A root canal is a special dental procedure used for a badly decaying or infected tooth.  Common causes of root canals include an untreated cavity, multiple dental procedures on the tooth, a chipped or cracked tooth, a large filling, or trauma to the mouth.

While root canals have a bad reputation, they actually aren’t any more uncomfortable than a regular filling.  So to help better understand what goes on during this procedure, let’s get into the basics.

We’ll first dive into the anatomy of the tooth and how a root canal is so effective against tooth pain and decay.  Then we’ll go step by step through the root canal process, which really isn’t scary at all.

Inside the Tooth

Inside the hard enamel of your tooth lies a nerve surrounded by an area called the pulp.  The pulp is a soft area of connective tissues and blood vessels, and it lies between the nerve and the white part of your tooth (the enamel).   The nerve in the center of the tooth is what allows us to feel pain when we have a cavity, a broken tooth, or sensitivity to food and beverages.

When a root canal becomes necessary, the dentist must go in and remove both the nerve and the surrounding pulp.  He or she then cleans the tooth and re-seals it with a filling, crown, or other restorative method.

Why Remove the Pulp and Nerve?

The inside of the tooth only functions to send hot, cold, or painful messages to your brain.  The pulp and nerve are actually not fundamentally important the health and vitality of your teeth.  So when they are removed, the tooth can go on functioning normally again.

The reason for removal is to avoid infection and to relieve pain.  Whenever either the nerve or pulp become damaged, bacteria can begin to accumulate in the pulp.  This can lead to painful infections or an abscessed tooth.

So while the nerve is the cause of dental pain, the pulp must also be removed to prevent infection that can spread to other areas of your face and cause pain, root drainage problems, or bone loss in the jaw.

Root Canals, Step by Step

An endodontist is a dentist who specializes in pulp and nerve problems in the teeth, and is often the type of dentist who will perform a root canal (especially more complex ones).  However your regular dentist may perform the procedure depending on the individual case and his or her comfort level with your teeth.

Root canals really aren’t much different than a regular filling.  Here is what to expect each step of the way.

  • An x-ray. Your dentist or endodontist will check for infection in your bones and the size and shape of your tooth’s root canal.
  • Numbing and preparation. The endodontist will numb your mouth, place a dam around the tooth to keep it dry, and drill into the tooth to create a hole.  This is very much like the procedure for a regular filling.
  • Pulp and nerve removal. The endodontist will remove the pulp and nerve from the tooth, and in the process remove any bacteria that may have been inhabiting the tooth.  At this point, your tooth can no longer cause you any pain.
  • The endodontist will clean out the tooth using files of various sizes, gently scraping and cleaning the inside walls of the tooth.  Sometimes the tooth is flushed with water or sodium hypochlorite to help clean it out.  The goal is to make sure any bacteria and leftover tissue are removed to clear up and avoid infections.
  • The tooth needs to be sealed once it is cleaned, however the timeframe will vary.  On many occasions your endodontist will treat your tooth with medication and then wait a week or so before sealing the tooth, allowing time for any infection to clear up.  In this case, a temporary filling or crown is placed on the tooth to keep it clean until the permanent filling is in place.
  • Tooth restoration. If the decay or damage was extensive on the tooth, a crown or other type of restoration may be necessary instead of a filling.  These types of treatments will help restore the function to your tooth and prevent it from breaking.  Only your endodontist can determine the additional steps needed to fully restore your tooth to a usable condition.

In cases of mild discomfort after the procedure, you can take ibuprofen (Advil, Motrin) or naproxen (Aleve) to help relieve the natural tissue inflammation that may be left over from the infection or the treatment itself.  But most people will return to normal the next day.

Scary?  Not really!

The not-so-scary truth is that root canals actually relieve pain rather than cause it, so you have nothing to fear if your dentist orders one.  Just be sure to talk to your dentist if you have symptoms like a severe toothache with chewing or pressure, prolonged tooth sensitivity, swelling and tenderness in the gums, or a discolored tooth.  These are all signs that you may need a root canal.

But also remember that sometimes no symptoms are present at all.  So make regular cleanings a part of your life to catch problems before they become painful and require a root canal as treatment.

Written by: Dr. Yahya Mansour