Endodontics is the dental specialty concerned with the study and treatment of the dental pulp. Endodontists perform a variety of procedures including endodontic therapy (commonly known as "root canal therapy"), endodontic retreatment, surgery, treating cracked teeth and treating dental trauma. Root canal therapy is one of the most common procedures. After receiving a dental degree, a dentist must undergo 2-3 additional years of postgraduate training to become an endodontist.
Laura Milroy, DDS, M.S.
Private Practice Owner Endodontist
Endodontics of the Rockies
Fort Collins/Loveland/Longmont, Colo.
- Why did you choose to pursue this career path?
In dental school, I had always wanted to specialize. My personality is such that I wanted to focus on a single aspect of dentistry and hone my skills to become a master clinician of that one facet. It was just a matter of narrowing it down to what I enjoyed most. I had originally elected to pursue a career in medicine. After I had changed to dentistry, I still was drawn to principles of biology and physiology. I had enjoyed my endodontics courses and the biological principles taught therein. I had also spent time as an endodontic assistant and was familiar with the day-to-day ins and outs of an endodontic practice so it was a natural choice for me.
- What does your typical day look like? Did some aspects of your job surprise you?
An endodontic schedule can vary greatly from what it appeared to be at the beginning of the day, to what it actually was at the end. Because it is an emergency-based field, patients in acute pain need to be seen immediately. Some offices will leave open appointment slots for emergencies while others will work them in as they come. Unlike a general dentist’s office, endodontists will lose patients if they are booked out weeks in advance because treatment cannot always be postponed. Although I am doing root canals all day, the procedures vary and include initial treatments, retreatments, apical surgeries, consultations, follow up visits, internal bleaching, etc. Each patient and each case presents with its own unique challenges so no two days are ever alike.
- What challenges present themselves frequently in your specialty?
Instead of having an established rapport with patients, I often only get a single visit (or a few at most) to gain a patient’s trust. I typically have about a 10-minute time frame to gain a patient’s confidence and trust. Patients that have mild dental anxiety can become extremely anxious when they need a root canal, especially if they have never had one before and are seeing a new provider. It is important to manage patient fears and anxieties. Treating patients in pain is a particular challenge unique to endodontics. Patients in acute pain need immediate treatment, reassurance, and drug management. This requires knowledge, clinical skills, and compassion on the part of the endodontist.
- What makes your field unique?
As an endodontist, you have to be a diagnostician. General dentists will refer patients to you when they cannot localize the etiology of pain or are unsure if it is odontogenic. Endodontists have the opportunity to create a differential diagnosis and determine a patient’s source of pain. Malocclusion, sinusitis, bruxism, periodontal disease and a plethora of the diagnoses can present as pulpal disease and the endodontist has the task of determining the true origin.
- What additional training, credentials or licenses are required beyond dental school for your career? What additional training would you recommend beyond what is required?
After dental school, an endodontic residency is required. It is challenging, but not impossible, to be accepted into residency directly out of dental school. Most residency programs prefer a minimum of a GPR/AEGD or work experience. As an endodontist, it is important to understand the principles of general dentistry and have a solid foundation in restorative dentistry. Endodontic residencies range in length from 24 to 36 months. Many programs offer a master of science (M.S.) degree, which may be optional or mandatory. This additional degree requires extra classes, research and composing and defending a thesis. A M.S. degree is important if you plan on a career in academia.
- What are current trends in your field? In what ways is it advancing?
This is an exciting time in endodontics. Modern endodontics includes the use of microscopes, cone beam computed tomography, ultrasonics and microsurgery. The current “hot topic” in endodontics is regeneration/revascularization. This is a procedure for immature teeth with necrotic pulps that builds upon principles of regenerative medicine and tissue engineering to promote subsequent root development. The principles from regenerative research will likely impact future efforts to retain the natural dentition. This is one of the most exciting developments in dentistry and endodontists are at the forefront.
- What skills are especially important in your field?
Clinically, it is important to have the manual dexterity and precision needed to negotiate small and/or curvy canals. Equally important to clinical skills are personality traits of compassion, patience and sympathy. These traits will help you manage patients who are fearful or in pain. Flexibility is also important. Because the schedule can be fluid and always changing, you need to be able to adapt.
- What advice would you give to somebody interested in your career path?
Learn as much about the profession of endodontics as you can before you make your decision to apply to residency. It can be challenging to decide if this is the career path for you, when as a dental student you may have only completed 6-10 root canals, or even less. To help you decide if you are ready to commit to root canals for the rest of your career, you need to spend time with endodontists and endodontic residents. Shadow at a residency program that interests you. This will give you an idea of the workload and lifestyle that will be required. Residents are candid and eager to share their experiences with you. Shadow endodontists from different practice models. Ask questions about what they feel the pros and cons of the industry are. Find a mentor. A new practitioner endodontist can help guide you through the process and can be a valuable asset for years to come.