Fernando J. Meza, DMD, PLLC

H. Vivian Lee, DDS 

Loken M. Patel, DMD


P R A C T I C E   L I M I T E D   T O   E N D O D O N T I C S







Alexandria Professional Center

4660 Kenmore Ave. Suite 700

Alexandria, VA  22304


You may find more information in our Frequently Asked Questions page.

Do you know....

Root Canal treatment doesn't cause pain, it relieves it!

Today Root Canal treatments are painless thank to the use of new technologies and anesthetics.

Extraction is not an alternative to root canal treatment.  When a tooth is missing, the other teeth become loose and with more risk of bite and chewing problems, this is why dentists usually will recommend placing an implant in the space left.


  • Diagnosis
  • Root Canal Therapy
  • Endodontic Retreatment
  • Endodontic Surgery (Apicoectomy)
  • Cracked Teeth
  • Dental Injuries




Diagnosis is done during the first visit and consist of the examination of the tooth an surrounding tissues where you are experiencing pain or discomfort.  Diagnosis of an endodontic problem involves testing the tooth for sensitivity to cold and hot, tapping on the tooth, and taking appropriate radiographs.  Some tooth pain is not severe enough to require a root canal, in which case you may be asked to return for another evaluation or be referred back to your general dentist with a recommendation for treatment. Occasionally, a patient may have diffuse pain in an area that is not attribute to a tooth (non-odontogenic). In these cases, symptoms may be coming from a nearby structure such as the sinus, muscles of mastication, or temporomandibular joint (TMJ).  Your endodontist is able to differentiate between pain from a tooth (odontogenic) versus non-odotogenic pain, and will make the appropriate referral to a pain management specialist if needed.


Root Canal Therapy

Root canal treatment is needed when the soft tissue inside the root of a tooth, known as the pulp experiences inflammation or infection. Inflammation or infection can occur as a result of several things, including severe decay, repeated dental procedures, trauma, or the presence of a chip or crack.  Often this injury occurs without any symptoms, however, if the tooth remains untreated, pain or sensitivity may occur and an abscess could develop.


  • You may experience the following symptoms prior to needing root canal therapy:
  • Persistent throbbing, sensitivity to hot and/or cold
  • Pain which may wake you in the middle of the night
  • Pain which radiates to your upper or lower jaw, ear, or side of face 
  • Tooth discoloration
  • Sensitivity to chewing and touch
  • Infection, drainage and sensitivity in the lymph nodes, nearby bone and gum tissues

Sometimes, however, you may not experience any symptoms but still be in need of endodontic treatment


Under a microscope, your endodontist will remove the inflamed or infected pulp, and then thoroughly clean and carefully reshape the canal.  Afterwards, the canal space is filled with either a temporary antimicrobial paste or a biocompatible permanent root filling.  Your endodontist will place a temporary filling on the chewing surface in order to close the space between office visits and also after the root canal therapy is completed.  You will need to see your general dentist after the root canal therapy is completed for a permanent restoration (filling or crown) of the tooth.  This will seal and protect the remaining tooth structure and restore your tooth to its proper function.


Endodontic Retreatment

Most teeth that have had root canal therapy heal uneventfully. In some cases, however a tooth that has had endodontic treatment develops a persistent or unhealing infection.  Occasionally, the tooth can become painful or diseased years after successful root canal therapy.  If your tooth has not healed or has developed new symptoms, you have a second chance at saving your tooth. Another procedure, root canal re-treatment, may be performed by your endodontist. 


A previously root canal treated tooth may need a retreatment for one of the following reasons:

  • During initial treatment, narrow or curved canals were not properly cleaned.
  • The final restoration was delayed follwing endodontic treatment
  • The restoration did not protect the central portion of the treated tooth from salivary contamination.
  • A fracture of the crown or root occurs on the treated tooth.
  • New decay develops, exposing the canal to bacteria and a new infection.
  • Infection of the canal space occurs due to a loose or cracked crown or filling.


When retreatment is necessary, your endodontist will re-open the tooth and remove the old root filling material.  The canals will be thoroughly cleaned and carefully examined under a microscope to observe for cracks, decay, and infection.  Once the canals are comprehensively cleaned, your endodontist will place a permanent root filling into the canal space.

Ater re-treatment is completed, you will again need to see your general dentist for the final restoration (filling or crown). If possible, preserving your natural tooth is always the best option. Teeth that have been restored with a filling or crown can last for years, even a lifetime.


Endodontic Surgery (Apicoectomy)

Also known as root-end-resection or apicoectomy. Apicoectomy may be necessary if initial root canal therapy or re-treatment has failed. Sometimes, apicoecomty may be performed in conjunction with or instead of endodontic re-treatment.

This procedure treats the bony area surrounding the end of your tooth, which has become inflamed or infected.  By folding back the gum near the tooth, the doctor can access the underlying bone and extract the inflamed tissue.  At the same time, the very tip of the root is removed and usually replaced with a small plug or filling.


Your endodontist will make a small incision into the gum tissue near your tooth to examine and diagnose the surrounding bone and to remove any inflamed or infected tissue.  After this, the endodontist will fill the end of the root to seal it from future infection, and will suture the gum tissue together to encourage proper healing.  Over the course of the next few months, the existing bone tissue will gradually grow back in to replace the infected tissue which was removed.  Most patients are able to return to ther normal routine as early as the day after their surgery.

Before committing to treatment, your endodontist will inform you of the specifics of your case, the risks and benefits of all proposed treatment options, as well as how to properly prepare for the procedure and steps to be taken after the procedure is finished.


Cracked Teeth

Teeth are constantly subjected to powerful chewing forces that my result in small cracks or craze lines to form in the enamel.  Often these craze lines are shallow and present no danger to the pulp space inside the tooth.  Occassionally, craze lines may propagate to form distinct cracks within the enamel and/or dentin.  These cracks may be asymptomatic, or result in pain when biting down or releasing on tough foods.  Your general dentist may be able to place a filling or crown on the tooth to eliminate the symptoms and slow the progression of the crack.  Sometimes however, the crack can initiate symptoms within the pulp tissue that eventually may require root canal therapy.  Cracks may be present only in the superficial layers of the tooth, or may propagate down the root of the tooth or from one side to the other.  Your endodontist is often able to see the extent of  the crack once root canal therapy is initiated, and inform you of the prognosis of the tooth.  Some cracks may be managed by placing the permanent crown on the tooth immediately after root canal therapy is completed.  Other cracks can propagate and worsen with time regardless of the placement of the crown, and may result in a persistent infection that requires extraction.


Dental Injuries

Dental injuries occur most often to the front upper and lower teeth, resulting in pain or discomfort of varying degrees.  Minor injuries may require simple monitoring of the traumatized area only.  More severe injuries may cause the tooth or teeth to become loose and damage the nerve inside.  In these cases, the tooth may be repositioned and root canal therapy initiated in order to prevent more serious sequelae.  Trauma may also result in discoloration of the injured tooth, which can be treated with root canal therapy and internal bleaching of the discolored crown. 

The American Association of Endodontist has this position statement on the use of mouthguards to prevent dental injury:

Impact injuries to the dentition, such as those occurring during participation in sports, often result in the need for endodontic treatment. The American Association of Endodontists recommends the use of mouth guards during participation in sports as their use may minimize the effect of impact injuries on the dentition and supporting structures. Participants in sporting events are encouraged to contact their dentist for fabrication of a custom mouth guard. In addition, organizers and coaches of children's sports are encouraged to recommend and/orrequire the use of mouth guards for all of their participants.


For more information, please visit the AAE website to learn about traumatic dental injuries and their treatment: Traumatic dental injury