Root Canal Treatment: Indications and What to Expect

Root canal treatment causes a lot of anxiety in patients requiring this type of therapy. Everyone has heard the horror stories of someone who knew someone whose brothers head exploded during a root canal! Inspite the overwhelming success and significant pain relief associated with root canal therapy these stories still abound. Many patients actually neglect treatment and live with the pain just because of these stories. The truth of the matter is that with local anesthetics, and quality root canal treatment, most patients feel no pain during treatment and minimal discomfort post treatment. 


Root canal therapy is an extremely successful treatment with success rates hovering around 92-98% in vital cases. A “vital case” means that the tooth is still alive but in the process of dying. These cases are typically extremely painful but at times may go unnoticed. They can be caused by tooth decay, physical trauma or fractures in the teeth. The good news (if any) is that they are very treatable and recovery time is minimal. Many times patients only have a slight ache from the treatment needing nothing more than tylenol during recovery. 


Necrotic (dead) teeth are a bit more complicated. The success rates for treatment on these teeth drop to 60-85% based on the nature of the infection. These teeth are quite often asymptomatic and only noticed on x-rays. When they are symptomatic they often present with extreme pain, swelling and sometimes pus creating a bad taste or odor in the mouth. Symptomatic teeth can be dangerous dependent on where the infection is draining. Occasionally the spread of infection can be life threatening. Teeth that are necrotic and asymptomatic are often at the higher end of the clinical success rates. Most of the “horror” stories regarding root canal treatment come from patients suffering from symptomatic necrotic teeth. Active infection makes it difficult to anesthetize teeth since pH levels in infected sites drops, effectively neutralizing the anesthetic. Either injection further up the nerve trunk or intrapulpal injections may be necessitated. The residual and active infections around the tooth may also reinfect the tooth causing it to fail. Cleaning the tooth out (removing infection and pulp remnants) is much more technique sensitive as there is much more leniency when treating vital teeth.


Because of these reasons it is extremely important to seek out treatment as soon as you feel something may be wrong. Timing is so important regarding root canal treatment. The difference of just a little amount of time can cause success rates to drop dramatically and potentially cause severe pain, swelling and life threatening infection. 


What To Be Aware Of: 

         1.) Temperature Sensitivity should be consulted on. Cold sensitivity that lasts more than 10 seconds or produces a throbbing sensation can be a sign of irreversible pulp damage. Heat sensitivity is almost always a sign of tooth death and root canal is typically indicated.

           2.) Sharp Pain When Chewing that resolves immediately when pressure is released. This is a sign of fracture in the tooth. When the fracture extends into the pulp space root canal therapy may be indicated. 

           3.) Pain on Biting With or Without Throbbing. This may be an indication that infection or bruising may be present around root tip of the tooth in the ligament space. Infection would indicate tooth death. Bruising may be a simple fix, typically adjusting the bite resolves this concern.

             4.) Pain Following Routine Dental Treatment. Sensitivity is common after routine dental treatment, including cold sensitivity. In most cases this sensitivity resolves within a few days to a couple weeks. Rarely up to 6 months can be needed to resolve post op tooth sensitivity in some patients. In some cases, again very rarely, a tooth may suffer irreversible pulp damage and require root canal therapy following routine dental treatment. 2-4% of asymptomatic crown preparations will require root canal therapy and 6-8% of teeth prepared for bridges will require treatment inspite our best efforts. These statistics should not deter you from getting needed treatment done as unresolved dental concerns have nearly a 100% chance of eventually needing root canal treatment or extraction if left unresolved.

            5.) Any Odd Sensation that you may be concerned about is reason to consult a dentist. Damaged root canal systems can present multiple odd symptoms and it’s always better to check it out than risk significant damage to teeth.


Root canal therapy is a very standard treatment. Steps (after diagnosis of the cause) are first anesthetizing the area. A rubber dam or other protective isolation should be placed to prevent the newly cleaned root canal system from having bacteria reintroduced. Access is made to expose the infected tissue within the tooth. Once the canals are located they are cleaned and shaped with small files. Medications may be placed in the canal to help with removal of the tissue and kill bacteria. After the infected tissue is cleaned out of the tooth a small pointed piece of rubber material (gutta percha) is placed in the canal with a special sealer. The excess rubber material is then removed and packed tight into the canal of the tooth. The tooth is then sealed with a filling material and the tooth is prepared for a crown if it is a back tooth or severely damaged front tooth. Most times this treatment can be completed within one appointment but under certain circumstances it may be necessary to wait until a second appointment to complete the treatment. In some cases an antibiotic and a pain medication will be prescribed.