Root Canals: Who Needs an Endodontist?

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When we asked dentists if they treat root canals or refer them out to endodontists, we saw lots of variation. One out of four said they do virtually all root canals in-house, and another 31% only refer out about one-quarter of root canal treatments. On the other hand, 17% of dentists refer out all root canals to endodontists.

"Actually, I refer only the ones I don’t want to do… maybe 5-10%of cases," explained one general dentist.

Who refers the least?

Rural dentists are distinctly more likely to treat root canals themselves. Urban and suburban doctors are more apt to refer out to an endodontist.

General dentists practicing in rural areas are more likely to perform more treatments in-house, as there are fewer specialists to refer patients out to.


Gender differences

Male dentists are far more likely to offer root canal therapy, while female dentists are more likely to refer patients to a specialist.

All but the tough ones

  • “Actually, I refer only the ones I don't want to do…maybe 5-10% of them — Maxillary Second Molars with no radiographic evidence of canals, etc.” (Arkansas dentist)
  • “I do all endos in-house unless there are complicating factors such as very calcified canals, unusual root curvatures, and complex natomies. I also refer most of the re-treatment and surgical cases.” (Texas dentist)
  • “I only refer out those cases where the prognosis is poor.” (Texas dentist)
  • “Before I sold the practice, I would only send out the really tough ones that might take an unpredictable amount of time.” (New York dental anesthesiologist resident)

Love it!

  • “I love doing root canal treatments. It is most pleasing to me personally. It keeps me motivated and challenged.” (North Carolina dentist)
  • “I enjoy and perform 90% of my own root canals.” (Connecticut dentist)

The endodontist’s perspective

  • “If every dentist could spend 1 week in my endodontic practice, they would all stop doing endodontics. It is an absolute tragedy… The quality of work is terrible. I see so many hacked-up teeth with gigantic accesses, separated files, perforated roots, etc… It is embarrassing. I cannot tell the patients their dentist is worthless and should never do another root canal in his life. For most dentists, it is just a fee they can charge, and they will do it all without even hesitating… Then I see the patient a year later, and I have to retreat the case or do surgery on something that could have been avoided if they would have referred it to someone with a microscope and a clue. GPs should stop doing endo … that is the bottom line.” (Nevada endodontist)

Retreatment cases go out

  • “I send out retreatments, apicos (if there is any real reason to do them anymore) and cases where I cannot find an orifice.” (Pennsylvania dentist)
  • “All retreats go to the endodontist.” (New York dentist)

No love lost for molars

  • “I feel that dentists can easily get in over their heads when doing molar root canals!!!” (Alabama dentist)
  • “I don't perform molar endo or endo surgery.” (Arizona dentist)
  • “I hate doing lower molars!” (Florida dentist)
  • “I refer out all molar endo and endo through crowns.” (Oregon dentist)
  • “I stay away from molars typically. The ones I get back from the Endodontist seem to all have 4 canals, and I do not have a microscope to help find that fourth canal." (Kentucky dentist)

It all comes down to money

  • “I am doing more now than before for monetary reasons.” (Florida dentist)
  • “Specialists are made for small mouths, tough patients, and tough teeth. With insurance companies keeping my fee low, there’s no gain for the pain.” (Michigan dentist)

Do what’s best for the patient

  • “I concentrate on doing what I do best and making sure my patients get the best care possible.” (California implantologist)
  • “I do not want my patients to associate the need for their root canal with my need to make money. I feel that patients are more likely to accept root canal treatment with referrals to a specialist I have used for my own dental needs.” (Florida dentist)
  • “New imaging has shown that canals have many exits from the root, and it is unusual to have a simple canal configuration. This explains why endodontic treatment can look great radiographically, but still be a failure. This is a great reason to refer.” (Illinois dentist)
  • “I refer to an endodontic group practice and they can usually get the patient in sooner.” (California dentist)

We all need specialists

  • “Thank god for endodontists.” (New York prosthodontist)


Note: Survey sample included 224 respondents.

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