Root Canal


Megan Freedman

What is a root canal?

A root canal is an outpatient dental procedure that treats decay and infection deep inside your tooth. The roots of your teeth contain a tissue called pulp. The pulp contains nerves, blood vessels and other tissues. If your tooth is cracked, injured or decayed, the pulp can become infected. A root canal saves the tooth by cleaning out infected pulp and sealing the tooth to prevent further problems.

A root canal is generally safe, but there are risks and potential complications. It is only one method used to treat tooth decay and infection. Discuss all of your treatment options with your dentist to understand which options are right for you.  

Other procedures that may be performed

Your dentist may use a few different methods to assess the extent of the damage to your tooth before a root canal. The tests and devices used include:

  • Apex locators are devices used to measure the length of root canals.

  • Electric pulp testing helps determine the extent of disease and if pulp within your tooth is alive or not.

  • X-rays are imaging tests that use radiation to make pictures of the inside of your mouth and teeth.

Why is a root canal performed? 

Your dentist may recommend a root canal to treat tooth decay. Tooth decay (also called cavities or dental caries) occurs when bacteria in your mouth produce an acid that damages the teeth. Your dentist may perform a root canal if decay in your tooth is deep enough to affect the pulp inside your tooth. The pulp contains nerves, blood vessels and other tissues. Injury or cracks in your teeth can also damage tooth pulp.

Your tooth may need to be removed and replaced with a dental bridge, dental implant, or a denture if infection in the pulp is not treated. A root canal removes infection in your tooth and saves the natural tooth.

Who performs a root canal?

The following dental providers perform root canals: 

  • Endodontists specialize in treating diseases of the deep parts of your teeth including the pulp and root canal.

  • General dentists prevent, diagnose and treat diseases and conditions of the teeth, gums, mouth, and associated structures of the jaw and face.

  • Pediatric dentists specialize in caring for the dental needs of children and teens.

How is a root canal performed?

Your root canal will be performed in a dental office or clinic. A root canal includes placement of a filling or crown that covers your natural tooth. The process typically requires two or more separate procedures spaced over a few weeks.

A root canal generally includes these steps:

  1. You will sit in a reclining position in the dentist chair and wear a clear shield over your eyes. The shield protects your eyes from spraying liquids and dental instruments.

  2. Your dentist will inject a local anesthetic into the gums near your tooth. The anesthetic numbs the pain during the procedure. Your dentist may apply a painless topical anesthetic to numb the gums partially before the injection.

  3. Your dentist will place a dental dam over the tooth. A dental dam is a thin sheet of latex. Latex-free options are also available. The dental dam keeps your tooth dry while your dentist repairs it.

  4. Your dentist will drill a hole in the top of your tooth to access the pulp deep inside your tooth in the root canals.

  5. Your dentist will clean out the pulp using small instruments. Your dentist will smooth out the surface of the root canals and scrape the inside of the roots to make them a little larger.

  6. If your tooth needs extra support, your dentist may insert a small post into one of your root canals.

  7. If there is an active infection in your tooth’s root, your dentist may want you to go home for a few days while the inside of your tooth heals. In this case, your dentist will put a temporary filling over the hole in your tooth. This protects your tooth from filling with debris and saliva, which may cause further infection.

  8. When your tooth is ready, your dentist fills your root canals with a rubber-like material. Your dentist will cover the rubber material with a type of cement near the top of your tooth. This seals the inside of your tooth and prevents further infection.

  9. Your dentist will make a mold (impression) of your tooth and the surrounding teeth to make a customized crown. A dental crown is a tooth-shaped cap that covers your tooth and restores the strength and function of your tooth.

  10. Your dentist will place your crown using cement that permanently attaches it to your tooth. This may occur at the same visit or at a later appointment. In this case, your dentist will place a temporary crown on your tooth until your permanent crown is ready.

  11. Your dentist will examine and test the crown for proper fit before placing it with permanent cement. This may involve grinding the crown to ensure a proper bite. You may need to return for painless adjustments of the crown to ensure a comfortable bite.

Will I feel pain?

Your comfort and relaxation are important to you and your care team. You may feel brief sharp pinches when your dentist injects your gums with local anesthetic. Ask your dentist if your gums can be partially numbed with a painless topical anesthetic before the injections. 

You may also feel pressure as your dentist performs your root canal and prepares your tooth to receive a crown. Take a few long, deep breaths to help yourself relax. Tell your dentist if any discomfort does not pass quickly.

What are the risks and potential complications of a root canal?  

Any dental procedure involves risks and potential complications. Complications may become serious in some cases. Complications can develop during the procedure or your recovery. Risks and potential complications of a root canal include:

  • Allergic reaction to the materials used in your root canal or crown

  • Anesthetic complications, such as allergic reaction and nerve or blood vessel injury

  • Crack and/or perforation in the tooth root

  • Mouth or tooth injury

  • Possible breakdown of root canal cement/sealer overtime

  • Possible unfilled canal

  • Return of tooth infection requiring retreatment

  • Sensitivity to heat and cold in the affected tooth

Reducing your risk of complications

You can reduce the risk of certain complications by:

  • Ensuring that the tooth is covered until the permanent restoration is placed

  • Following activity, dietary and lifestyle restrictions and recommendations before your root canal procedure and during recovery

  • Informing your dentist if you are nursing or if there is any possibility of pregnancy

  • Notifying your dentist immediately of any concerns after the procedure such as pain, fever, and difficulty chewing

  • Taking your medications exactly as directed

  • Telling all members of your care team if you have any allergies, especially any metal allergies if your dentist is using metal crown material

How do I prepare for my root canal? 

You are an important member of your own  dental care team. The steps you take before your procedure can improve your comfort and outcome. You can prepare for a root canal by:

  • Answering all questions about your medical history and medications. This includes prescriptions, medications, over-the-counter drugs, herbal treatments, and vitamins. It is a good idea to carry a current list of your medical conditions, medications, and allergies at all times.

  • Taking or stopping medications exactly as directed

  • Telling your dentist if there is any possibility of pregnancy