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Updated on September 30, 2022

Root Canal Procedure: Steps & After Care

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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.

It 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.

A root canal involves removing inflamed and infected soft tissue from the hollow internal chamber of the tooth. This reduces the risk of the problem worsening, which can lead to needing a 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 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 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, it becomes deeper over time. If this occurs, root canal treatment is necessary.
  • Cracked tooth — A cracked tooth gives bacteria the opportunity to infect your dental pulp. 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 you need a root canal:

Severe Toothaches

You need a root canal if you feel persistent tooth pain deep below the gum line or in areas other than the affected tooth.

Persistent pain means it is ongoing or it could stop and start over days and weeks.

It can be an indication that there is an infection or damage to your tooth’s pulp, which might require root canal treatment.

Gum Swelling

Gum swelling near the throbbing tooth may be a sign that you need a root canal. It’s caused by acidic waste products from dead pulp tissues. A gum boil, pimple, or abscess on your gum is also a sign of a tooth infection.

Tooth or Gum Discoloration

Discoloration occurs when there is an infection or damage in the dental pulp of your tooth. Inadequate blood flow causes tooth pulp to die, which leads to discoloration. Your gums could look darker near the infected tooth.

Tooth Sensitivity

You might need a root canal if you feel a dull ache or a sharp pain that occurs on an ongoing basis. Pain when eating or drinking hot and cold foods and beverages indicates damage and/or infection.

Tooth Injury

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

Loose teeth can also be an indicator of infected teeth, which might require a root canal treatment.

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?

During a root canal, your general dentist or endodontist will remove the infected dental pulp from the internal chamber of the tooth. They'll clean the tooth and seal it. Then, they will place a temporary filling.

A root canal procedure is typically 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.

severely decayed tooth with infected dental pulp

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.

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.

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.

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.

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, 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.

normal tooth with dental pulp

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 after a root canal. This includes:

  • brushing with fluoride toothpaste
  • flossing
  • getting routine teeth cleanings twice a year

Other root canal aftercare 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.

See Related: Root Canal Costs

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

If you do not get a root canal when you need one, the infection can spread to the gum and jawbone surrounding the decaying or infected pulp.

This could lead to the loss of the tooth or, in severe cases, the loss of part of your jaw. 

It can also cause severe 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.

Other problems linked to not having a root canal include:

  • 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. After, you’ll need to discuss dental implants and other treatment options with your dentist to replace the missing tooth. 

Common Questions and Answers

How long does a root canal take?

A simple root canal, which is when the tooth only has one canal, typically takes 30 to 60 minutes to complete. Major root canals take about 90 minutes to complete.

Are you awake during a root canal procedure?

Most patients are awake during a root canal procedure. Your endodontist will administer local anesthesia, which numbs the affected tooth and gums. You will not be able to feel anything during the procedure.

If the root canal procedure is more invasive, your dentist may use unconscious sedation, which means you are put to sleep for the duration of treatment.

Is a root canal painful during the procedure?

Many people think root canals are extremely painful. However, with advancements in technology, root canals feel about the same as a deep cavity filling. A numbing medication (local anesthetic) is also used, which reduces pain during the procedure.

Does insurance cover a root canal?

Root canal insurance coverage varies depending on your dental insurance plan. Root canal therapy is medically necessary, so insurance usually covers most of the treatment cost.

Learn more about the cost of a root canal without insurance and with insurance here.

4 Sources Cited
Last updated on September 30, 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, www.aae.org/patients/root-canal-treatment/.
  3. “Root Canal Explained.” American Association of Endodontists, www.aae.org/patients/root-canal-treatment/what-is-a-root-canal/root-canal-explained/.
  4. Syrbu, John DDS. The Complete Pre-Dental Guide to Modern Dentistry. 2013.
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