Endodontic engagement: the GP and endodontist can achieve more as a team

Dr. Brett E. Gilbert discusses the important interaction between generalists and specialists

The pulse

To truly feel the current pulse in dentistry, you must listen to what other dentists are thinking and saying. Online message boards are a great place to participate in the conversations that dentists are having. These forums give us a sense of the current trends. Social media is the emerging wave of communication for the younger generation of dentists. New grads are active participants online, focusing a light on what all dentists are thinking and feeling. Seasoned dentists also take advantage of this digital age by being able to readily share and learn from dentists far outside their local circles.

When the digital conversation turns to endodontics, it is clear that there are two overwhelming trends regarding endodontic treatment. First, there is a recognizable disparity in the competence and confidence between endodontists and general practitioners in performing successful root canal treatment. Second, new dental grads do not feel they have had enough clinical experience doing root canals in school to be confident in their endodontic skills. After dental school, general dentists have a limited amount of focus and energy to devote to endodontics with so much else to learn. Endodontic growth must be sought out by the clinician, and there are only so many hours in a day.

The pulse online also confirms the general consensus, which is that endodontists are really great at doing root canals! The advanced study and training, along with the implementation of new technologies, allow endodontists to master root canal therapy. This is evident in the quality of treatment and successful outcomes that save patients from losing their natural teeth.

I believe that these two trends — 1) a disparity in the quality of treatment and 2) a lack of clinical experience upon graduation — are reliant on each other. This lack of sufficient undergraduate training has been ongoing for much of the past few decades. I certainly do not mean to criticize the undergraduate endodontic curriculums as there are only so many root canal patients that walk through the doors of our nation’s dental schools. However, the mention of a lack of experience is a common thread online as new grads shy away from attempting endodontics in practice as fear and anxiety replace confidence. This leads to poor outcomes and may lead to the loss of patient trust. We all know that it is hard to hide the feelings of uncertainty when you are treating patients. Patients can smell uncertainty like a shark smells blood.

The opportunity to respond the pulse

I believe that the referral relationship between the general dentist and endodontist has much more to offer than may appear on the surface. An endodontist depends on referrals to maintain his/her practice, but there can be so much more to a strong referral relationship. Endodontists are passionate about their craft and are teachers at heart. Many endodontists, myself included, are teaching in dental schools, providing online continuing education, writing articles, performing research, presenting live courses, and thinking endodontics 24/7/365. Teaching is a part of every hour of the day as an endodontist must “teach” every patient about best practice treatment options. This creates a great opportunity for general dentists to continue their endodontic learning by growing their relationship with their local endodontist.

Endodontists are looking to engage colleagues as confidants, advisors, teachers, mentors, friends, and emergency backup in all things endo! Our primary role is to treat referred patients but to also be a resource to help guide treatment planning, case selection, and clinical techniques for the root canal cases appropriate to accomplish in general practice. The statistics are clear — only about 25% of the 25 million root canals performed in the United States are completed by endodontists. Endodontists could not possibly do all of the root canals alone. Our general dentist colleagues are key partners in helping patients save their teeth. Let’s find a balance in using realistic case selection to assure that any given patient is having root canal therapy performed in the chair most appropriate for the clinical situation at hand.

The pendulum is swinging back from implants to saving natural teeth due to clear evidence that peri-implant mucositis and peri-implantitis are more prevalent than we previously understood. There is a great opportunity for general dentists and endodontists to partner in saving more natural teeth. This relationship is about more than referral of patients, but a sharing of knowledge and resources with each other to promote better care for our patients. Patients want to keep their natural teeth, dentists love to keep teeth healthy, and endodontists are passionate about saving teeth. These three desires create a perfect triad of care.