What actually happens during a root canal

Nearly everyone who books a root canal has heard a story about one. The story is usually second hand, usually from somebody who had the treatment fifteen years ago, and usually worse than what actually happens. Here is the appointment, start to finish.

Why the tooth needs it at all

Inside every tooth there is a chamber holding nerve and blood vessels. When decay or a crack lets bacteria reach that chamber, the tissue inside becomes infected. It does not heal on its own. The pain either builds until the nerve dies, or fades and comes back later as swelling. A root canal clears out the infected tissue and seals the space so bacteria cannot return.

Before anything starts

An X-ray comes first. It shows how many canals the tooth has, how they curve, and whether infection has already reached the bone at the tip of the root. Molars often have three or four canals, and one of them is frequently narrow enough to be missed without magnification. That missed canal is the single most common reason a root canal fails and has to be redone.

The anaesthetic

The tooth is numbed and then tested. Nothing starts until you confirm you cannot feel it. If the tooth is badly inflamed the first dose sometimes does not take fully, which is normal and is dealt with by adding more or changing the technique. Say something the moment you feel anything sharp.

Cleaning and shaping

A small opening is made in the top of the tooth. The infected tissue is removed with fine files, and the canals are irrigated to wash out debris and bacteria. This is the part that takes the longest and it is also the part you feel least, because the nerve causing the pain is being taken out. Most people find it dull rather than distressing.

Sealing

Once the canals are clean, dry and shaped, they are filled with a rubbery material and sealed. In straightforward cases this happens in the same sitting. Where there is active swelling, a medicine is left inside and you come back in a week to finish.

The crown, which is not optional

A root treated back tooth has lost its blood supply and become brittle. Left without a crown it usually splits within a couple of years, and a split root cannot be saved. Budget for the crown at the same time as the root canal, not as a separate thing to think about later.

The days after

Expect the tooth to feel bruised for two or three days. That is the ligament around the root, not the nerve, which is gone. Chew on the other side until the crown is on. Ring us if the tooth feels taller than its neighbours, if swelling appears, or if pain is getting worse rather than better after day three.