Information for Patients

“Endo” is the Greek word for “inside” and “odont” is Greek for “tooth.” Endodontic treatment treats the inside of the tooth. The root canal is a channel inside of the tooth, which contains blood vessels, cells, and sensory fibers to provide nourishment and sensation to the tooth. 

Want to know more? -

Visit the official site of American Association of Endodontists,
 

Read about root canals here,
 

Checkout "Mouth Healthy" by American Dental Association.
 

We do provide diagnostic services and second opinions for endodontic problems such as need for root canal treatments and re-treatments, spontaneous toothache, sensitive teeth, etc.

However, we do not determine restorability of teeth, which is beyond our scope of specialty. Determination of restorability as well as restoration of teeth is prerogative of the referring doctor.

We provide specialty endodontic care. We do root canal treatments and re-treatments, post removals, dental trauma management, treatment of sensitive teeth, some surgical procedures, and more.  

The fee for root canals and other endodontic procedures depend on their complexity and is determined at the time of consultation. The procedures, which require negotiation of blocked/calcified canals, access through the crown, treatment of swelling, use of nitrous oxide sedation, and other complications often add to the cost, so it is important to have treatment done as soon as recommended. Do not delay just because the tooth does not hurt as it is always better to do it (cost-wise too) whenever symptoms are light.

We will provide you with gentle care, so do not delay. We do also understand that patients' financial situations differ and offer various payment methods including monthly payments*.

 Read this to understand (or at least to get an idea) on how the dental plans work.

We do take most PPO plans (both in-and-out-of-network) as well as Self-Insured, Direct-Reimbursement , some EPO (if in-network) plans, and many Discount programs.

We also take many Medicare (both in-and-out-of-network),

and (on very limited basis) Medicaid Husky (for patients age 11-20 only).

                                                         FYI:    Click here to download a list of in-network plans.

We do take some DHMO/DMO plans as out-of-network.

If a patient has a dental plan, which does pay to the office, and we are able to estimate out-of-pocket portion, the patient is responsible for its payment before procedure start. Any unpaid by the dental plan balance is responsibility of the patient/legal guardian/guarantor -see above information on dental plans.

For those without dental plans, entire cost is to be paid before treatment start.

We accept cash, check, card, money order, or PayPal. We also offer third-party financing*. 

If we have to bill, there are additional billing charges ($15 per e-statement or paper statement) + interest. 

Yes, we do offer third-party financial plans*, for which patients can apply at the office or at home.

How does financing work? ADA has prepared an informational brochure to help to understand various financing plans,  click here to read.  

We accept and offer CareCredit. Call us at 860-253-2573 to learn more.

We would appreciate if you bring with you: A government-issued ID (ex: Driver's License, Passport, State ID), referral letter from from your dentist (which may be our business card with referral information on the back), any radiographs, list of medications taken/ medical conditions, and forms of payment such as a credit / debit card. You would also need to provide your social security number, date of birth, and address (as well as of a parent/legal guardian for minors).

When a patient is under the age of 18 or requires a legal guardian, a parent or legal guardian must be present. 

For patients with dental plans, you must have your plan card in possession as well as name, social security, date of birth, address, and place of work of the subscriber (which may be you).

Many procedure with non-infected teeth could be done in one visit in approximately 1-2 hours. Depending on complexity, there may be a need for additional appointments or/and time. We do recommend to have at least 2-3 hours available for your first visit to make sure that there is enough time to diagnose, to go over finances, and to do treatment procedures properly.

When there is a non-temporary crown on a tooth, we assess the situation on a case-by-case basis. If it is good-fitting and underlying canals well-visible, we generally can access through it. In certain cases, such as when there is a significant decay/tooth destruction underneath, canals poorly visible, fracture suspicion, etc., we may have to remove the crown; a new crown will then have to be fabricated by your dentist and you may have to pay for it. In rare instances, crowns can fracture during access, which may /may not be repairable. 

When, there is a temporary crown on the tooth, we usually lift it, work on the tooth, and then place it back. In certain circumstances, we may unable to place it back due to inability to fit it back after underlying decay or tooth structure removal or dental plan restrictions; the crown will then be given to the patient for safe-keeping and the general dentist may often be able to re-cemented after adjustments. In rare instances, temporary crowns can fracture during lifting, which may /may not be repairable.

When root canal treatment is indicated (needed, doable, restorable), then here the alternatives, all of which are not very good: 1) Extraction - less expensive on short run, and very expensive long term (need to restore missing space, problems eating, esthetics, etc.), 2) Do nothing - the tooth may eventually become non-restorable, more infected, calcified, which may end up in tooth loss or higher costs, 3) Implant -not really an alternative in cases when root canal procedure can be performed b/s it is often more expensive, but most important you lose your own natural tooth. Implants are only good when root canal treatment is not possible due extensive root decay, large fractures, severe calcification; neither it is a first-level alternative if previous root canal treatment did not succeed as we often can re-treat.

Make sure that you have an endodontist, a specialist in root canal treatments, to make final decision. It is like if you have a heart problem, don't you want a cardiologist to take a look?

 Implants are designed to replace missing teeth lost due to trauma, vertically fractures, and other reasons. It is great that they exist because they restore what used to be uncorrectable, required bridges or/and dentures. However, they are to replace missing teeth or poorly restorable teeth (short roots in relation to a crown, extensive root decay, and/or similar).

Implants are not best choice just because the tooth has a deep cavity, needs a root canal treatment, has infection, needs crown lengthening, has blocked canals, and/or has previously done root canal treatment. A special word on previously done root canal treatments: root canal procedures may fail due to poorly cleaned/missed canals or absence of a crown and /or leaking restoration, and or not using rubber dam during the procedure, which are all correctable, while saving natural tooth. There are also medical reasons, when extraction/implant is not advisable, while the root canal is the only saver.

Although implants do not decay, they can still fail / not integrate, require proper maintenance, and inflammation (peri-implantitis or mucositis) may still develop around them.  Here is information about per-implantitis and mucositis from American Academy of Periododntology.

Natural teeth have PDL, a cushion between the teeth and surrounding bone, which provides among other things for proper biting perception, when you chew. Implants are fully embedded in bone, thus provide no such perception. Implants also cannot be moved by "braces" like natural teeth to correct their position.

Root canal treatments or/and re-treatments are often less costly and definitely less time consuming than implants, which often require  months of healing and restoration. In addition, although implants can not decay; they do require special maintenance, it is possible to develop inflammation of surrounding tissue (peri-implantitis), and removal of implants when they fail is always a surgical procedure.

To summarize, if you have a missing tooth, an implant is a great option, while when you have the tooth, it is rather better to save it. Let us put this way: if you have problem with an arm or a leg, would you rather try to save it, or just have it amputated to be replaced with an artificial one?

For more information, please read this article  "Treatment Planning: Comparing the Restored Endodontic Tooth and the Dental Implant". 

Although majority of canal procedures are successful; some may need to be re-done due to missed canals, persistent infection, cysts, as well as absence of restoration such as a crown. Root canal treatments also fail if performed without using rubber dam. Most issues are correctable with either convention re-treatment or occasional micro-surgery, while saving natural tooth. Remember that in large assessment of patients, which have had endodontic treatments, "97% of teeth were retained in the oral cavity 8 yr after initial nonsurgical endodontic treatment" (see this link).

Learn more by reading these two scientific peer-reviewed articles  on
1) success of initial root canal treatments
and
2) success of re-treatments.

You can also read:
1) a nice article about re-treatments
as well as
2) official information from American Associaion of Endodontists. 

 First thing is to ask your dentist whether root canal can be re-treated because most of the time it can be done (unless there is not enough tooth structure) -  see question above.

Second thing is to ask your dentist whether original root canal treatment has been treated under protection of rubber dam.

If the dentist says that root canal treatment cannot be re-done or if original treatment has been performed without rubber dam, please do ask an endodontist for a second opinion. Although second opinion, may cost you a bit, it is a lot less expensive than wrong treatment. Remember: most root canal treatments can be re-done and implants can also fail; natural tooth is still better (see questions above).
 

Except for systemic issues, some trauma cases, and some large facial swelling, antibiotics do not work when you need root canal treatment. Some teeth in need of treatment (therapy) have no infection and rather inflammation. The teeth with infection do not have adequate blood supply to bring in antibiotics. 

Taking antibiotics unnecessary can result in adverse reaction like allergies and also may make the medications useless when most needed. Read here more on antibiotics issue here. 

Rubber dam (or dental dam) is  a latex or nonlatex sheet with a hole punched in the material to allow placement around the tooth during the endodontic procedure.  

Dental dam provides for protection of the patient to minimize risk of small files and instruments falling down the throat. It also allows for very important disinfection of operating field and the tooth (root canal treatments do fail when dental rubber dam is not used). Rubber dam also helps the patient to keep mouth opened and for the dentist to see things better.

Read this article from American Association of Endodontists on importance of rubber dam use.

Important! Rubber dam is standard of care. If your dentist is attempting to start root canal treatment without using the rubber dam, tell him to stop. If your dentist, cannot do root canal treatment without rubber dam, have him/her refer you to an endodontist.
 

If a dentist cannot place dental rubber dam, then he/she cannot do root canal treatment as it will be not be upto standard of care and will put the patient at health risk.

If the tooth is so broken that rubber dam cannot be placed, a special procedure may be done to expose more tooth structure ("crown lengthening"); have you dentist refer you for consultation to an endodontist to see if rubber dam cannot be placed without additional procedures.

In any case, if the dentist cannot place rubber dam for any reason, he/she has to refer you to an endodontist. Please read here on why rubber dam is important. 

All dentists are trained to do some root canal procedures as well as fillings, cleaning, crowns, etc. The decision to refer depends on complexity of the case, need for specialized equipment such as microscope, anesthesia, the extent of infection, type of treatment (initial root canal treatment vs. re-treatment or surgery), and other factors.

Specialists in endodontics complete at least 2 years of post-dental-school training (Dr. Moline has 4 years of such training), have specialized tools (such as calcified canals instruments, surgical tools) and equipment (such as microscope, depth-measures, lasers, endo-ultrasonic). Specialists also have advanced training in anesthesia to tackle on hard-to-“numb” teeth, dental trauma to facilitate teeth survival, and may see patient of various ages such as kids.

Endodontic specialists perform many more endodontic procedures than general dentists and spend more time learning in specialized field.

General dentists usually do not perform endodontic procedures, which require re-treatment, surgery, regenerative therapy, calcified/blocked canals, or patients presented with difficult to anesthetize teeth, large swellings, and similar. Sometime, it may be difficult to determine the complexity of the root canal procedure until it is started; specialists most likely have all necessary materials and equipment to deal with these situations.

We use digital radiography, which is safer due to increased sensitivity and speed. We adhere to ALARA principles, which mean: As Low As Reasonably Possible. We also provide patients and staff with aprons for protection.

Certainly. We provide local anesthesia for all of our patients because we want to make sure that you are comfortable during the procedures. 

To ensure this, we schedule enough time, use various anesthetic solutions (including buffered ones), and employ special technique and equipment. 

Canals in teeth are quite narrow, which may require special tools including the microscope to see deep down. It not only magnifies, and also shines the LED light in different ways.  Sometime, easy-looking canals on radiographs are not so easy, when you start working on them; without the microscope, they may be impossible to complete the work on them. Various lights' and lens' settings helps to find hidden canals, observe calcification, curves, separated instruments, and fractures among other challenges. 

 Although each procedure is unique, there are some common steps.

First of all, every visit, we make sure that you are comfortable. We check blood pressure and temperature, and provide local anesthesia of type and dosage based on needed treatment, vital signs, weight, and other criteria. At this stage, we may also administer some nitrous oxide (additional charges apply).

Secondary, every visit, we place a rubber (non-latex if needed) cover (called "rubber dam") on a ring and a frame over your tooth. It is done for your comfort, proper disinfection, and to prevent any small instruments from falling; - this is a standard of care; the rubber dam is then disinfected.

Third, in many cases a small discreet access is made on tooth' top or back side. If there is decay, it is removed at this stage. The canals are accessed (discovered with help of microscope and ultrasonic if needed for calcified types), cleaned (disinfected when needed, old fillers/posts removed if present), and shaped. When there is infection, special medications are placed, which may require covering access with a temporary filling and additional visits. Additional visits may also be required in blocked/calcified canals cases and when there is a re-treatment of previously done root canal treatment is needed.

Fourth, the canals are filled with flexible material and cement (may be done on subsequent visit). The access to canals  is also filled. The access filling may be temporary, which requires you dentist to replace it with harder build up. In some cases or at request of your dentist, a harder access filling (composite build up or post-core) is placed, which the dentist will later prepare for a crown.

Finally, the rubber dam assembly is removed and the procedure is completed.

Radiogarphs are generally taken at the beginning, through out the procedure, and upon completion. Specialized equipment such as a microscope, a laser, ultrasonic access instruments, files, depth measurements sensors, control-delivery anesthesia units, and other items may be used to facilitate successful treatment. 

You can generally eat soft food after the anesthesia wears off, while be careful on harder food to prevent tooth fracture and loss of a temporary filling placed. Be also careful on chewing  to prevent biting into "numb" tissues like lips, tongue, chicks., etc.

Your dentist and us are partners in providing you with dental care. In most cases, you do need to return to your dentist for a more definite restoration such as a crown or a filling, which will allow you to chew food normally. It is like building a house -  we work to create the foundation, while you dentist put the walls and the roof. 

Taking antibiotics after root canal is usually is not needed (except for systemic issues and some trauma cases). The procedures performed and medications (which may/may not be antibiotics) used/placed into the inside of the tooth during the treatment are what will cure. Taking antibiotics systemically unnecessary can result in adverse reaction like allergies and also may make them useless when most needed. Read here more on antibiotics issue here. 

Many patient experience no discomfort whatsoever. However, it is normal to have soreness for a few days to weeks; especially in prolonged treatments, multiple-visit procedures, severely infected teeth, and other circumstances. In some complex cases, there may be a need to have another procedure done to save the tooth. We will advise you on those special circumstances. Nevertheless,  it is very important to have a definite restoration like a crown or a filing placed by your dentist to prevent tooth fracture and re-infection among other reasons.

 t is understandable that there is anxiety associated with root canals thanks to movies, TV, past history, and friends' "advice". We provide specialty dental anesthesia and kind individualized care to ensure your comfort.

We offer nitrous oxide (when there are no medical contraindications) for the beginning of a treatment. There is additional cost for the "gas", which is rarely covered by dental plans, and must be pre-paid regardless of a dental plan.

Please keep in mind that, although nitrous oxide ("laughing gas") provides some dizziness and relaxation; it does not "numb" teeth, so dental anesthesia is still required. Nitrous oxide has side effects, increases treatment time, costs extra, cannot be combined with certain medications, and cannot usually be done on pregnant women. 

Since our local anesthesia does not affect your ability to drive, you can do it. However, do not drive or operate machinery; if you are taking sedatives, narcotics, and similar action medications. You should be careful on chewing to prevent biting into "numb" tissues like lips, tongue, chicks., etc. 

 It will make treatment a bit more difficult due to tongue jewelry interfering with radiographs. The metal in jewelry can also fracture the tooth. Other problems not directly related to our treatments are: tongue and gum infection, bleeding, taste alterations, risk of swallowing / inhalation of the jewelry, etc. Read more about 
oral jewelry here.
 

Tooth coming out after trauma is called "tooth avulsion". It is dental emergency because, the longer the tooth is out of the mouth, the less likely it would survive after placing it back.

If possible, rinse it with water, BUT do not scratch it, then place it in 2% cold milk (NOT water), and call us at . It is better, if we can place it back within 45-60 minutes after it comes out.

Treatment of the avulsed tooth depends on amount of time the tooth was out of the mouth, how the tooth was stored/transported, and tooth' development. The avulsed tooth often has to be splinted (bonded to adjacent teeth) for 2-4 weeks and root canal treatment may be needed to save the tooth sometime later (or before placing the tooth back if > 60 minutes passed after the knock out).

It is also possible for the tooth to sometime ankylose ("melt away") especially if too much time passed since the tooth was knocked out (>60 minutes); the ankylosis will however preserve the bone for possible future implant placement.

The bottom line if the tooth is knocked out - do not scratch, place knocked out tooth in cold 2% milk, and call us at .
 

Crest Toothpastes 

Colgate Toothpastes

Arm & Hammer Toothpastes

Sensodyne Toothpastes

 We have no financial interest with those companies, and just like those toothpastes.

For children under age of 3, use smear of paste on the brush, for kids age 3-6, use pea-seized amount of paste.

Make sure that you supervise the kids during brushing. The paste should with fluoride to prevent caries.

Read this short article from Colgate on how to choose a toothbrush. 

It depends. Clinical studies have shown that chewing sugarless gum for 20 minutes following meals can help prevent tooth decay. Click hear to read more. 

Flossing prevents food from getting stuck too long between the teeth, thus preventing a hidden decay formation. When flossing, make sure to clean front and back of each tooth and do not forget the back side of farthest teeth. 

Sensitivity may depend on many factors. If there is a cavity or infection, then a filling or a root canal treatment may be needed.

However, true sensitivity may be due to a root exposure. The root is portion of the tooth, which is usually hidden beneath the gum and bone. Sometime, it gets exposed (ex. due to over-brushing, teeth-grinding, etc.), and teeth get sensitive on cold/hot. 

Read more about this here from Colgate.

In such true sensitivity cases, we can apply special desensitizing material, paste, or/and gel to exposed areas to reduce sensitivity and avoid more expensive and invasive treatments such as fillings, crowns, root canal procedures. After the office visit, we will recommend desensitizing home-care, which may include using desensitizing toothpastes like Colgate Sensitive Pro-Relief paste, Colgate Sensitive paste, or Sensodyne Repair and Protect paste, Arm&Hammer Sensitive paste, or Crest Pro-Health Sensitive paste, mouth-rinses such as Act Anti-Cavity rinse with extra fluoride, prescription pastes, and other remedies. Patients should also use soft toothbrushes to avoid over-brushing.

Read more about sensitive teeth:

From Crest,
 

From Sensodyne,

From Colgate,

From American Dental Association.

Give us a call at and make an appointment for evaluation of teeth sensitivity. We can help. 

We are generally opened Monday-Friday 8:30am - 5:30pm. 

For patients convenience, we also have scheduling service that can take calls outside of working hours to schedule appointments.