Exploring Dentistry: A Guide to Dental Specialties

An endodontist specialises in diagnosing and treating issues related to the dental pulp and root canals.

An endodontist will have specialist equipment to help them determine what treatment is required, if any. Treatments provided by Endodontists include root fillings, also known as root canals or root canal treatments.

A root filling may be complicated by the number, shape and length of the root canals within a tooth. If root canals are curved, s-shaped, long, or there may be additional ‘hidden’ root canals, this treatment is likely to be beyond the scope of a general dentist.

A general dentist may struggle to complete a root filling, or the root filling may fail. An endodontist will be able to understand what the issues are and correct them.

They perform complex root canal treatments and also treat dental trauma, root resorption and microsurgery around the tips of the roots of infected teeth. Patients experiencing persistent tooth pain or needing root canal treatment or retreatment may be referred to an endodontist.

General practitioners may choose to do some root fillings or may opt not to do any. Most cases, and any case that is slightly more complex will usually be referred to an endodontist. Surgical procedures and pretreatments are usually the sole remit of the specialist.

Orthodontists specialise in the alignment of teeth and jaws. They correct issues such as:

• Crooked, misaligned, or crowded teeth
• Overbites, underbites, and crossbites
• Jaw misalignments
• Missing teeth
• Supernumary (additional teeth)
• Buried or impacted teeth, often upper canines

They use braces, clear aligners (such as Invisalign), and other orthodontic appliances, such as fixed braces (train tracks - invisible ceramic or traditional metal) and removable appliances (jaw expanders, space maintainers), to fix crowding or spacing and misaligned teeth, correct bite issues, improve the function and appearance of a patient’s teeth and smile.

Orthodontists also provide:

• Fixed retainers - a thin metal wire or chain behind the upper or lower front teeth (not visible)
• Removable retainers - clear plastic slips that sit over the teeth and are usually worn several nights a week
• Snoring and sleep apnoea devices

Sometimes the orthodontists will work with other specialists, such as implant surgeons, or prosthodontists to help set teeth in a position so that implants, or crowns and bridges can be provided.

Some general practitioners may provide simple orthodontic treatment, but most cases will need to be seen by a specialist.

Periodontists focus on the health of the gums and supporting structures of the teeth. They diagnose and treat gum diseases such as gingivitis and periodontitis. They also perform procedures including:

• Professional mechanical plaque (and calculus) removal (PMPR), and root surface debridement (RSD or deep cleaning - cleaning the teeth under the gum line, removing calculus and infection)
• Surgical periodontal treatments
• Hemisecting teeth
• Gum and bone grafting
  
• Soft tissue contouring - where gums are overgrown
• Crown lengthening - in preparation for crowns or cosmetic treatment or in cases where teeth are very worn
• Dental implant placement

• Treatment of gum disease around implants (peri-implantitis)

If you have symptoms of gum disease, such as bleeding gums, persistent bad breath, wobbly teeth, or gum recession, a general dentist may refer you to a periodontist.

Where you have receding gums, you may need to see a periodontist, and the periodontist may be able to correct the recession.

If the gum disease or another disorder has led to bone loss, the periodontist may be able to correct this using a bone graft in a process known as 'guided bone regeneration' or GBR.

When there are persistent gum pockets, the periodontist can use procedures to reduce these pockets, making those parts of teeth more accessible and easy to clean.

Dental implants, which are so common place these days, are prone to gum disease and bone loss - a process know and peri-implantitis. A periodontist is needed to assess, treat and maintain implants affected by peri-implantitis.

Some simple cases of periodontal disease may be treated by a dentist or a dental hygienist or therapist. Any patient with periodontal or gum disease tending towards severe or severe in nature will usually be seen and managed by a specialist.

Surgical procedures, and gum and bone procedures will usually be referred to a specialist periodontist.

Prosthodontists specialise in the restoration and replacement of missing or damaged teeth. They will be able to provide:

• Dentures
• Crowns and bridges
• Veneers
• Fillings
• Composite bonding
• Dental implants
• Bite guards or splints, or other treatment to resolve Temporomandibular Joint Disorder
• Remedial treatment for bite issues
• Remedial treatments for cracked teeth
• Bone grafts
• Sinus lifts
• Addressing tooth decay
• Temporomandibular Joint Disorders (TMD)

Worn and failing teeth are a large part of a prosthodontist's skill set, as is diagnosing and providing remedial treatment and plans for failed treatment where a general dentist is unable to address the issue.

Replacing and repairing teeth is a significant aspect of the treatment provided by a prosthodontist, and replacing worn, broken down and missing teeth has a large cosmetic component so prosthodontists will be skilled in providing simple or extensive cosmetic dental treatments such as crowns, veneers, bonding and tooth whitening.

Often, in these cases, there is little good tooth structure left, and there will be a multitude of underlying issues and factors, meaning several specialists may be required for input, and the planning and execution of these types of cases is usually beyond the general dentists remit.

Most cases of worn teeth, and more complex cases of restoring or replacing teeth (with implants, bridges or dentures) will be referred to a prosthodontist. Similarly where there are underlying issues, such as a difficult bite, or continually failing restorations, or where patient's management difficult (eg, the patient is nervous, or cannot open their mouth wide, or they have a heightened gag reflex) the case is usually referred to a prosthodontist.

Oral and maxillofacial surgeons perform complex surgical procedures related to the mouth, face, and jaw. Their expertise includes:

• Wisdom tooth extractions
• Extractions
• Corrective jaw surgery
• Facial trauma and reconstructive surgery
• Oral ulcers
• Lichen planus
• Temporomandibular joint disorders (TMD)
• Biopsies
• Bone grafting
• Sinus lifts (lateral wall or Summer's procedures)

Patients needing anything more than simple to moderate difficult extractions, surgical extractions, jaw realignment, or treatment for facial injuries will usually be referred to this specialist. These specialists work closely with other medical professionals to provide comprehensive care for systemic conditions affecting oral health.

Bone grafting, biopsies, diagnosing medical conditions, and more complex surgical treatments should usually be referred to specialist oral surgeons.

Paediatric dentists provide dental care for infants, children, and teenagers. They are trained to handle:

• Child-friendly examinations and treatments
• Children's crowns
• Childrens' root fillings
• Childrens' fillings
• Preventative care such as fluoride treatments and sealants
• Managing complex cases, such as rapid and widespread tooth decay
• Diagnosing and managing developmental disorders in teeth, such as missing teeth, supernumerary (additional teeth) and odontomes, micro- and macro-dontia, enamel and dentine hyper and hypo plasma, and so on
• Management of children with special needs
• Management of trauma cases, including broken and avulsed (totally fallen out in an accident) teeth

• Management of dental anxiety in young patients, using specialist techniques or sedation such as IV sedation or Inhalation sedation (happy gas)

Treating children can be quite difficult for the general dentist - specialist management and treatment techniques (and a lot of patience!) are required. Most cases of nervous or special needs are and should be referred to the paedodontist.