Need a root canal? Here's what to expect

Millions of root canal treatments are performed each year. Because there are some fears and myths surrounding root canal procedures, it can be helpful to know the facts.

What is a root canal treatment?

A root canal treatment — commonly referred to as a "root canal" — is a procedure to clear the tissue from the root canals of your tooth. The procedure is performed by a general dentist or an endodontist.

A spongy material called pulp, which contains the tooth's nerve, blood vessels, and connective tissue, resides inside the roots of your teeth. Pulp can become infected and inflamed for various reasons. If left untreated, your tooth may become extremely painful and the infection may spread into the bones that support your teeth, which is a serious problem.

"The most common reason for a root canal treatment is to clear an infection in the pulp. It's important to remove the infection because if this doesn't happen, the only place for an infection to go is into the bone," Dr. Tien Jiang, assistant professor in oral health policy and epidemiology at the Harvard School of Dental Medicine, points out. "This causes pressure on the bone and ligaments holding your tooth, which is why it's painful."

A common worry is that a root canal is painful. But today's anesthetics and improved techniques have made the procedure much easier to tolerate.

"A root canal treatment shouldn't be any more painful than having a cavity filled or tooth extracted," says Dr. Jiang. "Some dentists will prescribe antibiotics before the procedure to calm the infection, since a very infected tooth is a little harder to numb."

Who needs a root canal treatment, and why?

You may need a root canal if you have an infected tooth. A tooth infection may occur if bacteria enter the tooth's pulp from a deep cavity, an old filling that has failed, or a crack or injury to the tooth. Signs of a problem include:

• pain when you chew or bite down
• gums that are tender, swollen, or dark in color
• small pimples on your gums
• lingering sensitivity to hot or cold foods and drinks, even when the stimulation has been removed.

Sometimes you may not have any symptoms, but an x-ray will show deep decay or an infection at your root or roots.

What happens during a root canal procedure?

Your dentist will give you an anesthetic injection to numb the area. A rubber covering, called a dental dam, will be placed over the area to prevent bacteria from your saliva from entering the space.

The dentist will then make an opening in the tooth and will use small instruments to remove the damaged pulp and clear out the root canals. The now-empty spaces are then filled with a latex material called gutta-percha. Your dentist may recommend a filling or crown to rebuild the tooth.

Contrary to popular belief, the roots of the tooth are kept intact and are not removed during a root canal treatment. This means that even after root canal therapy, your tooth may still be susceptible to decay, periodontal disease, or tooth sensitivity.

Recovering from a root canal

Your mouth probably will feel numb for a couple of hours after a root canal, but most people can return to their regular activities right after a root canal procedure. Dr. Jiang advises not eating until the numbness in your mouth wears off, to avoid biting your cheek or tongue.

After a root canal treatment, Dr. Jiang recommends avoiding hard or sticky foods. To ease any discomfort, she suggests trying soft food like yogurt, eggs, and fish that requires little chewing. After a root canal, you will likely have a temporary filling, so maintaining a soft diet helps preserve your tooth and filling until it can be repaired permanently.

After a root canal, you can brush and floss your teeth as you normally would, unless your dentist tells you otherwise.

Managing pain after a root canal treatment

Because the infection is cleared, you will likely experience pain relief soon after your treatment. However, during recovery you can manage pain by taking acetaminophen (Tylenol) or a nonsteroidal anti-inflammatory drug such as ibuprofen (Advil). If you need more pain relief, Dr. Jiang advises these medications can be more effective if taken together because they work in different ways. Just don't exceed the recommended dosages for each.

If pain persists beyond a few days or gets worse, let your dentist or endodontist know.