Does root canal treatment hurt? What to expect

What root canal treatment is, and when it is needed

Inside every tooth sits the pulp, a soft tissue of nerves and blood vessels filling the chamber and the canals within the roots. Once that tissue becomes inflamed or infected beyond recovery, there is no way to heal it: what we do is remove it, clean and disinfect the canals and seal them with a material that keeps bacteria out. That is root canal treatment.

The usual reason is decay that has reached the pulp, but it is not the only one. These are the signs that make us consider it:

• Spontaneous pain that comes on without touching anything, often worse when you lie down.
• Sensitivity to heat that lingers for minutes after the stimulus is removed.
• Sharp pain on biting or when one particular tooth is tapped.
• A tooth that has darkened over time after a knock.
• An abscess, facial swelling, or a small discharging spot on the gum.
• Very deep decay or a fracture reaching the pulp, even when it is not painful.

So, does it hurt?

During the treatment, no. It is carried out under local anaesthetic and, when a tooth is badly inflamed and hard to numb, we have additional techniques to get there; all we ask is that you tell us if you feel anything at any point. What genuinely hurts is the tooth beforehand, the pain that keeps you awake. Root canal treatment is what takes that away.

Afterwards you will notice some discomfort. It is normal for the tooth to feel tender on biting for two to five days, because the ligament around it has been irritated; where there was an infection beforehand it can last a little longer. An ordinary anti-inflammatory usually handles it. What is not normal is pain that grows day by day, or swelling that increases — then give us a ring.

How many appointments, and what happens in them

It depends on the tooth. Many root canals are completed in a single appointment of an hour to an hour and a half; where there is infection, where the canals are curved, or on a molar with three or four canals, we split it over two visits with an antibacterial dressing in between. An incisor is usually quicker than a back tooth.

We place a rubber dam, a sheet that isolates the tooth from the rest of the mouth: it keeps the field dry and clean, stops you swallowing anything and is a basic condition for doing the job properly. X-rays along the way confirm the length of the canals, and at the end we seal them and place either a temporary or a definitive restoration.

When it has to be redone: retreatment and apicectomy

Root canal treatment has a high success rate, though not one hundred per cent. If pain returns later on, or an X-ray shows a lesion at the root tip, the first option is retreatment: we remove the old filling material, clean and disinfect the canals again — often finding one that had been missed — and seal them afresh.

Where retreatment is not feasible or has already been tried, there is apicectomy: minor surgery under local anaesthetic in which the root tip is reached through the gum, the last few millimetres are removed along with the inflamed tissue, and a seal is placed from the end. It is more straightforward than it sounds and saves teeth that would otherwise have to come out.

Afterwards: the crown, and how to avoid needing one

A root-treated tooth does not become brittle because it has lost its nerve; what weakens it is all the structure lost to decay and to gaining access. That is why, on molars and premolars, we usually protect it with a crown or an onlay within a few weeks. Without that protection the risk of a vertical fracture is high, and a fracture of that kind normally ends in extraction.

While you wait for the crown, chew on the other side and keep ice, nuts and very crusty bread away from that tooth. And to avoid going through it again:

• Two minutes of brushing, twice a day, with a fluoride toothpaste.
• Floss or interdental brushes daily: many deep cavities start between the teeth.
• Regular check-ups: decay caught early is dealt with by a simple filling.
• A mouthguard for contact sports, and a night guard if you grind your teeth.

Booking an appointment

If a tooth is keeping you awake at night, cannot tolerate heat, or you have already been told it needs root canal treatment, do not put it off: the longer you wait, the more complicated it becomes and the more tooth structure is lost. Call us on 972 30 65 64 or write through the contact form and we will take an X-ray and tell you exactly what is going on.