Five Things to Look for When Referring to an Endodontist

According to the AAE, over 70% of the 15+ million root canal treatments performed annually in America are accomplished by general dentists. If you’re one of them, you probably already have a good feel for when to refer special cases and retreatments to an endodontic specialist. But how do you choose the right endodontist for your valued patients?

Joel Small, DDS, MBA is a leading endodontist, healthcare coach and author of Face to Face: A Leadership Guide for Health Care Professionals and Entrepreneurs. From his vantage point at his busy Dallas-area practice, North Texas Endodontic Associates, Dr. Small advises looking beyond mere proximity – to what will give your patients an exceptional overall experience.

“In our practice, patients come first … We seek out referral sources who share our patient care philosophy.”

– Dr. Joel Small


Will your patient report that he or she had a comfortable visit and clearly understood the necessary next steps and billing? Will both you and your patient feel confident in the outcome of the procedure? Ultimately, the care your patient receives from a specialist should be aligned with the culture you’ve created in your own dental practice. With that in mind, here are five things to look for in partnering with an endodontic specialty practice to care for your referral cases.

1. Similar Practice Priorities

North Texas Endodontic Associates maintains scores of successful referral relationships with general and restorative dentists. The endodontic practice asks each referring clinician to complete a profile to capture his or her preferences.

“In our practice, patients come first,” said Dr. Small. “We seek out referral sources who share our patient care philosophy. Our best referring doctors see us as an extension of their office.”

This vetting process should be a two-way street. The key is to find endodontic practices that promote similar cultures and do what they say.

2. Standards of Care

You’ve worked hard to build your patient base and earn their trust. Ensure you’re placing them in the best hands by checking for simple quality benchmarks such as a single-patient-use policy for endodontic instruments.

“The more discerning restorative dentist will be interested in great practice integrity,” explained Dr. Small, whose practice follows strict adherence to single-patient use to not only avoid cross contamination, but also cyclic fatigue in endodontic files. Cyclic fatigue, it should be noted, is one of the leading causes of file separation. While single-patient use is indicated in the directions for use for many endodontic files, it is not legally mandated the way it is in Europe or within the U.S. military.

3. Focus on Long-term Outcomes

You want your patient’s good experience to extend beyond a positive office visit to a long-term clinical outcome for their root canal treatment or retreatment. Look for endodontic practices that have invested in and practice with the latest techniques and technology. Specifically inquire about these issues when considering a working relationship with a dental specialist.


Today’s endodontic operatory is defined by its modern technology, including powerful microscopes for improved visibility.
  • Microscopes. Advanced endodontic operatories are equipped with microscopes that provide enhanced visibility, making smaller, more conservative access feasible while improving the endodontist’s ability to locate and treat canals including MB2.

“Without the microscope, we might not see a fracture and could therefore treat a tooth that would soon fail,” explained Dr. Small. “The microscope helps create more predictable long-lasting results and successful outcomes.”

  • Cone-Beam Computed Tomography (CBCT). Imaging technologies such as CBCT facilitate improved diagnostics and treatment planning.

Endodontic diagnostics and treatment planning greatly advanced with the introduction of cone-beam computed tomography (CBCT) imaging.
  • Advanced Irrigation Protocols. Smaller, 30-gauge irrigation needles, some with side-vented ports, allow endodontists to safely deliver irrigants to more conservatively shaped apical areas. Irrigant activation can further enhance disinfection protocols.
  • Dentin Preservation. The four endodontists of North Texas Endodontic Associates use TRUShape® 3D Conforming files to preserve more dentinal structure while removing pulp and debris along the entire root canal. The file’s unique S-shape design allows it to remove up to 36% less dentin with superior overall shaping, while better disrupting biofilms for improved bacterial reduction. For Dr. Small, an important difference is the overall experience for patients.

“The more technically precise I can be, the less discomfort for patients,” he said. “The patients also seem to like it – they’re in the chair for less time.”

4. Accessibility

“Front offices are busy and want patients taken quickly. Having a multiple-doctor practice allows us to consistently see patients in pain on the day they call.”

– Dr. Joel Small


It may be handy for your patient to see an endodontist located near your office, where they are used to coming for their routine dental care. The truer mark of convenience for both your patient and your front office, however, is accessibility. People are more likely to drive a little farther for a one-time event or to see a specialist. The greater concern is being seen and treated in a timely manner without scheduling hassles and delays. Consider using more than one endodontic practice or a larger practice with multiple endodontists, as is the case with North Texas Endodontic Associates, to ensure that patients are seen quickly when necessary.

5. Commitment to Continuing Education

Finally, look for a culture of continuous improvement – specifically one dedicated to promoting excellence throughout the specialty of endodontics. For example, all of the endodontists of North Texas Endodontic Associates lecture locally and globally. They also serve as mentors for Baylor dental students in the university’s “Great Expectations” mentoring program.

Referring your valued patients to the right endodontist is an act of trust. Taking the time to ensure your practice’s priorities are aligned can help you enjoy a successful referral relationship for years to come.


Dr. Joel C. Small is an endodontist, speaker, author and entrepreneur. He is a cofounder of North Texas Endodontic Associates in Plano, Texas. His thirty plus years as an endodontist have been spent in private clinical practice. Dr. Small speaks nationally on the topics of leadership, practice management, and specialty practice transitions. He and his partners in North Texas Endodontic Associates have published numerous clinical research articles in various general and specialty dental journals throughout the US and abroad. Dr. Small completed his post graduate training in endodontics at the University of Texas Dental Branch in Houston, Texas. He received his Master of Business Administration degree, with an emphasis in health care management, from Texas Tech University.


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