Root canal treatment (endodontics)

Root canal treatment has a reputation it no longer deserves. The pain people associate with it is the pain of the infection — the treatment is what relieves it, and it is carried out under local anaesthetic in much the same way as a filling.

The purpose is straightforward: to save a tooth that would otherwise have to come out.

What is actually happening inside the tooth

Under the enamel and dentine, each tooth has a hollow space containing the pulp — the nerve and blood supply. If bacteria reach it, the pulp becomes inflamed and then dies. Because it is sealed inside a rigid tooth, the pressure has nowhere to go, which is why the pain can be severe and why it does not settle on its own.

The pulp can be lost through:

• Deep decay reaching the nerve
• A crack or fracture, sometimes years after the event
• Trauma — a knock that kills the nerve without breaking the tooth
• Repeated treatment on the same tooth over many years
• Severe gum disease reaching the root tip

Once the pulp is irreversibly damaged, there are two options: remove the pulp and keep the tooth, or remove the tooth. It does not heal by itself, and it does not get better with time.

Symptoms

• Severe, spontaneous pain, often worse at night or when lying down
• Pain that lingers long after something hot or cold is removed
• Pain relieved by cold and provoked by heat — a fairly specific sign
• Tenderness when biting on that tooth
• A darkening or greying tooth
• A gum boil, or a bad taste from a discharging spot on the gum
• Facial swelling

Sometimes there are no symptoms at all, and a dying nerve is found on a routine radiograph. That is not a reason to leave it.

Facial swelling that is spreading, difficulty swallowing or breathing, or fever alongside dental pain needs urgent care — hospital emergency department rather than a dental appointment. See our dental emergency page.

A note on antibiotics

Antibiotics do not cure an infected tooth. There is no blood supply left inside the canal for them to reach, so they cannot clear the source. They can settle spreading facial swelling and buy time, which is why they are sometimes prescribed alongside treatment, but the infection returns unless the canal is cleaned or the tooth removed.

If you have been given antibiotics for a dental abscess and the pain settled, the problem has not gone away. Book the treatment.

What the treatment involves

1. Diagnosis. Examination, radiographs and tests to confirm which tooth is involved and whether the pulp can be saved. Getting the right tooth matters — dental pain refers, and patients frequently point to the wrong one.
2. Anaesthetic and isolation. The tooth is numbed and isolated with a rubber dam, which keeps saliva and bacteria out of the canals and stops anything being swallowed.
3. Access and cleaning. A small opening is made and the pulp removed. The canals are shaped with fine instruments and irrigated to disinfect them.
4. Medication and temporary seal. Often an antibacterial dressing is placed and the tooth temporarily sealed while it settles.
5. Filling the canals. At a later visit the canals are filled and sealed permanently.
6. Restoring the tooth. The access opening is restored, and on back teeth a crown is usually recommended.

Most cases take two or more appointments, depending on the tooth and whether infection is present. A front tooth has one canal; a molar commonly has three or four, and treating it takes considerably longer. Expect appointments of around an hour to ninety minutes.

Between appointments

The tooth is sealed with a temporary filling and is usually far more comfortable than before treatment started. Chew on the other side, because a temporarily sealed tooth is weaker than a restored one.

If the temporary filling comes out, call us rather than leaving it — an open canal lets bacteria straight back in and can undo the work. Mild tenderness for a few days is normal; increasing pain or swelling is not, and should be reported.

Why a crown afterwards

A root-treated tooth has had its blood supply removed and usually had substantial structure lost to decay or fracture. It becomes more brittle, and back teeth take heavy chewing loads. A crown covers and splints the remaining tooth so it is far less likely to split.

A tooth that fractures below the gum after successful root treatment usually cannot be saved — which is a poor outcome after the investment of the treatment. This is why we recommend the crown rather than leaving a large filling.

Front teeth with small access cavities can often be restored with a filling instead. Your practitioner will tell you which applies.

Does it work?

Root canal treatment has a high success rate, and most treated teeth go on to function normally for many years.

It is not guaranteed. Canals can be curved, calcified or unusually branched; infection can persist; a tooth can crack. Where a case does not settle, the options are retreatment, a minor surgical procedure at the root tip, or extraction. Your practitioner will tell you honestly if the outlook for a particular tooth is uncertain before you commit.

Retreatment means reopening the tooth, removing the previous filling material, re-cleaning and re-sealing. It is more demanding than the original treatment and is often referred.

Apicoectomy, or root-end surgery, removes the very tip of the root and seals it from the outside. It is used where retreatment is not possible or has not worked, and it is a specialist procedure we refer.

Will it hurt?

The treatment itself is done under local anaesthetic and most patients are comfortable throughout. A very inflamed tooth can be harder to numb, so tell your practitioner if you feel anything — more anaesthetic can be given.

Afterwards the tooth is often tender to bite on for a few days as the surrounding tissues settle. Over-the-counter pain relief taken as directed is usually sufficient. Ibuprofen is not suitable for everyone, including people with asthma, stomach ulcers, kidney problems or on blood thinners; check with your pharmacist.

We would not describe the procedure as painless. We would say that it is the treatment that stops the pain you came in with.

Aftercare

• Avoid chewing on the tooth until the permanent restoration is placed
• Expect tenderness on biting for a few days, easing steadily
• Keep brushing and cleaning between the teeth normally
• Come back if pain increases after the first few days, if swelling appears, or if the temporary filling is lost
• Have the permanent restoration done on schedule. A root-treated tooth left under a temporary filling for months is a tooth at risk

If you do nothing

An untreated infected tooth does not stabilise. The likely course is recurring pain, an abscess, bone loss around the root tip, and eventually losing the tooth anyway — having paid for the emergency visits along the way. Occasionally the infection spreads into the tissues of the face and neck, which is a medical emergency.

Deciding to extract instead is entirely reasonable. Deciding to ignore it is not a third option.

Cost

Fees depend on which tooth is involved and how many canals it has — a single-canal front tooth and a four-canal molar are very different pieces of work. The cost of the final crown is separate. You will be given a written plan with all costs before treatment starts.

We claim on the spot through HICAPS, and Afterpay and Zip are available for staged treatment. Root canal treatment usually falls under major dental, with annual limits and waiting periods; ask for the item numbers and check with your fund. See payment options.

Complex cases — unusual anatomy, retreatment of a previous root canal, or a tooth that has not responded — may be referred to a specialist endodontist. Victorian Dental Group is a general practice and none of our practitioners holds specialist registration.

Root canal, or extraction?

Both are legitimate. Keeping your own tooth preserves the bone around it and avoids the cost and complexity of replacing it later with an implant, bridge or denture. Extraction is quicker and cheaper on the day, and leaves a gap to deal with.

Your practitioner will explain the outlook for your tooth and the cost of each path, and we always recommend seeking a second opinion from another appropriately qualified practitioner if you would like one.

Questions we are asked

How many visits? Usually two, sometimes three, plus a separate visit for the crown.

Can I drive afterwards? Yes. Local anaesthetic does not affect driving, though your lip will be numb for a few hours.

Will the tooth go dark? Modern technique makes this far less common than it was. A front tooth that does darken can usually be lightened internally or veneered.

Is it safe while pregnant? Generally yes, and an untreated infection is the greater risk. Tell us you are pregnant so we can plan timing, shielding and medication appropriately.

Do I really need the crown? On a back tooth, usually yes, and it is the single thing most likely to determine whether the tooth survives long-term.

I have heard root canals cause illness. That claim comes from research from the 1920s that was long ago discredited. It is not supported by current evidence.

Book an assessment

Victorian Dental Group — 291 Wattletree Road, Malvern East VIC 3145

Phone (03) 9088 5808 · Monday to Friday, 8:00am–5:00pm · closed weekends and public holidays

Book online at any hour.

This page is general information and does not replace advice from a registered dental practitioner about your own circumstances. Please see our Disclaimer.