Q: Can you please define endodontics? We think we know what a root canal is, but some might have misconceptions.
A: I define endodontics as the dental specialty concentrating on saving your comfortable, aesthetic, and natural teeth, through root canal treatment. However, I never rush into doing a root canal. My approach is to fully and thoroughly examine the area before deciding on a treatment plan; if there’s a reasonable way to avoid a root canal, I usually steer in that direction first.
That said, there are many times where root canal treatment is unavoidable: typically when the nerve inside the tooth is irreversibly inflamed or infected. In those cases, we make a small entry through the tooth into the root canal space and remove the nerve that was inside—not the entire root! The entry and canal space are then sealed, and in many cases, a crown (or cap) is recommended afterwards with your general dentist to help protect the structural integrity of the tooth. Removing the nerve in its entirety allows the tooth to recover and return to comfortable function. I joke that our teeth are very much like our undergarments—you can tell they are working properly when you don’t notice they are there!
Q: How did you decide to open your practice in New Milford?
A: When I was starting to research potential areas for my practice, many people advised me to look into places far far away from where I live (Bergenfield). The rationale was, getting a root canal can at times be stressful in and of itself, and having a pool of patients that also happens to be neighbors and friends can only add an additional and unnecessary layer of pressure. They painted grim pictures of me being accosted at Grand and Essex or at parent/teacher conferences by disgruntled patients on a regular basis.
However, these warnings never sat well with me. As my wife can attest, I’m a huge root canal nerd, and after a full day of patients, I usually sit down to discuss cases with colleagues online, which has been very helpful in improving my care over the years. So, if my goal was to open a specialty practice providing the highest level of care possible, why would I purposefully choose to set it up outside of my community? And, if someone is not fully satisfied with their experience with me, why would I want to avoid getting their feedback?
With this in mind, I decided to look for an office as close to home as possible. When a space opened up right next to Bora Nails on River Road, it was almost a no-brainer, as I really wanted the ability to squeeze in a quick mani/pedi between patients. (Just kidding.)
The office is just three minutes away from my house, which is incredibly convenient if someone needs to be seen during off-hours. As a matter of routine, I give my cell phone number out to patients of the practice, with specific instructions to call or text with any concerns, at any time. My mantra is, if something is not working for you, it’s not working for me. And of course, if you see me around town, feel free to stop me with any questions you may have.
Q: Most people have some qualms associated with the thought of getting endodontic care. Can you please tell the readers about what you do to assure them and provide the confidence patients need to feel at ease and comfortable in your environment of care? Is there anything special that separates BEC from other practices in this regard?
A: If the thought of getting a root canal makes you feel uneasy—you’re not alone! Former President Obama once commented that the bank bailout of 2008 was “as popular as a root canal.” Thankfully, we’ve come a long way in our ability to provide relief during root canal treatment, and nowadays most procedures can be performed without feeling anything whatsoever. Many of my patients actually fall asleep during treatment!
I’ve actually found that the source of most people’s unease—especially in our community—comes from the fear of the unknown. I know when I go in for a procedure myself, I don’t want to feel like just another number, and I appreciate knowing what to expect and what is going on throughout the treatment. In my office, I typically spend a fair amount of time just getting to know the patient and their expectations prior to examining them, which makes them feel more at ease. The practice is also equipped with high-resolution photography and live streaming, so that patients can see exactly what I see during the evaluation and treatment phase. This allows the patient to be educated and avoid any surprises throughout the visit. Some patients choose to close their eyes, and that is totally understandable as well!
Q: What kinds of problems are either typical or unusual—or both—that you deal with in endodontic care?
A: Although every root canal is unique, the “typical” case that is referred to an endodontist is a tooth with a “history”—a deep cavity or filling, crown, or crack—which starts to gradually become uncomfortable, and where the patient’s general dentist believes evaluation and treatment would be best under the care of a specialist. This gradual buildup of pain is a more typical case.
However, there are other instances where pain or swelling from a root canal-involved tooth can come out of nowhere. One patient said he only first started noticing a throb during Kol Nidre … and it worsened consistently over the next 25 hours.
I had another patient who needed an emergency root canal during her ninth month of pregnancy, and she called to cancel her appointment at the last minute—it turns out, she had gone into labor that morning. In both of these cases, the pain was sudden and unexpected.
Besides for more emergent situations, root canal specialists are more likely to see cases that are on the complicated end of the spectrum. These include teeth that have already had root canal treatment but have been reinfected; teeth that require a surgical root canal approach; traumatized teeth; teeth that have been heavily restored and/or are very broken down; and root canals that have aberrant or difficult anatomy. We also see cases of vague or chronic pain, which can be difficult to localize to one tooth or to diagnose properly—these sometimes overlap with a history of sinus, TMJ, or orofacial pain symptoms.
Q: What are some of the cutting-edge treatment advances that have emerged in the past 10 years that make endodontics better for patients now than before?
A: This is a great and important question, as much has changed over the past couple of decades in endodontics. As was mentioned before, the basic root canal procedure involves making an entry into the tooth and cleaning out the diseased nerves. If part of the nerve is missed during treatment, the tooth may continue to be uncomfortable, and could become reinfected. However, if too large an entry into the tooth is made to find the nerves, the tooth may weaken and will be at a greater risk of breaking or fracturing. Endodontics has constantly had to balance between these two concerns: minimizing risk of infection while respecting healthy tooth structure.
Lately, minimally-invasive trends that have become popular in surgery in general have also caught on in endodontics. Minimally-invasive technology improves our long-term outcomes while still allowing us to maintain the balance mentioned above. These technologies include 3D imaging (CBCT), which we use to “cheat” and see a cross-section through the tooth before we even touch it; as well as surgical microscopes, which give us the ability to operate through smaller spaces, work more precisely, and find anatomy that could never have been treated otherwise. I believe this is part of what makes Bergen Endodontic Care stand out: making our patients’ experience comfortable and as painless as possible through the use of our progressive and cutting-edge technology.
By Ellie Wolf