Root Canal Treatment: Is It Painful, and Is Saving the Tooth Worth It?

Is a root canal painful?

Most people feel pressure, not sharp pain, during a root canal. The ADA says there is “little to no pain” because your dentist uses local anesthesia, which numbs the tooth and the area around it. Cleveland Clinic says root canals are usually no more painful than getting a filling.

The pain people fear usually comes from the infection, not the treatment. A tooth with an inflamed or infected pulp can ache, throb, or react to hot and cold. The root canal removes that source. After the numbness wears off, you may feel sore, and the tooth can be sensitive for a few days. That soreness is different from the pain of the infection.

If you are nervous about the visit, say so when you book. Your dentist can explain each step before it starts and tell you what to expect for your tooth.

What is a root canal, and why would a tooth need one?

A root canal is a treatment that removes damaged or infected tissue from inside a tooth, cleans the inner canals, and seals them. The ADA says it is used to repair and save a tooth instead of removing it. Dentists call it root canal therapy.

Inside every tooth is soft tissue called pulp. It holds nerves and blood vessels. The ADA lists the usual reasons pulp becomes infected or damaged:

• A deep cavity
• Repeated dental procedures on the same tooth
• A cracked or fractured tooth
• An injury to the tooth, even without a visible crack or chip

If the pulp is not treated, bacteria can spread to the tissue around the root. The ADA says you will often feel pain and swelling, and an abscess may form. An abscess is a pocket of pus. Mayo Clinic says leaving a tooth abscess untreated can lead to serious complications.

What are the signs that a tooth may need a root canal?

Signs include a toothache that does not go away, pain when you chew or press on the tooth, lasting sensitivity to hot or cold, a swollen gum, or a pimple-like bump on the gum. Only a dentist can tell you the cause. Many other problems cause the same symptoms.

Pain is not always present. Cleveland Clinic notes that you might not notice an infected tooth at first. This is why your dentist uses an exam, a few tests, and X-rays rather than relying on how the tooth feels. The ADA says X-rays give a clear view of the tooth and the bone around it.

If you have a toothache, you do not need to wait for it to become severe.

What happens during a root canal, step by step?

The ADA describes the same basic sequence. Your dentist numbs the area, keeps the tooth dry, removes the damaged pulp, cleans the canals, and seals them. The table shows the main stages.

The rubber-like material is gutta-percha. The ADA says treatment usually takes 1 or 2 office visits. The tooth then needs a follow-up visit, where the temporary filling is replaced with a regular filling or a crown. The ADA also says a post may be placed in the canal to hold the filling material and support a crown.

Some dentists refer complex cases to an endodontist, a dentist who completed extra training in treating the inside of the tooth. The ADA says your dentist may do this. Whether your case is simple or complex depends on the tooth, the shape of its canals, and how much infection is present. Your dentist will tell you at your exam.

Why do many root canal teeth need a crown?

A crown covers the whole tooth and gives it added strength and support. Cleveland Clinic says that in most cases people who have root canal therapy also need a crown.

Cleveland Clinic also says to wait until the final crown is placed before you bite down hard on the treated tooth. Between visits, eat soft foods and chew on the other side.

Your dentist decides between a filling and a crown based on how much healthy tooth is left. You can read about crown types on our dental crown page.

What is root canal recovery like?

Most people recover in less than a week, according to Cleveland Clinic. You may feel mild soreness and some lingering sensitivity. The ADA says the tooth and the area around it may feel sensitive for a few days and that you can talk with your dentist about how to relieve discomfort.

Here is what Cleveland Clinic suggests for the first days:

1. Eat soft foods for a few days, such as yogurt, mashed potatoes, or smoothies.
2. Wait until the final crown is placed before you bite down on the treated tooth.
3. Brush after meals and floss once a day.
4. Avoid smoking, because it can slow healing.
5. Call your dentist if you have throbbing pain.

If your face swells, or you have trouble breathing or swallowing, do not wait for an appointment. Mayo Clinic says to go to an emergency room for those symptoms, and to go if you have a fever and facial swelling and you cannot reach your dentist.

The office is closed Friday through Sunday. If trouble starts then, use an emergency room.

What happens if you leave an infected tooth alone?

An infection inside a tooth does not go away on its own. Mayo Clinic says a tooth abscess will not go away without treatment. If the abscess does not drain, the infection may spread to your jaw and to other areas of your head and neck. Leaving it untreated can lead to serious, even life-threatening, complications.

There is a trap here. If an abscess ruptures, the pain may drop a lot. Mayo Clinic warns that this can make you think the problem has gone away, but you still need dental treatment. A tooth that stops hurting is not always a tooth that is fine.

This is not meant to scare you. The point is simple: if your dentist finds an infection, ask how soon to treat it and what happens if you wait.

How is a root canal different from a filling or a crown?

These three treatments solve different problems, and they often work together. A filling repairs a small hole. A crown covers and strengthens a whole tooth. A root canal treats the inside of the tooth. Cleveland Clinic explains that a root canal may be followed by a crown, because the crown adds strength and support.

Our guide on crowns, fillings, and onlays explains how dentists choose between the outside repairs.

What should you ask your dentist before a root canal?

Good questions make the visit easier. You can ask:

• What did the X-ray and exam show about my tooth?
• How many visits will I need, including the crown visit?
• Will the same office place the final crown?
• How should I eat and care for the tooth between visits?
• What happens if the root canal does not work?
• What are my options if I choose not to treat the tooth?
• How will fees and insurance work for each step?

Your dentist can answer these from your own exam. Write the answers down, because they help you compare options if you want a second opinion.

Does a root canal always work?

No treatment always works. Cleveland Clinic says that sometimes root canals do not work if the damage is too severe. If that happens, a provider may treat the tooth again with another root canal, or remove the tooth and replace it with an implant or bridge.

Several things affect the result. How severe the damage is matters most. Cleveland Clinic also suggests brushing after meals, flossing once a day, and using an antibacterial mouthwash during recovery.

Ask your dentist what the odds look like for your tooth. They can base the answer on your X-rays and exam, not on an average.

Root canal or extraction: how do you choose?

A root canal tries to keep your natural tooth. An extraction removes it. Mayo Clinic says a dentist may be able to save a tooth with a root canal, but in some cases the tooth may need to be pulled. The right choice depends on your tooth, not on a rule.

If you have a tooth pulled, Cleveland Clinic advises you to discuss replacement options at the same time. You can learn about the options on our tooth extraction page.

Insurance and fees vary by plan and tooth. The practice gives each patient their own estimate after an exam. See insurance and financing for how to ask.

How can you lower the chance of needing a root canal?

You cannot prevent every problem, but you can lower the odds. Cleveland Clinic suggests brushing after meals, flossing daily, and getting regular dental checkups. Small cavities are easier to fill than deep ones. A cracked tooth is easier to protect when it is found early.

Cleveland Clinic also says a lingering toothache, or pain with hot or cold drinks, may mean an infected tooth, and that these infections will not heal on their own. See a dentist when a tooth keeps hurting.

Next step

If a tooth hurts or you were told you may need a root canal, learn more on our root canal page. Call Town Center Dental at (636) 273-5866 or request an appointment, and your dentist will talk with you about what to expect.