Patients are living longer and the rate of edentulism is decreasing. Endodontic treatment is an essential part of maintain-ing the health and well-being of the elderly. Retention of natural teeth improves the quality of life and the overall healthand longevity of ageing patients. Also, teeth that might be otherwise extracted may be strategically valuable to retain aprosthesis, and elderly patients are more likely to have medical complications that may prevent dental extractions frombeing safely performed. The technical goals of endodontic treatment in the elderly are the same as those for youngerpatients. However, the pulpo-dentinal complex undergoes calcific changes over time, which may pose challenges for theclinician. The purposes of this review are to discuss age changes in the pulp and the challenges posed by diagnosing,treatment planning and treating the elderly endodontic patient.