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Root canal treatment is an often straightforward procedure to relieve dental pain and save your teeth. Patients typically need a root canal when there is inflammation or infection in the roots of a tooth. During root canal treatment, an endodontist who specializes in such treatment carefully removes the pulp inside the tooth, cleans, disinfects and shapes the root canals, and places a filling to seal the space.

“Root canal” is the term used to describe the natural cavity within the center of the tooth. The pulp or pulp chamber is the soft area within the root canal. The tooth’s nerve lies within the root canal.

Why Does Tooth Pulp Need to Be Removed?

When a tooth’s nerve tissue or pulp is damaged, it breaks down and bacteria begin to multiply within the pulp chamber. The bacteria and other decayed debris can cause an infection or abscessed tooth. An abscess is a pus-filled pocket that forms at the end of the roots of the tooth. An abscess occurs when the infection spreads all the way past the ends of the roots of the tooth. In addition to an abscess, an infection in the root canal of a tooth can cause:

  • Swelling that may spread to other areas of the face, neck, or head
  • Bone loss around the tip of the root
  • Drainage problems extending outward from the root. A hole can occur through the side of the tooth with drainage into the gums or through the cheek with drainage into the skin.

Generally speaking, whatever the cause of root canal or pulpal disease, root canal or endodontic treatment will be necessary to save the tooth. All dentists receive training in endodontic treatment and can perform root canal procedures, but often a general dentist will refer individuals who need endodontic treatment to an endodontist, a root canal specialist.

Endodontists are dentists who have completed an additional two or more years of advanced residency training in the diagnosis and management of diseases and disorders of the dental pulp, and in the diagnosis of dental pain; their focus is therefore on saving teeth. In order to make a proper assessment and accurate diagnosis of which tooth is affected and exactly what is causing the pain, a thorough history and examination is necessary, together with a radiographic picture (x-ray) of the tooth or area.

Your dentist or endodontist will check your medical history and current medications to ensure your health and treatment safety. If you are very nervous, an oral sedative or anti-anxiety medication may be helpful — discuss the options with your dentist or endodontist ahead of time.

Endodontic (Root Canal) Treatment, Step By Step

Preliminary treatment to remove the decay and the source of infection of the pulp is necessary, along with a determination of whether the lost tooth structure can be restored. If a fracture of the tooth has reached the pulp, or infection is associated with gum disease, it could be more difficult, if not impossible, to save the tooth.

The general sequence of a root canal procedure is as follows:

Step 1

Local anesthesia is administered via injections to numb the tooth to be treated and the surrounding tissues. If the pulp in a tooth is acutely inflamed, and therefore very painful, it may take a while to get it numb, but your dentist will not start the treatment until it is.

Step 2

Dental dam.
Dental dam in place, used to isolate infected tooth from the rest of mouth to facilitate root canal treatment.

A dental dam — a thin sheet of rubber or vinyl — will be placed over the affected and adjacent teeth. The tooth undergoing treatment protrudes through a hole punched in the dam, isolating it from the rest of the mouth. This allows the root canal treatment to be carried out in a sterile environment free from contamination by bacteria found in saliva or the rest of the mouth.

Step 3

A small access hole is drilled through the biting surface of an affected back tooth or from behind a front tooth, allowing access to the pulp chamber and root canals for treatment.

Step 4

The diseased and dead pulp tissue is removed from the tooth with specially designed instruments used to clean out the root canals and pulp chamber. This is not painful; the area is numb and the tissue being removed is either dead or dying. Once the pulp, along with the nerves contained in it, is removed, the tooth itself can no longer feel pain.

Step 5

The canals are disinfected with antiseptic and antibacterial solutions.

Step 6

The canals are then shaped with tiny flexible instruments to allow them to receive root canal fillings and sealers. The canals are washed and cleaned again to remove root canal debris prior to sealing them.

Step 7

Root canal fillings are selected that will exactly fit into the freshly prepared canals. Usually a rubber-like material called gutta-percha is used to fill the canal space. It is a thermoplastic material (“thermo” – heat; “plastic” – to shape), which literally is heated and then compressed into and against the walls of the root canals to seal them. Together with adhesive cement called a sealer, the gutta-percha fills the prepared canal space. Sealing the canals is critically important to prevent them from becoming reinfected with bacteria.

Step 8

A temporary or permanent filling material will then be placed to seal the access hole that was made to treat the canals, and the dental dam is removed. If the tooth lacks sufficient structure to hold a restoration (filling) in place, the dentist or endodontist may place a post (either metal or a very strong plastic) in one of the canals inside the tooth to help retain it.

Step 9

After root canal treatment.
Root canal filling material (gutta percha) is placed in the canals and the tooth is sealed with a temporary filling to protect it from contamination. Then a crown is usually placed over the tooth to seal and protect it from recontamination and future damage.

After the procedure, an antibiotic may be prescribed to treat or prevent infection. Be sure to follow the instructions of your dentist or endodontist carefully. After-effects of treatment are minimal, generally lasting from a couple of days to about a week. It is normal to have some minor discomfort after treatment including slight soreness that can usually be managed with over-the-counter (aspirin, ibuprofen) medications or prescription (codeine-type) drugs, or a combination of the two.

Step 10

Your tooth will need a permanent restoration — a filling or a crown — to replace lost tooth structure, and provide a complete seal to the top of the tooth. Your endodontist will send you back to your general dentist to determine which type of restoration is best for you. This step is of particular importance since many studies show that if the filled root canals are recontaminated with bacteria from the mouth, there could be a recurrence of infection around the tooth.

Knowledge Is Power

Almost like the root system of a plant, the root canals of a tooth have a main branch and many smaller side branches, and the whole system needs to be sealed during root canal treatment to be successful long term. Since root canals are very small spaces, they require a great deal of precision and care to treat well. Therefore, most endodontists today use state-of-the-art technology including digital (radiographic) imaging to diagnose root canal problems, and after treatment to verify that the canals are properly sealed; ultrasonic instrumentation to remove old canal fillings and posts and clean canals; and operating microscopes to accurately locate, visualize and seal root canal systems; it really is quite high-tech.

I have found that people who are nervous tend to lack information about endodontic (root canal) treatment; knowledge gives them the power to understand what’s to come and to eliminate their fears. I hope that this step-by-step explanation will alleviate any apprehension. Root canal treatment really does relieve pain, not cause it — and saves teeth.