Root canal treatment has a reputation as the worst procedure in dentistry, and it is a reputation from a bygone era. It dates from a time when dentists worked without anaesthesia or magnification, and preparations that killed the pulp were placed in the canals.
Today the procedure looks different: pain is what brings a patient to the chair, not what they find there. This article describes the procedure step by step and how long it takes. It then covers the realistic level of discomfort afterwards and what determines how long the tooth will last in the years that follow.
What does root canal treatment involve?
Endodontics, or root canal treatment, saves a tooth from extraction. The dentist removes the affected tissue and the dead pulp from the pulp chamber and root canals. The canals are then cleaned, disinfected and tightly sealed along their entire length.
Treatment that preserves the tooth is preferred to extraction, because your own root maintains the bone and does not force you to fill a gap later. Keeping the tooth in the arch remains the simplest biological solution, as long as the tooth can still be restored.
Prosthetic preparation can also be an indication. If a root is to serve as a support for a prosthetic crown, it is sometimes treated endodontically before the final restoration is made.
The dental pulp and why it is removed
The dental pulp is living tissue that fills the pulp chamber and canals, with a rich supply of blood vessels and nerves. It nourishes the hard tissues from the inside and is responsible for sensation, including the response to temperature.
Removing the pulp becomes necessary when it is irreversibly inflamed or has died. The most common cause is deep decay, but injury or a cracked tooth can also lead to this. An infected pulp can cause severe pain, and if left untreated it leads to changes at the tip of the root. How severe the inflammation of the pulp is determines whether it can still be kept alive.
In this situation, not having root canal treatment leads to losing the tooth, and tooth extraction means the gap will have to be filled later. The infection can lead to abscesses, and leaving it untreated sometimes results in health problems more serious than the tooth itself.
Indications: when root canal treatment is necessary
The decision is made by the dentist after an examination and an assessment of the X-ray. There is, however, a set of symptoms that point a tooth in this direction.
Symptoms of pulp inflammation
Inflammation of the dental pulp gives fairly characteristic signals, although not always all at once.
- severe, spontaneous, throbbing pain, often worse at night,
- prolonged sensitivity to cold and heat that persists after the stimulus is removed,
- pain when biting and when the tooth is touched,
- the crown turning darker, grey or bluish,
- swelling of the gum or a draining sinus (a pus-filled channel) near the root.
The main symptoms that call for root canal treatment are sharp pain, sensitivity and swelling of the gum. The sooner a patient comes in with this set of symptoms, the simpler the procedure tends to be.
Contraindications: when a tooth cannot be saved
In most cases the tooth can be saved, but not always. Some situations mean it has to be extracted straight away.
- a vertical root fracture,
- a crown so damaged that a tight seal cannot be achieved,
- advanced gum disease with significant tooth mobility,
- no technical way of accessing the canals, for example when they are severely calcified.
Whether to carry out root canal treatment is decided by the dentist after analysing the X-ray image. In doubtful cases, a CT scan helps by showing the course of the canals in three dimensions.
What does root canal treatment involve, step by step?
The order of the stages is fixed, and each one is a prerequisite for the next. Below are the three main parts of the procedure.
Stage 1: diagnostics, anaesthesia and a rubber dam
Diagnostics include taking your medical history and an X-ray or CT scan. We use a NewTom Giano HR CT scanner, which lets us assess the anatomy of the roots and the condition of the surrounding tissues before the tooth is opened.
The first step of the procedure itself is giving the anaesthetic. Local anaesthetic numbs the tooth and the tissues around it, so the patient feels no pain during the procedure.
The tooth is then isolated with a rubber sheet, called a rubber dam, to protect it from bacteria in saliva. The rubber dam also stops the patient from swallowing instruments and keeps the treatment area dry, which is essential for a tight seal.
Stage 2: cleaning and shaping the canals under a microscope
After opening the pulp chamber, the dentist locates the openings of all the canals. This moment decides the success of the whole treatment, because a missed canal remains a home for bacteria.
The canals are prepared with fine rotary instruments. The dentist removes the infected pulp and shapes the canal so that it can be tightly filled. The canals are widened and cleaned with fine instruments and rinsed with disinfecting solutions, and ultrasound makes the rinsing more effective. The length of each canal is measured with an apex locator.
Modern root canal treatment combines working under a microscope with rotary instruments, and this combination has changed how effective the procedure is. We work at high magnification with a ZEISS Extaro 300 microscope.
Stage 3: filling the root canals and restoring the tooth
After drying, the root canals are filled with gutta-percha, a material of natural origin. When heated, gutta-percha becomes pliable, so when introduced under pressure it also fills the side branches of the whole canal system. Thermoplastic canal filling improves the seal.
The last stage of root canal treatment is restoring the crown. Finally, the tooth is rebuilt with composite material or a prosthetic crown, depending on how much tissue remains. When treatment takes several stages, the first visit ends with a temporary filling.
Length of treatment: how many visits and how many minutes?
The whole process usually takes one to three visits. The number of visits depends on the condition of the tooth and the number of canals, and difficult cases may need several visits or a temporary medication. In extreme situations, two to five visits may be needed.
When is treatment completed in a single visit?
For a single tooth, treatment can be completed in one visit if there is no acute inflammation or discharge. Primary treatment of a tooth with a living pulp most often follows this pattern.
With severe inflammation, treatment is rarely completed in one visit. Pus draining from the canals means they first have to be settled down. A dressing with an antiseptic medication then has to be placed for anywhere from a few days to around two weeks.
How long does it take to clean one canal?
Cleaning one canal takes 30 to 60 minutes, including mechanical preparation and rinsing. The length of treatment therefore depends directly on the number of canals in the tooth.
One visit lasts 60 to 120 minutes. Root canal treatment under a microscope shortens the procedure, because the dentist can see the canal openings straight away. A dental microscope increases the precision of root canal treatment, and modern techniques save time thanks to rotary instruments.
How long does root canal treatment take on a front tooth, and how long on a first molar?
Root canal treatment on a central incisor is the quickest, because the tooth has one canal that is usually straight, so it more often fits into a single visit. The same applies to canines.
Root canal treatment on a first molar is different, because molars have three, four or sometimes more curved canals. Treating a first molar therefore takes correspondingly longer, and more visits may be needed. The more branched a tooth's canal system, the longer its root canal treatment takes. Front teeth and molars differ here not in the procedure, but in the amount of work.
What does the cost of root canal treatment depend on?
The price depends mainly on the number of canals. Treating a single-canal tooth costs 1500 PLN and a multi-canal tooth 2000 PLN, and both prices include working with a rubber dam and under a microscope.
- the type of treatment: re-treatment is more expensive than primary treatment and costs 2000 PLN or 3000 PLN,
- how advanced the infection is and how many visits are needed,
- the anatomy of the canals, because curved and calcified canals take more time,
- additional procedures, for example removing a broken instrument for 1000 PLN,
- the final restoration, which is priced separately.
A tooth's internal structure cannot be predicted without an X-ray, so we give a quote after diagnostics. One sign of an experienced endodontist is that they talk about costs before the procedure, not after it.
Does root canal treatment hurt?
The procedure is carried out under local anaesthetic, so during treatment the patient feels touch and vibration, but not pain. In a tooth with dead pulp, the canal itself no longer has any sensation, and the anaesthetic then numbs the tissues around the root.
The pain that brings a tooth to root canal treatment is usually much stronger than anything that appears after the procedure. Root canal treatment is not the source of pain but the solution to it.
Pain after the procedure: what is normal
Tenderness when biting and a feeling that the tooth is being pushed out for a few days are the response of the tissues around the root tip to the canal preparation. Discomfort usually peaks in the first 24 hours and eases with each passing day.
Over-the-counter painkillers bring relief, especially non-steroidal anti-inflammatory drugs, which also act on the inflammation. It is worth agreeing the dosage with your doctor, particularly if you have a chronic condition or take regular medication.
Warning signs
Some symptoms mean you should contact us without waiting for your scheduled check-up.
- pain that gets worse from day to day instead of easing,
- severe throbbing pain that painkillers do not control,
- swelling of the cheek, lip or gum,
- fever and generally feeling unwell,
- a draining sinus on the gum,
- difficulty opening your mouth or swallowing.
Pain on pressure that lasts longer than a week can also be caused by a filling that is too high and overloads the tooth. This is easy to put right at a check-up, but you need to let us know.
The tooth after root canal treatment: restoration and durability
A tooth after root canal treatment is non-vital and needs to be restored. It loses the moisture previously supplied by the pulp and a large part of its tissue from the inside, which makes it more brittle.
How long it lasts depends on three things: the quality of the treatment itself, how well the restoration seals the tooth, and hygiene. Each of them directly affects whether the tooth survives for years, and neglecting any one of them undoes the other two.
Post, crown or endocrown?
Front teeth carry smaller forces, so a composite filling is often enough there. Molars and premolars need stronger protection, because they are the teeth that crack most often.
In these situations we use a restoration on a glass-fibre post, an all-ceramic crown or an endocrown, which combines the features of a post and a crown. A tightly sealed restoration protects the tooth from bacteria from the mouth getting back in, and for back teeth it also protects against fracture.
Does a tooth change colour after treatment?
Yes, over time it may take on a grey or bluish tint, caused by pigments penetrating the hard tissues. In some cases the change only becomes noticeable after years.
The aesthetic solution is a restoration: a composite or porcelain veneer that masks the discolouration, or a prosthetic crown, which also strengthens the structure of the tooth.
Root canal retreatment
A tooth can be treated again: root canal treatment can be repeated if the first attempt did not work or if the infection has returned after some years. This is root canal re-treatment. The procedure involves removing the old filling from the canals, cleaning them again and sealing them tightly.
Root canal re-treatment is more difficult than primary treatment. Along the way there may be broken instruments, hard cements and perforations in the root walls, which is why we carry it out only under a microscope. Successful treatment is then sometimes the last chance to save the tooth.
Diet and care after the procedure
You need to wait to eat until the anaesthetic wears off, usually two to four hours. The aim is to avoid biting your cheek or lip, which happens easily when you have no feeling.
- the first few days: soups, yoghurts, smoothies, cooked vegetables and other soft foods,
- to avoid: nuts, hard sweets, raw carrots and chewy sweets,
- chewing on the other side until the tenderness goes,
- no very hot drinks in the first few hours,
- brushing and flossing around the treated tooth every day.
Regular oral hygiene and check-ups every six months protect the treated tooth from secondary decay at the edge of the restoration. The patient's comfort in the first few days depends mainly on not putting load on the tooth, and its long-term durability on daily habits.
What really determines success?
The whole process comes down to one thing: remove the infection, seal the canals tightly and restore the crown with a tight seal. Healthy neighbouring teeth matter too, because untreated decay next door will sooner or later reach the restoration.
The biggest difference is made by when you come in. A tooth with a living but irritated pulp can sometimes still be saved with vital pulp therapy, while the same tooth a few weeks later needs full root canal treatment.
