, the topic of root canal treatment comes up often. However, this ease also comes with a lot of dis-information and refuting such falsehoods is also a common part of my patient discussions. As a practice, we do not place a limit to the time or questions that our patients need to be satisfied until they fully understand their treatment choices.

I came out to private practice after my years in institution precisely because I desired a good work-life balance. Although endodontics is the dental speciality that manages oral and dental pain, most cases are not true emergencies. More often than not, I have ample time to spend with my family on the weekends and even planned vacations. As I am able to complete most root canal treatments within a single session, I do not have a long post operative tail (for patients) to follow up on and arranging for another endodontist to cover such unlikely probabilities in my absence is not arduous.

The last 20 years have been the most vibrant and exciting times in terms of development in the field of endodontics. Not only has there been an exponential increase in good research with regards to the science regarding root canal related disease, but also in the development of materials and instruments in providing treatment. The use of high-quality surgical microscopes, advanced instruments based on cutting edge use of materials for root canal treatment and the increasing use of Cone Beam CT scans for diagnosis and treatment planning – are the visible signs of the continued advancements in endodontics. The ever-increasing field of knowledge of leveraging on how stem cells work in the root canal area in pulpal regeneration, has even provided a pathway that certain groups of patients may not even require root canal treatment when they traditionally would be prescribed to save their teeth.

I often tell my patients that the mouth is not a pleasant environment. Whatever that is in thereneeds regular self, and also professional, maintenance. The most careful, detailed or beautiful dental work done by any dentists in the world can easily be undone by a lack of regular dental maintenance in a short period of time.

Find a good family general dentist that you are comfortable with for your routine dental maintenance. A good general dentist (GP) should be experienced and skilled enough to diagnose and manage most of your basic and non-complex dental care. In the same vein, their diagnostic skills will also enable them to know what is sufficiently complex that you will require a referral to an endodontist for management.

Why see an endodontist? Besides the additional 3 years of advanced training beyond dental school, endodontists are highly skilled in performing complex root canal treatments which also includes certain types of endodontic surgeries. A typical GP will manage about 2-3 root canal cases a week in a busy practice, whilst an endodontist sees about 20-25 such cases a week. Endodontist are also specially trained to retreat or re-do root canal treatment that was done previously, which was somehow reinfected by bacteria from decay or failing fillings or crowns. It is almost like renewing the “COE” of the tooth.