If you’ve fallen and damaged your tooth, need a root canal, or developed puffy, bleeding gums, your regular dentist might refer you to a dental specialist. Most of us are familiar with orthodontists or pediatric dentists—but what’s a periodontist? An endodontist? And when would we need to see one?

General dentists “have a scope of practice that allows them to perform a wide array of procedures,” says Nadeem Karimbux, dean of Tufts University School of Dental Medicine and a professor of periodontology. The Commission on Dental Accreditation, known as CODA, sets dental school training standards, which include the ability to diagnose disease, to plan treatments, and to communicate with patients, Karimbux says.

Those standards lead to a general dentist’s baseline competency. These dentists are adept at managing a variety of cases, can perform procedures such as root canals, crowns, extractions, or bridges—and know when it’s appropriate to refer their patients to specialists. The threshold for referrals varies, though; general dentists in remote areas might not have the same luxury of referring patients as their urban colleagues. 

“If you’re a general dentist up in the northernmost part of Maine and you don’t have a specialty referral network, you probably are adept at doing more kinds of treatments,” Karimbux says. “If you're in a city like Boston, where you’ve got that specialist network, you’ll probably be on the conservative side and say, ‘I’m going to refer you to an endodontist or a periodontist.’ ” 

Endodontists and periodontists are just two of the 12 specialties recognized by the American Dental Association. The specific techniques and instruments they use and the volume of patients they see uniquely qualify practitioners of each specialty to manage the complexity of the dental woes they treat, Karimbux says.

Tufts Now spoke with the dean about the specialists you’re most likely to visit and why you might need to see them. 

Endodontists

Those of us who have seen a complete tooth (say, after having one pulled) know that the top, or crown, of each tooth—the part we chew with—is anchored in place by one or more roots. Inside each root is a canal filled with soft tissue known as pulp. When infection strikes the root canal, “the pain can be excruciating,” Karimbux says. And when that happens, it’s time to see an endodontist: a dentist specially trained in diagnosing and treating conditions that affect the root of the tooth and its inner pulp.

When a root canal is infected, the nerves swell “and are essentially trapped,” Karimbux says. “By opening up the tooth, endodontists can relieve that pain.”

Another situation that can send someone to the endodontist is a tooth fracture or crack—say, if a baseball knocked out your child’s tooth—that has harmed the root canal.

But the biggest reason people see endodontists is inflammation within the canal. Left untreated, inflammation or infection “can spread to the bottom of the tooth, which is where the jawbone is,” Karimbux says; left alone, it can spread beyond the jaw and cause a life-threatening infection. 

Periodontists

Even if everything seems fine with your teeth and your gums, you might need to see a periodontist, the specialist who treats the inflammatory conditions known as gingivitis and periodontitis. These diseases take hold when bacteria collect in a pocket around your teeth. The conditions cause no pain, Karimbux says, unless they become severe enough to cause abscesses or ulcers.

“If you cut your skin and get bacteria underneath, you get inflammation. Similarly, bacteria collecting around the neck of your teeth, in an area called a sulcus or a pocket, causes inflammation over time,” Karimbux explains. Gingivitis is inflammation of the gums, while periodontitis is inflammation that has spread under the gums and affects the bone around the teeth.

Periodontists can perform surgical treatments as well as non-surgical treatments such as gum scraping and putting patients on a maintenance deep-cleaning schedule. 

“Periodontists also manage a variety of ulcers, viral diseases, other gum issues, and make the correct referrals,” Karimbux says. “If a periodontist thinks something's cancer, they might recommend a biopsy. If they think something needs to be referred to an oral surgeon, they will.” 

Prosthodontists

Prosthodontists deal with someone’s bite, ability to chew, and aesthetic appearance. “They really are the architects of rebuilding the teeth,” Karimbux says. “It’s complex, just like building a house.” 

These specialists take on complex cases and need to be able to understand the build of each patient’s mouth and bite—as well as the materials they use to correct it. In some cases, that means replacing or rebuilding all of the teeth. 

Prosthodontists are skilled in various tooth restoration techniques. They can create complete dentures or removable partial dentures and are adept at using CT scans to map the architecture of someone’s bone or intraoral scanning to get a 3D image of the inside of their mouth—and blending the two as they develop a treatment plan.

“You talk about hip surgery, knee surgery. This is really at that level of restoring one's abilities, not only to bite and chew and function, but also to have an aesthetic appearance,” Karimbux says.