Root Canal Treatment: Symptoms, Procedure and How It Can Save Your Tooth
Root Canal Treatment
Severe toothache can be frightening, particularly when you are told that you may need root canal treatment. Patients often worry that the procedure will be painful or wonder whether removing the tooth would be easier.
Root canal treatment is designed to remove infection, relieve pain and preserve your natural tooth. Modern local anaesthetic and careful techniques usually make the procedure feel similar to having a filling, although it normally takes longer.
This blog answers the questions patients commonly ask about root canal treatment, including the warning signs, what happens during the procedure and how long the treated tooth may last.
What Is Root Canal Treatment?
Inside every healthy tooth is a soft tissue called the dental pulp. It contains nerves, blood vessels and connective tissue.
The pulp can become inflamed or infected because of:
- deep tooth decay;
- a crack or fracture;
- a leaking or damaged filling;
- repeated dental treatment on the same tooth;
- an injury to the tooth; or
- an abscess.
Root canal treatment, also called endodontic treatment, removes the inflamed or infected pulp. The dentist then cleans, disinfects, fills and seals the space inside the tooth.
A fully developed tooth can continue to function without its pulp because it remains supported and nourished by the tissues surrounding its root.
Do I Need Root Canal Treatment? Seven Possible Warning Signs
Only a dental examination and, where appropriate, an X-ray can confirm whether you need root canal treatment. However, the following symptoms may indicate that the pulp inside a tooth has been damaged.
- Persistent or Severe Toothache
Pain from an inflamed pulp may occur without warning or become worse when you lie down. It may feel difficult to identify which tooth is causing it because the discomfort can spread towards the jaw, ear or neighbouring teeth.
Pain can sometimes reduce when the nerve inside the tooth dies. This does not necessarily mean that the infection has healed.
- Pain When Biting or Chewing
A tooth that hurts when you bite may have inflammation around its root. This can make the tooth feel tender, raised or different from the teeth around it.
Biting pain can have several causes, including a crack or a problem with the bite, so the tooth needs to be assessed.
- Sensitivity That Continues After the Trigger Has Gone
Brief sensitivity to something cold does not always mean that you need root canal treatment. However, pain that continues after a hot or cold drink has been removed can indicate deeper inflammation inside the tooth.
The duration and intensity of the discomfort help your dentist understand whether the pulp may recover or requires treatment.
- A Swollen or Tender Gum
Swelling close to one tooth can be a sign of infection. It may be small and localised or develop into more noticeable swelling of the gum, face or jaw.
Any unexplained dental swelling should be examined promptly.
- A Small Spot or “Pimple” on the Gum
A recurring spot on the gum may be a draining sinus. This can develop when an infection around a tooth’s root creates a channel through which fluid drains.
It may disappear and return, sometimes leaving an unpleasant taste. Even if it is not painful, the source of the infection still requires treatment.
- A Darkened Tooth
A tooth may become grey or darker after an injury, even when the accident happened years earlier. This colour change can mean that the pulp has been damaged or has died.
Not every dark tooth requires root canal treatment, so the dentist will carry out appropriate tests before recommending it.
- A Deep Cavity, Crack or Broken Tooth
Deep decay, a crack or a significant fracture can allow bacteria to reach the pulp. You may not always experience severe pain, particularly if the nerve has already died.
Early assessment may give the dentist more options for saving the tooth.
Does Root Canal Treatment Hurt?
This is one of the most common concerns we hear from patients.
Before treatment begins, the dentist normally numbs the tooth and surrounding area with local anaesthetic. You may notice pressure, vibration or movement during the procedure, but you should not feel sharp pain.
If the tooth is particularly inflamed, additional anaesthetic techniques may be needed. Tell your dentist immediately if you feel uncomfortable so that treatment can be paused and the anaesthetic adjusted.
The pain people associate with root canal treatment usually comes from the infection that made treatment necessary. Removing the infected tissue aims to relieve that pain.
The tooth and surrounding tissues may feel tender for several days afterwards, especially if there was inflammation around the root. This should gradually settle. Contact your dentist if the pain is severe, is becoming worse or is accompanied by swelling.
What Happens During Root Canal Treatment?
The exact procedure depends on the tooth and the complexity of its roots, but treatment commonly involves the following stages.
Examination and X-rays
Your dentist examines the tooth, asks about your symptoms and may carry out tests involving gentle tapping, biting, cold or heat. Dental X-rays help show the roots and the bone surrounding them.
Local anaesthetic
The area is numbed to keep you comfortable.
Isolation of the tooth
The tooth is isolated to keep it clean and prevent saliva from entering the root canal system during treatment.
Accessing the pulp
The dentist creates a small opening in the tooth to reach the pulp chamber and root canals.
Cleaning and shaping
The infected or inflamed tissue is removed using very fine instruments. The canals are carefully shaped and disinfected.
Filling the canals
Once cleaned, the canals are filled and sealed with a material designed for this purpose. This helps prevent bacteria from re-entering the space.
Restoring the tooth
The access opening is closed with a filling. In some cases, a temporary filling is placed between appointments before the final restoration is completed.
Root canal treatment commonly requires two or more appointments. More complicated cases may be referred to an endodontist, who can use a dental operating microscope for enhanced magnification and precision.
Root Canal Treatment or Tooth Extraction: Which Is Better?
There is no single answer for every tooth. The decision depends on whether the tooth can be predictably treated and restored.
When possible, keeping a natural tooth usually has valuable advantages. It maintains normal chewing, preserves the space in the dental arch and avoids the immediate need to replace a missing tooth.
Root canal treatment may be appropriate when:
- the tooth has enough healthy structure to restore;
- the roots are treatable;
- the supporting gum and bone are reasonably healthy; and
- the tooth has a useful long-term role in your bite.
Extraction may be more appropriate when:
- the tooth has a vertical root fracture;
- decay extends so far below the gum that the tooth cannot be restored;
- there is insufficient healthy tooth structure;
- severe gum disease has left the tooth with poor support; or
- the likely outcome of further treatment is very poor.
Although extraction may initially appear simpler, the resulting gap can affect chewing and allow nearby teeth to move. Replacing the tooth with a bridge, denture or implant may require additional treatment and cost.
Your dentist should explain the likely outcome, treatment stages, alternatives and costs before you decide.
How Long Does a Root Canal-Treated Tooth Last?
A successfully treated and properly restored tooth can remain functional for many years—and sometimes for life.
A systematic review found that approximately 86% to 93% of root canal-treated teeth survived over follow-up periods ranging from two to ten years. “Survival” means that the tooth remained in the mouth; it does not guarantee that every tooth was completely free from symptoms or required no further treatment.
Longevity depends on factors including:
- how much healthy tooth remains;
- the position of the tooth;
- the complexity of its root canals;
- the quality of the root canal treatment;
- how quickly the tooth receives its final restoration;
- the health of the surrounding gum and bone;
- tooth grinding or clenching;
- oral hygiene; and
- regular dental examinations.
A root canal-treated tooth can still develop decay or gum disease, so it needs the same daily care as your other teeth.
Why Might You Need a Crown After Root Canal Treatment?
Root canal treatment does not automatically mean that every tooth needs a crown. However, back teeth often require additional protection because they experience considerable pressure during chewing.
A tooth may already be weakened by:
- a large cavity;
- an extensive filling;
- a crack or fracture;
- loss of tooth structure needed to reach the canals; or
- previous dental work.
A crown covers and protects the remaining tooth, helping distribute biting forces and reduce the risk of fracture. In some cases, an onlay or another bonded restoration may be suitable instead.
Front teeth sometimes need only a bonded filling if enough healthy tooth remains and the biting forces are favourable. Your dentist will recommend the most conservative restoration that can protect the tooth reliably.
Avoid biting hard foods on a root canal-treated tooth until its final restoration has been completed.
Can a Root Canal Infection Return?
Yes. Although root canal treatment has a strong record of success, an infection can occasionally persist or return months or years later.
Possible reasons include:
- very narrow or complex canals that were difficult to clean;
- an additional canal that was not detected;
- leakage around a filling or crown;
- new tooth decay;
- a delayed or damaged final restoration;
- a crack in the tooth or root; or
- bacteria remaining in areas that instruments and disinfectants could not fully reach.
A returning infection may cause pain, tenderness, swelling or a spot on the gum. Sometimes it is discovered on an X-ray before symptoms appear.
Depending on the cause, the tooth may be treated again through root canal retreatment. Other options can include endodontic surgery or extraction. A dentist or endodontist will assess whether the tooth can reasonably be saved.
Tooth Abscess: Can Root Canal Treatment Save the Tooth?
A dental abscess is a collection of pus caused by infection. When the infection begins inside a restorable tooth, root canal treatment may remove the source and allow the surrounding tissues to heal.
Treatment may involve:
- draining the abscess where necessary;
- removing the infected pulp;
- cleaning and disinfecting the root canals;
- sealing the canals; and
- restoring and protecting the tooth.
Antibiotics may sometimes be prescribed when infection is spreading or there are signs of wider illness. However, antibiotics alone do not remove infected tissue from inside the tooth and are not a permanent substitute for dental treatment.
Request an urgent dental appointment if you have facial or jaw swelling, intense toothache, a bad taste, difficulty opening your mouth or a high temperature.
Call 999 or attend A&E if swelling makes it difficult to breathe, swallow or speak, affects your eye or eyesight, or becomes extensive inside your mouth.
Looking After a Root Canal-Treated Tooth
To give the tooth the best chance of lasting:
- complete the full course of treatment;
- arrange the recommended final filling, onlay or crown;
- brush twice daily with fluoride toothpaste;
- clean between your teeth every day;
- avoid biting hard objects such as pens or ice;
- wear a protective night guard if advised because you grind your teeth; and
- attend regular dental examinations.
Root Canal Treatment in Guildford
At Surrey Dental Practice, root canal treatment is provided by Dr Nadia Tawfiq.
Dr Nadia holds an MSc in Endodontics alongside her BDS and MJDFRCS (Eng.) qualifications. Her additional training and experience allow her to assess and treat both routine and more complicated root canal cases. Where appropriate, treatment can be carried out using a dental operating microscope, providing enhanced magnification and precision when locating, cleaning and filling the fine canals inside a tooth.
Dr Nadia’s aim is to control infection, relieve discomfort and preserve your natural tooth whenever this offers a predictable outcome. She will explain the diagnosis, treatment stages and available alternatives before treatment begins.
If you have persistent toothache, pain when biting, swelling or a suspected dental abscess, contact Surrey Dental Practice in Guildford on 01483 506 277 to arrange an assessment with your dentist and Dr Nadia for further assessment.
Surrey Dental Practice in Guildford, we can assess your symptoms, examine the tooth and explain whether root canal treatment, another restorative option or extraction offers the most appropriate outcome.
This article provides general information and cannot replace an individual dental diagnosis.
Research and Further Information
Book your appointment now
Schedule your implant consultation today!
Located in the heart of Guilford
Surrey Dental Practice
127 Worplesdon Road GU2 9XA