An endodontist is the dental specialist who performs root canals. These are dentists who completed an additional two to three years of training beyond dental school, focused entirely on treating the interior of teeth. General dentists also perform root canals and handle the majority of straightforward cases, but endodontists are the specialists your dentist calls when a case is complex or when something goes wrong with a previous treatment.
What an Endodontist Actually Does
Every endodontist starts as a general dentist, completing four years of dental school before entering an advanced residency program. During those extra two to three years, they focus exclusively on diagnosing tooth pain and performing procedures inside the tooth, particularly root canals. By the time they finish training, an endodontist has performed hundreds more root canals than a typical general dentist will do in years of practice.
Beyond standard root canals, endodontists handle procedures that most general dentists don’t offer. Retreatment, where a previous root canal is reopened because infection persisted or new decay developed, is a common one. They also perform apicoectomies, a microsurgical procedure where the tip of an infected root is removed through a small opening in the gum and sealed to prevent bacteria from returning. These procedures require precision instruments and advanced training that falls squarely within an endodontist’s scope.
General Dentists Do Root Canals Too
Your regular dentist is fully licensed to perform root canals, and many do them routinely. For a straightforward case on a front tooth or a premolar with one or two canals, a general dentist can typically handle the procedure without any issue. The distinction isn’t about whether a general dentist is qualified. It’s about how often they do the procedure and whether your particular tooth presents challenges.
A large study evaluating nearly 488,000 root canal treatments found that the combined survival rate for treated teeth was 98% at one year, 92% at five years, and 86% at ten years. At the ten-year mark, teeth treated by endodontists had a modestly higher success rate, roughly 5% better than those treated by general dentists. That gap is small for routine cases but can matter more when the tooth is anatomically difficult.
When Your Dentist Refers You Out
General dentists refer to endodontists when a case exceeds what they can comfortably manage given their skills, equipment, and available chair time. The reasons vary widely. Some are about the tooth itself: sharply curved roots that increase the risk of instrument breakage, calcified or blocked canals that are hard to locate, thin root walls prone to perforation, or molars with unusual anatomy. Others are about the patient: limited ability to open the mouth, significant dental anxiety, or medical conditions that complicate treatment.
If a previous root canal has failed, that’s another common trigger for referral. Retreatment requires removing old filling material, finding canals that may have been missed the first time, and re-cleaning the entire system. When retreatment itself isn’t enough, an apicoectomy may follow. Both procedures benefit from the specialized tools and daily experience an endodontist brings.
Technology in a Specialist’s Office
Endodontists typically work with equipment you won’t find in most general dental offices. Surgical operating microscopes provide high magnification and lighting, allowing them to see fine details inside root canals that are sometimes thinner than a human hair. Cone beam computed tomography, a type of 3D imaging, gives a detailed view of root shape, canal anatomy, and surrounding bone that flat dental X-rays simply can’t match. This level of imaging helps catch missed canals, cracks, and infections that might otherwise go undetected.
These tools also play a role in managing teeth that are notoriously hard to numb. Lower molars with active inflammation have failure rates for standard numbing injections as high as 46% to 86%. Endodontists use supplemental techniques, including injections directly into the bone around the tooth or into the ligament surrounding the root, to achieve the deep anesthesia needed. When standard numbing fails, an injection into the bone has success rates between 66% and 91%, significantly higher than simply repeating the original injection.
What to Expect During the Procedure
A root canal typically takes anywhere from 45 minutes to 90 minutes or more, depending on which tooth is being treated. Front teeth with a single canal are the fastest, usually wrapping up in under an hour. Premolars with one or two roots take about an hour. Molars, which can have up to four canals, often run 90 minutes or longer because each canal needs to be individually cleaned, disinfected, and filled. Plan to spend about 90 minutes in the chair for a typical appointment regardless of the tooth, since setup, numbing, and imaging add time.
The procedure itself involves removing the inflamed or infected tissue from inside the tooth, shaping the canals, disinfecting them, and sealing everything with a filling material. Most people need a crown placed afterward to protect the tooth, which usually happens at a separate appointment with your general dentist.
Cost Differences Between Dentists and Specialists
Root canals cost around $1,200 on average without insurance, though the range depends heavily on which tooth needs treatment. Front teeth run between $776 and $1,911, premolars between $757 and $1,798, and molars between $1,030 and $2,471. Seeing an endodontist rather than a general dentist is listed as a factor that can push the cost higher, though the premium varies by practice and region.
Dental insurance typically covers 50% to 80% of a root canal after your deductible, but most plans cap annual benefits at $1,000 to $2,000. If you need a crown on top of the root canal, you could hit that ceiling quickly. It’s worth checking your plan’s details before your appointment, since some insurers require a referral for specialist coverage while others don’t.
Choosing Between a Generalist and Specialist
For a routine root canal on a front tooth or premolar, your general dentist is a perfectly reasonable choice, especially if they perform the procedure regularly. You’ll likely save some money and avoid coordinating between two offices. If your dentist recommends a referral, take it. They’re telling you the tooth has features that benefit from specialized training and equipment.
You can also request a referral on your own. If you’ve had a failed root canal, if you’re experiencing persistent pain in a previously treated tooth, or if you simply want a specialist’s hands on a molar with complicated roots, asking for an endodontist is always an option. Many endodontists accept patients without a referral, so you can call directly if you prefer.