Root Canal Procedure: Steps, After Care & Costs

What is a Root Canal?

Tooth decay, disease, and injury can result in tooth loss. However, with advancements in treatment and technology, teeth have a better chance of being saved.

For example, root canal treatment is a common dental procedure that saves a severely damaged tooth. A root canal is necessary when the dental pulp inside of the tooth becomes infected and inflamed. Deep cavities, cracks, fractures, and chips can all cause infected dental pulp.

During a root canal, your general dentist or endodontist will remove the infected pulp, clean the tooth, and seal it. Then they will place a temporary filling. After a few days, you will get a dental crown placed, which restores your tooth to normal function.

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

American Association of Endodontics

What is Dental Pulp?

Dentin, the soft layer of a tooth below your tooth enamel, contains the "pulp chamber." Inside the pulp chamber are the nerves, connective tissue, and blood vessels of a tooth. The dental pulp has a gel-like texture that consists of 75 percent water and 25 percent organic materials.

Tooth pulp provides sensory innervation (stimulation) through a tooth’s nerve. Extreme tooth sensitivity is a common symptom of infected dental pulp. However, if your tooth nerve dies, you may not feel any pain.

Root Canal Causes

Common root canal causes include:

• Severe tooth decay — If you have an untreated cavity, a deep cavity will form over time. If this occurs, root canal treatment is necessary.
• Cracked tooth — These fractures can be caused by injuries, teeth grinding (bruxism), or tooth enamel damage.
• A gum infection — When the gums around the tooth become infected, it is more likely that the bacteria will travel to your tooth’s root.
• Previous dental trauma — After a permanent tooth is dislodged or moved sideways from a traumatic injury, the nerve may die. Root canal treatment restores the tooth to proper function.
• Large cavity fillings — Teeth with large cavity fillings are more prone to infection.

How Do You Know If You Need a Root Canal?

Signs your need a root canal:

• Deep cavity
• Severe toothaches that occur after chewing or when pressure is applied
• Tooth sensitivity to hot or cold substances
• Gum swelling and tenderness near the infected tooth
• Tooth and/or gum discoloration (darker gums near the infected tooth)
• A dental abscess (a small, white pimple-like swelling near the tooth's root)

If pulp inflammation is left untreated, it can cause pain or a dental abscess. An abscess is a small, white pimple-like swelling near the tooth's root. Abscesses can be very dangerous if left untreated.

Who Performs Root Canals?

Endodontists

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

Endodontists require advanced training in endodontic treatment and use state-of-the-art technologies, such as 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.

General dentists only perform about two root canals per day, while endodontists perform 25 per day.

What Happens During a Root Canal?

A root canal procedure is separated into three appointments. Each appointment lasts 30 to 90 minutes.

During the first appointment, your endodontist takes x-rays of the infected tooth, numbs the tooth, and extracts the infected pulp. Then a medicated paste made of rubber-like material, called gutta-percha, is placed into the root of the tooth 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.

Root Canal Procedure: Step-By-Step

There are five steps in a root canal procedure, including:

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 to keep the infected tooth clean, dry, and isolated during treatment.

2. Access the Dental Pulp

After the tooth is numbed, your endodontist will make an opening through the biting surface of your tooth and into the pulp chamber. This allows them to access the dental pulp easily and quickly.

3. Remove the Dental Pulp

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

To do this, your endodontist will carefully remove all soft tissue from within the roots and then clean and shape the root canals using small instruments. Then they will place a medicated irrigation fluid into the root canal to disinfect it and rinse out any bacteria.

4. Fill and Seal the Root Canal

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

5. Tooth Restoration

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

Root Canal Aftercare

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 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, such as brushing, flossing, and using fluoride, after a root canal. You should also get routine teeth cleanings (twice a year) and regular checkups.

Other root canal after care tips include:

• Pain management — depending on the patient, over-the-counter pain medications, such as ibuprofen, are recommended for the first few days following treatment.
• Food restrictions — as mentioned above, chewing food with an unrestored tooth can lead to a serious fracture. It’s also crucial to avoid sticky or hard food and only eat soft food until the tooth heals.
• Recovery time — recovery is typically quick after the tooth restoration is placed. Patients may experience mild pain for a few days after treatment.

Root Canal Cost

Root canals cost anywhere between $500 and $1800 per tooth. An anterior root canal (front tooth) costs between $500 and $1200. A posterior root canal (back tooth) costs between $1200 and $1800.

Sometimes, root canal treatment is an alternative to tooth extractions. Instead of removing the entire tooth, your endodontist may recommend only removing the infected pulp in your tooth (a root canal).

Root canals are more expensive than tooth extractions. However, a root canal restores your tooth to normal function and eliminates the need for a dental implant (fake tooth). If you get a tooth extracted, a dental implant will be necessary. Dental implants are very expensive.