For years, root canal procedures have had a bad reputation as something extremely painful. But most patients agree that the discomfort is not that much different than getting a dental filling. Root canals are the safest, most effective way to ease the pain of an infected tooth. In fact, the pain and sensitivity of an infected tooth are usually worse than the root canal procedure itself. The procedure of a root canal is routine and straightforward. It can restore teeth that might otherwise need to be pulled. According to the American Association of Endodontists, root canal treatment saves more than 15 million teeth every year. Understanding the steps helps patients know what to expect from this simple procedure.

What is a Root Canal, and Why Might You Need One?

The root canal is a narrow pathway at the center of a tooth. It consists of soft tissue with blood vessels and nerves. When a cavity or a broken tooth allows bacteria into a tooth’s root, a painful infection can form. This can lead to a condition called irreversible pulpitis, where the pulpy tissue inside a tooth starts to decay, or dental pulp necrosis where the nerves and blood vessels in the tooth die.  

Ideally, the dentist will discover a tooth’s infected root canal before either of these things happen. The only way to stop the spread of the infection is to either pull the tooth or perform a root canal procedure. The procedure involves cleaning out the damaged tissue (including the nerves and blood vessels) and sealing off the tooth from further decay. Dentists are trained to do root canal procedures. But many prefer to send patients to a root specialist called an endodontist. Endodontists have more experience with complicated cases. For example, molars have four roots rather than one, and some teeth have a network of tiny roots. These might need the special instruments and skills of a specialist.

The Typical Procedure of a Root Canal

Every patient is different, and dentists may follow slightly different protocols, but most root canal procedures follow a pattern. These steps are common in the course of a root canal procedure:

Diagnosis

1. A dentist might discover a problem at a tooth’s root by examining x-rays during a checkup. Or, a patient might come in complaining of pain and sensitivity to heat or cold. A root canal is necessary when there is an active infection, or when tooth decay is too widespread for a basic filling.
2. The dentist may refer the patient to an endodontist at this point.
3. The dentist or endodontist will go over the patient’s options and answer any questions. They will recommend the best way to save the tooth. For example, will the tooth be capped off with a filling or will it need a crown? Should the crown be porcelain, composite resin, or gold? How much will the procedure cost? 

Prep

1. On the day of the procedure, the dentist will use a local anesthetic to numb the area around the affected tooth. Some dental and endodontic practices offer sedation dentistry. This will put the patient in a relaxed, twilight state, or let them completely sleep through the process.
2. A flexible piece of rubber called a dental dam isolates the affected tooth from the rest of the mouth.

Clearing the Root

1. Once the area is numb, the endodontist uses a drill to make a hole at the top of the tooth, exposing the center root. 
2. Using tiny tools, the dentist removes the infected tissue, then widens and shapes the hollowed-out space left behind.
3. The entire tooth is rinsed to remove any pulp debris, then thoroughly dried.
4. Depending on how bad the tooth was infected, an antimicrobial medication may be painted onto the inner walls of the tooth. In most cases, the patient is ready for the next step. In others, the endodontist may choose to wait a few days to make sure that the infection is gone and the tooth is healing properly.

Preparing for a Filling or Crown

1. If the patient is to receive a crown, the dentist now takes a putty impression of the tooth. It is best to wait until this point—after drilling and reshaping—to ensure that the crown properly fits the new shape of the tooth. 
2. Next, the hole is filled with a rubbery substance, typically something called gutta-percha. This is held in place with a thin layer of an adhesive cement. If the tooth needs more stability, the endodontist may put in a small post to help the tooth hold its structure.
3. Depending on the treatment plan, the patient will either get a filling or a temporary crown. In the case of a filling, this is the final step of the procedure. 
4. In a traditional root canal procedure, the impressions taken earlier are sent to a lab where technicians create a crown that matches the natural contours of the tooth. This takes approximately two weeks. The placement of a temporary crown allows the patient to go home and eat normally while waiting. 
5. An alternative is to find a practice with the equipment to perform a same-day root canal. Instead of an impression, they scan the tooth to make a 3D image, then use special machinery to carve the crown on-site. This technology is becoming more common, but is not available everywhere and might not be best for every patient.

Post-Op and Followup

1. Avoid eating or drinking while they wait for the anesthesia to wear off. Then, start with only soft food. It is normal for the tooth to be sensitive or even sore for a few days. Over-the-counter ibuprofen or acetaminophen will usually bring adequate relief. If pain is severe or persists, contact the dentist.
2. Follow the dentist’s or endodontist’s orders after the procedure. They may write a prescription for an antibiotic if the infection was severe.
3. Patients with a temporary crown will return for a follow-up appointment about two weeks after the procedure. There, the dentist will remove it and replace it with the custom-made permanent crown.

Alternatives to a Root Canal

Dentists will always opt to save a tooth if possible, and a root canal is a reliable way to do so. The procedure of a root canal does not hurt as much as some people think, and a crowned tooth can look and feel as natural as the original. Often the only other option is to extract the tooth, but leaving a space is not ideal. Instead, the patient should consider getting a dental plate or a dental implant. 

While a root canal procedure may end up costing more than extraction and a partial denture, it is more economical than a dental implant. An implant will also take months rather than weeks and is much more invasive.  

Avoiding Future Root Canal Problems

Root canals are not foolproof. It is rare, but they do sometimes fail and require retreatment. It is also possible to get a cavity under a crown. Patients can lessen the chance of these things happening—and avoid needing root canals on other teeth—by practicing good dental hygiene.

This should also include regular dental checkups with a trusted dental professional. Our online database has numerous dentists for routine oral care, as well as dentists and endodontists who are skilled in root canal procedures. Click here to find one nearby.