Howard Speaks By: Howard Farran, DDS, MBA, MAGD
Publisher, DentalTown Magazine

Implants and endodontics are growing three times faster than the rest of the dental industry. More and more, Americans are finding it totally unacceptable to lose their teeth and live with missing teeth. According to www.OralHealthAmerica.org, one-third of all Americans age 65 or older have zero teeth. The baby boomers will surely reverse this trend.

Realizing the importance of endodontics, DentalTown has added the 4414 USA endodontists to our regular monthly mailing, bringing our total DentalTown Magazine circulation to over 111,000 and our online membership to over 20,000. Our goal is very simple—to further endodontic understanding and knowledge in our profession. We believe by promoting dialogue between endodontic specialists and general dentists all patients will receive higher quality care.

The endodontists currently participating online at www.DentalTown.com have answered so many questions and added so much valuable information to many endodontic debates. It was a real eye opener for many Townies when several endodontists began talking about seeing and/or treating 4+ canals in over two-thirds of maxillary first molars while some general dentists were saying they hardly ever see a 4th canal!

These participating endodontists, while increasing the quality of our online endo discussions, simultaneously gather valuable information regarding how general dentists feel about their referral relationships. This type of open and unedited communication can help endodontists increase both the number and the success of their referral relationships. A prime example of this is the need for an immediate seal after endodontic therapy. Personally, I agree with many endodontists who feel that the build up should be placed immediately after the root canal. This ensures against leakage of bacteria laden-saliva into the root canal system before patients return to their general dentist for a final restoration.

What is your own rational for doing a single visit endo? When should you never do endo in one visit? When is it appropriate to do single visit endo? These are the kinds of questions and answers going back and forth in the Endodontic Forum on www.DentalTown.com.

Even the use of endo irrigants is highly controversial. Many endodontists on the boards use bleach, NaOCl, with every single endodontic case. Many endodontists let the bleach soak in for as much as an hour in vital pulp tissue cases, and 30-45 minutes in necrotic pulp cases. Yet some dentists have been doing endo for years without ever using bleach! They feel bleach is caustic and harmful to the periapical tissue. These are exactly the kinds of pinpoint differences our virtual online dental community can identify. You need to know where your own endodontic protocol stands. Why do you endodontically do whatever it is that you do? Just think of all the things you could learn watching and reading others debate the merits of their own endodontic protocol!

Why do as many as a quarter of all dentists buy and use Thermafil for most all of their endodontic cases while others use EZ-Fill? The difference in cost is so staggering! Have you ever figured out how much you spend on Thermafil in an entire year? You could probably buy a car! Why do endodontists hardly ever use Thermafil? If you are a Thermafil user when was the last time you really thought out the decision?

Why do most endodontists use rotary NiTi files at $5 a piece, while others are using the stainless steel files from Ultradent at $1 a piece? Why do some say that the rotary NiTi files over instrument the canals while others claim the AET system by Ultradent under instruments the canal?

Have you seen the new RACE files from Brasseler, the new K3 files from Kerr, or the new EndoMagic files? The boards on www.DentalTown.com have many threads giving opinions as to which ones to use and why.

Why do some dentists prescribe antibiotics after every root canal while others hardly ever prescribe antibiotics? If you are going to prescribe an antibiotic why is Clindamyacin such a top favorite? The same goes with pain medications! When is dexamethasone after endodontic treatment a good idea?

What about formocresol or CaOH? When do you place a pulp cap with a high degree of success and when is it better to go straight to endodontic therapy? Which is the best apex locator? What is the exact source of pathogens for most endodontic failures? Touch ‘n Heat versus System B? When should you place a post?

So starting with this issue we will have a regular monthly column titled “The Endo Files”. Our unique editorial style is to publish excerpts from the messages exchanged online. Instead of just publishing a 2000 word essay on root canals, we try to isolate the debate and get straight to the point and controversy by publishing the back and forth questions and answers that are happening online 24/7 at www.DentalTown.com.

For the complete listing of endodontic threads just go to www.DentalTown.com, click Forums, and then click Endodontics--The Endo Files.