Archive for January, 2011

A letter from an Endodontist

Wednesday, January 19th, 2011

In the Fall 2010 issue of The New Dentist Magazine, I wrote an article addressing new dentist’s fear of endodontics.  We received the following letter from a practicing endodontist with his opinion.


It’s good to see you staying active in the community and advancing yourself with CE courses, especially the Seattle Study Club, of which I am also a member.

Congratulations, too, on your growing dental practice.  The pictures on your website show a very nice office.  I enjoy seeing the successes of dentists that I went to school with.

I read your articles from time-to-time and am glad you enjoy writing them.  You may even be on the lecture circuit one day if that’s what you enjoying doing.  Writing a quick article on endodontics is very difficult, and your coverage was good for the amount of words and space you were limited to using in the Fall 2010 edition of the New Dentist.

I am also a big advocate of dentists (cosmetic, general, family, classify to your liking) performing endodontic treatment.  However, as an endodontist, a large part of my practice is retreating teeth that have failed (some teeth even treated two months prior by their family dentist) or repairing same-day perforations in different areas of the tooth.  Bottom line, the dentists that attempted these particularly difficult endodontic treatments should not have opened the tooth from the start.  Granted, it takes experience to extrapolate what one reads from the radiograph into what the tooth may be like during treatment.  I am passionate about this topic because the patient is the one who ultimately suffers.  If the tooth is perforated, ledged, zipped, blocked, you name it, the treatment becomes exponentially more difficult and expensive for the patient.  Or worse, they end up losing the tooth.

These are some of the reasons why the American Association of Endodontists created the Endodontic Case Difficulty Assessment Form that is available in the Dental Professionals section of the AAE website (  I included a copy of the form and the accompanying article in this email for your reference.  This form really does help a dentist create their own boundaries for when to start treatment or when to refer to an endodontist.  After using it a few times, it becomes a standard part of a dentist’s thought process.  Since we are both big advocates for continuing education, I thought you would appreciate this.  Also, this may give you an idea for one of your future articles.

There is a saying among endodontists: ‘There is no easy root canal.’  Knowing this, it’s sometimes okay to not set “terror aside” and just use your best clinical judgment for what’s best for the patient, even if that means not making your practice more profitable as you mentioned in the article.

May God bless you and your practice.  I look forward to seeing you at future alumni events and will keep looking for your articles.  Have a Happy Thanksgiving and a Merry Christmas!

Warmest regards,

Michael Larsen, DDS

Southlake Endodontics, PLLC

1100 E Southlake Blvd, Ste 400

Southlake, TX 76092

(817) 488-3636

I think Dr. Larsen brings up some great points here.  As with anything, the key in Endodontics is case selection.  This is not a secret.  In no way do I advocate a young general dentist taking on all endodontic challenges that walk in the door.  Endodontists are a very needed member of the team of specialists a general dentist must use to treat more complex patients.  My concern is that many new dentists refuse to take on the challenge of endodontics because their predoctoral education did not prepare them well enough for private practice.   Many colleagues I graduated with are still frightened of endodontics.  They refuse to treat anything posterior to a premolar for fear of the complexity of a molar.  I am sure Dr. Larsen will agree that this philosophy is fool-hearty.  There are many endodontic cases with molars that are much simpler than many premolars.  Many very difficult endodontic cases are lower incisors with multiple canals.  Many new dentists would gladly jump into a mandibular anterior case  without thinking but avoid a molar at all cost.

Young general dentists need to seek good continuing education in endodontics.  There are plenty of really great endodontic lectures out there.  Personally, I have seen Dr. John West and Dr. Cliff Ruddle.  I think they are both great educators.  There are other great ones out there as well.  My main contention is that young dentists need to stop being afraid of endodontics and get comfortable with it. There are many simple cases that general dentists can treat very well.  Equally as important, don’t get too cavalier with your endodontic case selection without proper post-doctoral education.  Dr. Larsen provided a link to the AAE’s assessment protocol that can help general dentists triage difficult endodontic cases effectively.  This would be a great document to review.

At the end of the day, whether or not to perform endodontics is every general dentists choice.  The opportunity exists for new general dentists to add to their patient base by performing endodontics.  I encourage every new dentist to take some endodontic continuing education and begin to enhance your skills in the area.