"What they're payng me for is to make this pain go away now."
Dr. Tony Soileau

But then he began to realize something: The main difference between a GP and an endodontist is that an endodontist schedules root canals, while GPs usually get these cases as emergency patients walking through the doors. “So once I learned how to do root canals on the spot, as an emergency appointment, it greatly increased my practice,” he said. “Not a little, a lot.

“Because if someone’s in pain, the last thing they want to do is take a day off work, go to one doctor and be told, ‘OK, here’s a script for antibiotics; come back next week. Or if you want it done today, go to another doctor.’ Patients don’t want that. They’re hurting, they already took time off work, and they want to be treated now. The pain hurts now.”

So, Dr. Soileau learned how to efficiently handle root canals on the spot. He put systems in place and trained his assistants to the point where if a patient walked in for an emergency, the staff could explain the need for a root canal, the cost, and ask the patient whether they wanted it done right away.

“They always want to do it right away,” he said. “Now, sometimes I’m busy and don’t have time to do the whole root canal. But if I can at least open up the tooth and just put some files in there and get the nerves cleaned out, that’s going to knock out 80% of the pain. The patient now loves me and then I can get that patient back whenever I have time. But what they’re paying me for is to make their pain go away today.”

	SybronEndo's new Twisted Files are designed not to break while in use. Photo courtesy of SybronEndo.
	Most GPs use some form of magnification and enhanced illumination while performing endo treatment. Photo courtesy of Global Surgical.

Dr. Soileau, who lectures on endodontics and also beta tests several new products before other docs get a shot at them, markets his practice as one that can make patients’ pain go away quickly.

“All of a sudden, you start looking at root canals as a practice builder,” he said. “I’ve just done everything I can to get the reputation that if you have a tooth that’s hurting, call Tony—he’ll fix it now. It’s a huge marketing thing.”

Dr. Antenucci thinks some GPs just never have liked performing endodontics, while others may be primarily influenced by economics. “General practitioners have varying opinions regarding endodontics, which seem to fall within a spectrum of viewpoints. These range from disliking endodontics and never wanting to do any, preferring to refer out all procedures to specialists; to being too busy to provide endodontic services; to providing some services as a courtesy to patients; to incorporating endodontics as a service to patients on par with prosthetic, periodontal, and pedodontic care,” he said.

“Endodontics for many GPs is purely an economic issue—wanting to keep as much care in-house. Routine endodontics can be performed at the same level as a specialist, while full-arch fixed orthodontics or advanced oral surgery is beyond the ability or interest of most GPs. Dentists who have recently graduated tend to be well-trained in endodontics, having been adequately trained in rotary and single-visit fill techniques.”

Single-visit endo certainly has caught on. In last year’s survey, 78% of respondents performed single-visit preparation/obturation endo procedures, while that figure has risen to 87% this year.

“Motivated established practitioners have gained knowledge and experience in up-to-date endodontic modalities,” Dr. Antenucci said.

“The forces of economics, better training, and market factors such as positioning a practice to provide a full range of services for patient convenience has led to a growth of endodontics performed by GPs. The specialty currently is redefining itself—providing active training in implant placement, which, by nature, involves tooth loss. Perhaps this is because the market share of endodontic procedures performed by specialists has decreased."

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