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Updated on November 7, 2022

Root Canal Procedure

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What is a Root Canal?

A root canal treatment is a common dental procedure that saves a severely damaged tooth. The most common reasons for needing a root canal are:

A root canal involves removing inflamed and infected soft tissue from the hollow internal chamber of the tooth. This reduces the risk of worsening problems that can lead to tooth extraction.

Root canals are one of the most common dental procedures, with more than 15 million performed every year.

American Association of Endodontics

What is the Dental Pulp?

Dental pulp is the nerve under your enamel and dentin. The tooth pulp provides sensory stimulation through a tooth’s nerve. 

The pulp chamber contains:

  • Nerves 
  • Connective tissue
  • Blood vessels 

How Do You Know If You Need a Root Canal?

Root canals are necessary when the dental pulp becomes infected and inflamed. Deep cavities, cracks, fractures, and chips can cause dental pulp infection.

Signs you need a root canal:

Severe Toothaches

If you feel persistent tooth pain deep below the gum line, you may need a root canal. You may also feel persistent pain in areas other than the affected tooth.

Persistent pain indicates damage or infection to your tooth’s pulp. These toothaches could be ongoing, or they could stop and start over days and weeks.

Gum Swelling

Gum swelling near the throbbing tooth may signify the need for a root canal. It’s caused by acidic waste products from dead pulp tissues. 

Other signs of a tooth infection due to gum swelling include:

  • A gum boil 
  • Pimple
  • Abscess

Tooth or Gum Discoloration

Inadequate blood flow causes tooth pulp to die, causing discoloration. Discoloration can signify an infection or damage to your dental pulp. 

A common sign of discoloration is darker gums near the infected tooth.

Tooth Sensitivity

Feeling pain after consuming something hot or cold could indicate damage to the pulp. You might need a root canal if you feel a dull ache or a sharp pain that occurs on an ongoing basis.

Tooth Injury

Tooth injuries are one of the most common reasons for needing a root canal. Other reasons include deep cavities and chipped or cracked teeth.

Loose teeth can also indicate tooth infections and might require root canal treatment.

Who Performs Root Canals?

A root canal procedure is done by a general dentist or endodontist.

Endodontists

Endodontics is a specialized area of dentistry that focuses on treating dental pulp diseases. Endodontists are the primary providers of root canals. They may perform up to 25 root canals per day.

Endodontists require advanced training in endodontic treatment and use state-of-the-art technologies. They routinely use digital imaging and microscopes to treat patients safely and effectively.

General Dentists

Many general dentists also perform root canals. However, they do not get advanced training in endodontic treatment. As a result, they may not perform as many root canals daily.

How Much Does a Root Canal Cost?

The cost of a root canal can depend on the severity and location of the infection:

  • Front tooth — $620 to $1,100
  • Premolar — $720 to $$1,300
  • Molar — $890 to $1,500

Root canal therapy is medically necessary, so most insurance plans can cover the cost. However, this can vary depending on your insurance plan.

The type of dental office you visit may affect the cost, too. Learn more about the cost of a root canal with and without insurance here.

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What Happens During a Root Canal?

A root canal procedure is typically separated into up to three appointments

During the first appointment, your endodontist takes X-rays of the infected tooth. The tooth is then numbed, and the infected pulp is removed. 

A medical paste called calcium hydroxide is placed into the tooth's root between visits.

During the second appointment, your endodontist cleans, shapes, and seals the root canal. In the third appointment, your tooth is restored with a dental crown.

How Long Does a Root Canal Take?

Each appointment lasts 30 to 90 minutes. The procedure itself takes about 30 to 60 minutes. 

A major root canal can take 90 minutes or longer to complete.

Root Canal Procedure Steps

There are generally five steps in a root canal procedure:

1. Numb the Tooth

The first step of root canal treatment is to numb the tooth. This ensures you do not feel anything during the procedure.

Your dentist will also use a small shield called a dental dam to keep the infected tooth clean, dry, and isolated during treatment.

severely decayed tooth with infected dental pulp

2. Access the Dental Pulp

Next, the endodontist will make an opening through the biting surface of your tooth. This provides quick access to the pulp chamber and dental pulp.

This image has an empty alt attribute; its file name is root-canal-procedure-step2-1.png

3. Remove the Dental Pulp

Removing the infected dental pulp is the most important step of root canal treatment. Removal of the infected dental pulp involves:

  • Careful removal of all soft tissue
  • Cleaning and shaping the root canal
  • Disinfecting the root canal

Disinfecting the area involves a medicated irrigation fluid. This helps to rinse out any leftover bacteria.

tooth with infected dental pulp removed

4. Fill and Seal the Root Canal

After being shaped and cleaned, the root canal is sealed. Then a temporary filling is placed.

4. Fill and Seal the Root Canal

After being shaped and cleaned, the root canal is sealed. Then a temporary filling is placed.

This image has an empty alt attribute; its file name is root-canal-procedure-step4.png

5. Tooth Restoration

After the root canal is complete, a dental crown will be placed by a general or family dentist. The crown protects the treated tooth and restores its natural function, shape, and look.

normal tooth with dental pulp

Is a Root Canal Painful?

A root canal is typically done while the patient is awake. Your endodontist will administer local anesthesia to help with pain and discomfort.

The anesthesia numbs the affected area, so you won’t feel any pain during the procedure. However, if the root canal is more invasive, your dentist may put you to sleep for the duration of treatment.

What Happens After a Root Canal?

Do not chew or bite with a root canal-treated tooth that does not have a crown yet. Only a crown protects an endo-treated back tooth from fracture; a filling does not. 

After the crown is placed, you can chew normally again within a few days.

Endodontists recommend following good oral hygiene practices after a root canal. This includes:

  • Brushing with a fluoridated toothpaste
  • Flossing
  • Getting routine teeth cleanings twice a year

Aftercare Tips

Other root canal aftercare tips include:

  • Pain management — Over-the-counter pain medications, such as ibuprofen, are recommended for the first few days following treatment.
  • Food restrictions — Only eat soft food until the tooth heals. Avoid eating hard or sticky foods.
  • Recovery time — It only takes a few days to recover from the procedure. However, some people will take one or two weeks if there are complications.

See Related: Root Canal Costs

Outlook

Root canal treatment is highly successful, with a 97% success rate.8 If the affected tooth heals properly, the results of a root canal can last a lifetime.5

What Happens if You Don't Get a Root Canal?

The infection can spread to the gum and jawbone if you do not get a root canal. Once the infection surrounds the decaying pulp, you could lose your tooth.

In severe cases, you may lose a part of your jaw. 

Other problems linked to neglecting a root canal include:

  • Severe pain
  • Dental abscess
  • Joint pain
  • Heart attack
  • Stroke
  • Sepsis

It’s potentially life-threatening to ignore the need for a root canal.

The only alternative to a root canal is to extract the tooth in question. Talk to your dentist about dental implants and other treatment options to replace the missing tooth.  

Summary

A root canal treatment is a common dental procedure used to treat conditions like severe tooth decay.

The procedure involves removing inflamed and infected soft tissue from the hollow internal chamber of the tooth. This helps reduce the risk of further damage.

Endodontists and general dentists can perform root canals. The cost varies depending on the location and severity of the affected tooth. Your dentist's location may also affect the cost.

If a root canal isn’t treated, it can severely damage your mouth and jaw, causing other complications. Speak to your dentist immediately if you think you need a root canal.

8 Sources Cited
Last updated on November 7, 2022
All NewMouth content is medically reviewed and fact-checked by a licensed dentist or orthodontist to ensure the information is factual, current, and relevant.

We have strict sourcing guidelines and only cite from current scientific research, such as scholarly articles, dentistry textbooks, government agencies, and medical journals. This also includes information provided by the American Dental Association (ADA), the American Association of Orthodontics (AAO), and the American Academy of Pediatrics (AAP).
  1. Restoration of Root Canal-Treated Teeth: an Adhesive Dentistry Perspective. Springer International PU, 2018.
  2. “Root Canal Treatment.” American Association of Endodontists. 
  3. Root Canal Explained.” American Association of Endodontists.
  4. Syrbu, John DDS. The Complete Pre-Dental Guide to Modern Dentistry. 2013.
  5. Burry J, et al. “Outcomes of Primary Endodontic Therapy Provided by Endodontic Specialists Compared with Other Providers.” Journal Of Endodontics, 2016.
  6. Root canal treatment.” National Health Service UK, 2022.
  7. Smaïl-Faugeron, V., et al. “Pulp treatment for extensive decay in primary teeth.” The Cochrane database of systematic reviews, 2018.
  8. He, J., et al. “Clinical and Patient-centered Outcomes of Nonsurgical Root Canal Retreatment in First Molars Using Contemporary Techniques.” American Association of Endodontists, 2017.
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