Endodontics

Each year there are around 9,000 patient visits, of whom approximately 2,600 are new patients.

• Referral form for pan London referrals
• Referral form for practices not included in pan London commissioning

Urgent referrals, for example acute adult dental trauma, must be clearly marked and are given priority.

Eastman Dental Hospital Endodontic Service referral criteria

Referrals are accepted on the basis of good restorative status, prognosis of treatment and strategic importance of maintaining the tooth.

1. Primary root canal treatment of teeth with anatomical complexities:
   • Combination of curved, narrow, long root canals
   • Multiple curves in root canals
   • Calcified pulp chamber or root canals; canal space not visible on diagnostic quality radiographs
   • Adults with incomplete root development
   • Anatomical anomalies (e.g. invaginations; palato-gingival grooves).
2. Surgical endodontic treatment of restoratively sound teeth when orthograde endodontic treatment is not viable.
3. Acute traumatic dento-alveolar injuries in adults or consequences thereof.
4. Vital pulp therapy (traumatic pulp exposures; stabilised deep caries with adequate tooth structure, possible exposure and absence of periapical disease).
5. Root resorption: affecting single restoratively viable tooth or affecting multiple teeth.
6. Endodontic diagnosis or opinion.
7. Facilitation or management of complex retreatment in strategic teeth only:
   • Post removal and instrument retrieval, in cases where this would be deemed to be viable; the endodontic treatment may then have to be completed in general dental practice
   • Canal location or negotiation.

We may progress the root canal treatment to a point where the rest of the treatment can then be completed in general dental practice.

All referrals are assessed regarding the complexity of the endodontic treatment required. We target the service that we provide to the management of strategically important teeth and priority is given to the above conditions. 

We do not currently consider accepting patients for:

• Root canal retreatment in teeth not deemed to be strategic
• Endodontic treatment of second or third molar teeth
• Patients who have untreated primary dental disease
• Teeth of questionable restorative prognosis* 
• Treatment requiring conscious sedation; this is not a service that we offer
• Teeth it has not been possible to anaesthetise, when all modes of administration, including intraosseous and intraligamentary routes, have not been previously attempted. 

*Restorative prognosis refers to predictability of long-term survival and healthful function of restoration and tooth. Within the limits of clinical predictability, this is defined as a periodontally sound tooth with at least 3mm height of supra-gingival dentine circumferentially (70%) with a minimum of 2mm thickness and an intact pulp chamber. The occlusal loading scheme should be favourable with the potential for an absence of interfering contacts on the final restoration.

Additional information required:

As well as the general referral information, the following is required:

• Parallel view periapical radiograph(s) of the tooth/teeth in question must be enclosed; these must be of diagnostic quality.
• The tooth/teeth in question must be clearly stated.
• The type of treatment required should be stated, e.g. primary root canal treatment, root canal re-treatment, vital pulp therapy, surgery.
• A thorough pain history must be provided.
• A detailed history of previous treatment for the tooth in question, including any previous root canal treatment provided and of any difficulties encountered.
• Details of any fractured instruments, if applicable.
• Details of any previous treatment including, for example, pulp capping.
• Confirmation that the patient is free from primary dental disease (e.g. dental caries or periodontal inflammation) and details of treatment carried out to address these aspects. Basic periodontal examination (BPE) scores are required.
• Confirmation that the tooth in question has been appropriately assessed in terms of restorability, is caries free and is appropriately restored with a restoration which provides a good coronal seal.

The endodontic referral criteria are reviewed on a four-monthly basis, to ensure they are appropriate, in order to target the department’s resources to help those patients in greatest need of specialist endodontic care and to manage teeth with a good endodontic prognosis.