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Root canal treatment removes the damaged nerve and blood vessels from inside a tooth, disinfects the canals, and seals them, so that a tooth with deep decay, a crack or an injured nerve can be kept instead of removed. With modern anesthesia it is a long but uneventful appointment. At Vizcaya Dental Arts we do most root canals in the office, under a rubber dam, and we decide first whether the tooth can be usefully restored afterward, because a root canal is only worth doing on a tooth that can then carry a filling or a crown.
Signs a tooth may need a root canal
- Pain that lingers for more than a few seconds after something cold or hot, or that arrives on its own, often at night
- A tooth that hurts to bite on, or that aches after chewing
- Swelling or a pimple-like bump on the gum beside a tooth, sometimes with a bad taste
- A tooth that has darkened compared with its neighbors, often months after a knock
- Tenderness when the tooth is tapped, or a tooth that feels raised in the bite
Some teeth with a dead nerve have no symptoms and are found on an X-ray at a routine visit. Several of the signs above have other causes, which is why testing comes before treatment.
Is the tooth worth saving?
The first question is whether the tooth can be restored afterward. A root canal on a tooth that cannot hold a filling or a crown wastes your time and money. So we assess the whole tooth:
- How much sound structure remains
- Whether there are cracks
- The condition of the gum and bone around it
- What will be needed to rebuild it
When the tooth is restorable, saving it is our preference. We have kept many teeth that patients had been told elsewhere to extract. When the tooth is too far gone, a root canal only delays the extraction, and we recommend removal instead.
Is it really the nerve?
Not every toothache comes from the nerve. Our diagnostics page describes how we test a tooth. Sensitivity and pain on biting sometimes come from a tooth hitting slightly early in the bite, and a small adjustment resolves it. Pain can be felt in a healthy tooth next to the real cause. Before anyone treats a nerve, it should be clear that the nerve is the problem and which tooth it belongs to.
What the visit is like
- Step 1 of 5 Anesthesia
A topical gel, then local anesthesia given slowly. We wait until the tooth is fully numb and check before starting. If you feel anything sharp during the treatment, raise a hand and we stop and add more.
- Step 2 of 5 Isolation
A rubber dam, a thin sheet that isolates the tooth, keeps the inside of the tooth clean and the materials out of your mouth. We use one for every root canal.
- Step 3 of 5 Cleaning the canals
A small opening is made in the top of the tooth, the damaged pulp is removed, and each root canal is cleaned, shaped and disinfected along its length.
- Step 4 of 5 Sealing
The canals are filled and sealed, and the opening is closed with a filling that protects the tooth until the final restoration.
- Step 5 of 5 Restoring the tooth
A filling or a crown, decided by how much tooth is left and how hard it has to work. This step is part of the treatment.
The treatment usually takes between one and two hours depending on the tooth. Most patients listen to music or a podcast through it. Expect some soreness when biting for a few days afterward, which ordinary pain relief handles.
Emergency visits
When a tooth is in severe pain, the first visit may be about relief: the inflamed pulp is removed and the tooth is medicated and sealed temporarily so the pain stops. That is not a completed root canal. You need to come back to finish cleaning and sealing the canals and to restore the tooth. Skipping that step is how a tooth that could have been kept ends up lost, so we make the plan clear at the first visit.
The restoration afterward
Once the pulp is gone, the tooth is more brittle, and it has often lost structure to the decay or crack that started the problem. Whether it needs a crown depends on the load it carries and how much of it is left:
- Molars and premolars, which do the chewing, usually need a crown to protect them from splitting.
- Front teeth that lost little structure can often be restored with a filling.
Whichever it is, the final restoration should be done soon after the root canal.
Front teeth, premolars and molars
- Front teeth usually have a single root canal and are the quickest to treat.
- Premolars have one or two.
- Molars have three or four, sometimes curved or very fine, and they take the longest and demand the most care.
That is why the fee and the time differ by tooth, and why a molar may be completed over two visits.
When an old root canal fails
A root canal done years ago can develop a problem: a persistent infection at the root tip, a crown that leaked, a canal that was missed, a new crack. The signs are the same as for a fresh problem, often a dull ache or a bump on the gum, and sometimes only a shadow on an X-ray. The options:
- Some of those teeth can be retreated and saved.
- Some are better referred to an endodontist for specialized retreatment.
- Some have reached the point where extraction and replacement is the right recommendation.
We do not leave a failing root canal alone because it does not hurt yet.
Second opinions
If you have been told you need a root canal, or that a tooth cannot be saved, we are glad to see it. Sometimes the tooth can be kept when extraction was proposed. Sometimes the pain has a simpler cause than a nerve. Sometimes the tooth is beyond saving. You will know which, and why, before deciding.
Frequently asked questions
Does a root canal hurt?
No. The tooth is numbed with local anesthesia and stays numb throughout; modern anesthetics are strong and effective, and we check before we begin. Most patients describe the visit as long and boring rather than painful. Some soreness when biting for a few days afterward is normal and manageable.
How long does it take?
Usually between one and two hours, depending on the tooth and how complex its roots are. Some teeth are completed in one visit, others in two, for example when treatment began as an emergency to relieve pain.
Do I need a crown afterward?
Often, but not always. Back teeth take heavy chewing forces and usually need a crown to protect them from fracture, especially when decay has already weakened the tooth. Front teeth with little structure lost can often be restored with a filling. The decision is about the forces on the tooth and how much of it is left.
Root canal or implant?
If the tooth can be predictably restored, we save it. A root canal and a crown on your own tooth is, in our view, a better outcome than an implant in most cases, and implants are for teeth that cannot be saved. We have kept many teeth that other offices had proposed to extract.
What if the tooth still hurts afterward?
Tenderness for a few days is expected. Pain that is severe, worsening after the second or third day, or accompanied by swelling is not, and you should call us. Occasionally a tooth needs the treatment revisited or a different approach, and we would rather know early.
How long will the tooth last?
A root-canal-treated tooth that is properly sealed, restored and kept clean can serve for many years, often as long as its neighbors. What shortens its life is a delayed or missing final restoration, a crack, or decay at the edges, so the restoration and your home care matter as much as the root canal itself.
Sources
Professional guidelines and peer-reviewed reviews this page draws on.
- Torabinejad M, Anderson P, Bader J, et al. Outcomes of root canal treatment and restoration, implant-supported single crowns, fixed partial dentures, and extraction without replacement: a systematic review. Journal of Prosthetic Dentistry. 2007;98(4):285-311. PubMed
- Lockhart PB, Tampi MP, Abt E, et al. Evidence-based clinical practice guideline on antibiotic use for the urgent management of pulpal- and periapical-related dental pain and intraoral swelling. Journal of the American Dental Association. 2019;150(11):906-921. DOI
