A root canal is a dental treatment used to save a tooth when the soft tissue inside the tooth, called the pulp, becomes inflamed or infected.

During treatment, the infected or damaged tissue is removed from inside the tooth, the canals are cleaned and disinfected, and the space is sealed. The tooth is then restored so it can continue functioning normally.

Common signs that a tooth may need root canal treatment include severe or lingering tooth pain, sensitivity to hot or cold, pain when biting, swelling of the gums, a pimple-like bump near the tooth, or darkening of the tooth.

Some infected teeth cause very little pain, so dental X-rays and an examination are often needed to determine whether the nerve inside the tooth has been damaged.

Modern root canal treatment is typically performed with local anesthesia, so patients should not feel pain during the procedure.

It is normal to experience some tenderness or soreness for a few days afterward, especially if the tooth was already infected or painful before treatment. Most post-treatment discomfort can be managed with the medications and instructions recommended by your dentist.

The length of a root canal appointment depends on the tooth being treated and the complexity of its root canals.

Many root canals can be completed in approximately 60 to 90 minutes, although some cases may require more than one appointment.

Molars typically have more canals than front teeth and may take longer to treat.

The cost of root canal treatment varies depending on which tooth is being treated, the complexity of the root canal system, whether additional procedures are needed, and the patient’s dental insurance coverage.

Front teeth generally have fewer canals, while molars usually have several canals and can require more complex treatment.

A dental examination and X-rays are typically needed before an accurate treatment estimate can be provided.

Antibiotics may help control swelling or the spread of a dental infection, but they usually cannot eliminate an infection located inside the root canal system of a tooth.

If the pulp inside the tooth is infected or has died, the source of the infection generally needs to be treated with root canal therapy or the tooth may need to be extracted.

Antibiotics are sometimes prescribed in addition to dental treatment when there are signs that the infection has spread beyond the tooth.

An untreated infected tooth can continue to worsen. The infection may spread into the surrounding bone and tissues and can lead to increasing pain, swelling, an abscess, or loss of the tooth.

In some cases, the pain may temporarily decrease if the nerve dies, but the infection can still remain present.

Treating the tooth earlier may provide a better chance of saving it.

When a tooth can be predictably restored, saving the natural tooth with root canal treatment is often preferred.

Removing a tooth can create additional problems, including shifting of nearby teeth, changes in the bite, and bone loss in the area. Replacing the missing tooth may later require a dental implant, bridge, or removable prosthesis.

However, extraction may be recommended when a tooth has a severe fracture, extensive decay, insufficient remaining tooth structure, or a poor long-term prognosis.

Your dentist can explain the advantages and disadvantages of each option based on the condition of the tooth.

Many teeth require a crown after root canal treatment, particularly molars and premolars.

Teeth that need root canal treatment often already have large fillings, decay, fractures, or significant loss of tooth structure. A crown can help protect the tooth from breaking under normal chewing forces.

Some front teeth may not require a crown if enough healthy tooth structure remains, but this depends on the individual case.

A successfully treated and properly restored tooth can remain functional for many years and, in some cases, for the rest of a patient’s life.

Long-term success depends on factors such as the amount of healthy tooth structure remaining, the quality of the root canal treatment and final restoration, oral hygiene, bite forces, and regular dental care.

A crown or other final restoration should be completed when recommended to help protect the tooth.

Although root canal treatment has a high success rate, a treated tooth can sometimes develop another infection.

This can happen because of complex root anatomy, a missed canal, new decay, leakage around the restoration, a fracture, or contamination of the tooth.

Depending on the situation, the tooth may be treated again with root canal retreatment, evaluated for endodontic surgery, or removed if it cannot be predictably saved.

After a root canal, the tooth and surrounding tissues may feel tender for several days.

Patients should avoid chewing hard foods on the treated tooth until the permanent restoration has been completed, particularly if the tooth has a temporary filling.

You should contact your dentist if you develop significant swelling, severe pain that is getting worse, fever, or other unusual symptoms after treatment.