When Should You Refer a Case for Endodontic Treatment?
Drs. Gevik Malkhassian and Craig Bellamy, Endodontists in Toronto, spoke with Dr. John O’Keefe about when general dentists should refer patients for endodontic treatment.
While mid-treatment challenges can occur in a seemingly “straight forward” endodontic treatment, a careful pre-assessment of the tooth and one’s own skill and expertise can minimize and/or prevent some of these challenges before treatment is started. In some instances, it may be determined that an endodontic referral is in the best interest of the patient and the practitioner.
Some of the questions to consider include:
- Do I feel comfortable completing this treatment?
- Have I successfully treated a similar case in the past?
- Can I meet the patient’s expectations?
- Can I access the tooth easily and isolate it adequately?
- Are the pulp chamber and root canal system visible, radiographically?
- Can I visualize the apex of the roots easily?
- Is there a coronal restoration?
- Can I visualize the outcome and can I see each sequence of treatment that will lead to the outcome?
Several resources exist to help clinicians objectively determine their suitability to treat a tooth that requires endodontic treatment (listed below). These resources provide a pragmatic approach and road map to help dentists see what challenges may arise during treatment.
- RCDSO Dispatch Magazine: The Duty to Refer
- AAE Endodontic Case Difficulty Assessment Form and Guidelines
Dr. Craig D. Bellamy, DDS, MSc, FRCD(C), is a board certified specialist in Endodontics registered with the Royal College of Dental Surgeons of Ontario, and currently maintains a full-scope endodontic practice in Toronto, Ontario.
Dr. Bellamy is a graduate of the University of Toronto, Faculty of Dentistry, where he obtained his Doctor of Dental Surgery (DDS) degree. He practiced general dentistry for 16 years and completed his 3-year Endodontic specialty training at the University of Toronto, where he served as Resident-Chief for the duration of his training, concomitantly earning a Master of Science degree in the field of Regenerative Endodontics.
Dr. Bellamy was awarded national and international grant funding for his research, served on the Resident Expert Advisory Council of the American Association of Endodontists Foundation, and was awarded the AAE-Dentsply Award for his research presentation at the American Association of Endodontists Annual Convention and the CAE-Dentsply Sirona Endodontics Award at the Canadian Academy of Endodontics Annual Convention.
Dr. Bellamy is a clinical instructor at the University of Toronto, Faculty of Dentistry, is Past-President of the George Hare Endodontic Study Club, is a published author in peer-reviewed journals, and actively participates in several dental organizations.
Dr. Gevik Malkhassian is an endodontist. He received his dental degree from Iran in 1990 and practiced general dentistry for 11 years before immigrating to Canada. Upon completion of a two year program at the University of Toronto for foreign-trained dentists, he continued his education at the graduate Endodontics program at the University of Toronto where he received his Master of Science in Endodontics in 2007. Since then, Dr. Gevik has kept his affiliation with the Faculty of Dentistry at the University of Toronto as an Assistant Professor. He is involved in teaching both graduate and undergraduate levels while practicing as an endodontist in Toronto and Mississauga. He is currently the director of the second year undergraduate endodontics courses at the University of Toronto.
He has received several awards from both undergraduate and graduate students including Dr. A. Bruce Hord Master Teacher Award for excellence in teaching (2015-2016). He has co-authored book chapters and published various articles in the field of endodontics. He is also involved in continuing education courses. He is a member and past president of Omicron Kappa Upsilon Honorary Dental Society, Tau Tau Chapter.