What Actually Happens During a Root Canal

The phrase “root canal” triggers more dental anxiety than perhaps any other procedure, yet most people don’t actually know what happens during this treatment. Pop culture has transformed root canals into horror stories, but the reality is far different from the myth. 

Here’s the problem with that reputation: it’s largely undeserved and based on outdated information. Modern root canal treatment, performed with current techniques and anesthesia, is no more uncomfortable than getting a filling. The pain people associate with root canals is actually the pain from the infected tooth before treatment, not the treatment itself.

Understanding what actually happens during a root canal removes most of the fear. The reality is far less dramatic than the reputation suggests, and the procedure often provides immediate relief from the severe pain that brought you to the dentist in the first place.

Why Root Canals Become Necessary

Your tooth is more than the hard white surface you see. Inside each tooth is soft tissue called pulp, which contains nerves, blood vessels, and connective tissue. During tooth development, this pulp is essential. In a fully mature tooth, it’s less critical because the tooth gets nourishment from surrounding tissues.

When decay penetrates deep enough to reach the pulp, or when a tooth cracks and exposes it, bacteria enter and cause infection. The pulp becomes inflamed and eventually dies. This creates an abscess, which is an infection at the root tip that can spread to surrounding bone.

The pain from an infected or dying pulp can be severe. Sensitivity to hot and cold that lingers, throbbing pain that wakes you at night, pain when chewing, swelling of the gum near the affected tooth. These symptoms indicate the pulp is compromised and needs treatment.

You have two options at this point: extract the tooth or perform a root canal to save it. Root canal treatment removes the infected pulp, cleans and disinfects the interior of the tooth, and seals it to prevent reinfection. The tooth remains functional without its pulp.

Saving your natural tooth is almost always preferable to extraction. Natural teeth maintain bone structure, enable normal chewing force, and don’t require the additional procedures and expenses of replacing extracted teeth with implants or bridges.

The Step-by-Step Treatment Process

The procedure itself is methodical and surprisingly straightforward once you understand what’s happening and why.

1. Numbing the area completely.

Before anything else happens, the dentist ensures you’re thoroughly numb. Local anesthetic is administered around the tooth, usually with multiple injections to ensure complete numbness. You might feel pressure during the procedure, but you shouldn’t feel pain. If you do, more anesthetic gets added. The goal is complete comfort.

2. Isolating the tooth.

A small rubber sheet called a dental dam gets placed over the treatment area, isolating the tooth being worked on. This keeps saliva and bacteria away from the sterile work area and prevents you from accidentally swallowing or inhaling small instruments or irrigation solutions. It feels strange but serves important protective purposes.

3. Accessing the pulp chamber.

The dentist creates an opening through the top of the tooth to access the pulp chamber and root canals inside. This is done with a dental drill, similar to preparing a tooth for a filling. Because you’re numb, you’ll hear and feel vibration but not pain.

4. Removing infected tissue.

Small instruments called files are used to remove the diseased pulp from the pulp chamber and root canals. The canals are narrow passages running from the pulp chamber down through the roots of the tooth. Each tooth has a different number of canals. Front teeth typically have one, premolars have one or two, and molars have three or four. The files come in progressively larger sizes to thoroughly clean and shape each canal.

5. Cleaning and disinfecting.

Throughout the process, the canals are repeatedly irrigated with antibacterial solutions that kill remaining bacteria and wash away debris. This thorough cleaning is critical to the procedure’s success. Bacteria left behind can cause reinfection.

6. Filling the canals.

Once cleaned and dried, the empty canals are filled with a rubber-like material called gutta-percha. This seals the canals and prevents bacteria from re-entering. The access opening in the tooth is then sealed with a temporary or permanent filling.

7. Restoring the tooth.

Most teeth requiring root canals need crowns afterward because they’re weakened by the original decay and the access opening created during treatment. The crown is usually placed a few weeks after the root canal, once the dentist confirms the infection has resolved and the tooth has stabilized.

The entire procedure typically takes 60 to 90 minutes, depending on which tooth is being treated and how many canals it has. Molars take longer than front teeth due to their additional canals and more complex anatomy.

What You’ll Actually Feel

Let’s address the experience honestly. Modern root canal treatment, performed properly with adequate anesthesia, should not be painful during the procedure.

You’ll feel pressure and vibration. The drilling, filing, and irrigation create sensations, but they shouldn’t be painful. Some people find the prolonged time sitting with their mouth open uncomfortable, but that’s different from procedural pain.

You might hear sounds that seem concerning. Dental instruments make various noises that can seem alarming if you don’t know they’re normal. The drill, the suction, the irrigation. None of these sounds indicate pain should be happening.

If you feel actual pain, speak up immediately. More anesthetic can be administered. Sometimes teeth with severe infections are harder to numb completely, but dentists have techniques for managing this. You’re not being tough or brave by enduring pain. You’re just making the experience worse than it needs to be.

After the anesthesia wears off, some tenderness is normal for a few days. The tooth and surrounding tissues have been manipulated, and mild inflammation is expected. Over-the-counter pain relievers usually manage this discomfort adequately. If you experience severe pain after the procedure, contact your dentist because it might indicate a complication needing attention.

Recovery and Aftercare Expectations

Most patients return to normal activities the day after root canal treatment. Some mild soreness is normal, similar to what you might experience after a filling. This discomfort typically responds well to over-the-counter pain relievers and subsides within a few days. The tooth might feel slightly different when biting, but this sensation gradually disappears as surrounding tissues heal.

Avoid chewing on the treated tooth until permanent restoration is complete. Temporary fillings can dislodge if subjected to heavy forces. Continue normal oral hygiene, including gentle brushing and flossing around the treated tooth. Good oral care prevents new infections and protects your investment in saving the tooth.

Follow-up appointments are essential for long-term success. Your dentist will monitor healing through periodic X-rays and clinical examinations. The final restoration, usually a crown, should be placed within a few weeks to protect the treated tooth from fracture. Delaying this protection risks undoing the benefits of root canal treatment.

The Treatment That Saves Teeth

Root canals have a reputation problem that doesn’t match the reality of modern treatment. The procedure relieves pain rather than causing it, saves teeth that would otherwise be lost, and is performed routinely with techniques and anesthesia that make it no more uncomfortable than other dental work.

If your dentist recommends a root canal, it means you have an infection that needs treatment and a tooth worth saving. The alternative is extraction, which creates its own set of complications and expenses related to replacement.

Understanding what actually happens during the procedure removes much of the fear. It’s methodical, predictable, and focused on eliminating infection while preserving your natural tooth. The cultural perception of root canals as nightmarish experiences is outdated mythology that doesn’t reflect current dental practice.

Frequently Asked Questions About Root Canals

How long does recovery take after a root canal?

Most people return to normal activities immediately after the appointment once numbness wears off. Mild tenderness typically resolves within a few days. Take over-the-counter pain relievers as needed, avoid chewing on the treated tooth until it’s permanently restored, and maintain normal oral hygiene. If pain persists beyond a week or worsens instead of improving, contact your dentist.

Why do I need a crown after a root canal?

Teeth requiring root canals are usually weakened by significant decay and the access opening created during treatment. Crowns protect the remaining tooth structure from fracturing during normal chewing forces. Back teeth especially need crowns because they withstand substantial pressure. Skipping the crown risks the tooth breaking, which could make it non-restorable despite the successful root canal.

Can all teeth be saved with root canals or are some too damaged?

Not every tooth can be saved. Extensive decay that has destroyed too much tooth structure, vertical root fractures, severe gum disease affecting the tooth’s support, or anatomy that makes thorough cleaning impossible can make extraction the better option. Your dentist will evaluate whether the tooth is savable before recommending root canal treatment.

Are root canals covered by dental insurance?

Most dental insurance plans cover a portion of root canal treatment, typically 50% to 80% after deductibles. Coverage varies by plan, so verify your specific benefits. Root canal treatment plus crown restoration represents a significant investment, but it’s typically less expensive than extraction followed by implant or bridge replacement, and it preserves your natural tooth.

Can I drive myself home after a root canal?

Yes, unless you’ve received sedation beyond local anesthetic. Standard numbing injections don’t impair your ability to drive. The numbness typically wears off within two to four hours after treatment.

How long do root canal-treated teeth last?

With proper restoration and care, root canal-treated teeth can last a lifetime. Success rates exceed 95% when teeth receive appropriate crowns and patients maintain good oral hygiene. Regular dental checkups help ensure long-term success.

What happens if I don’t get a needed root canal?

Untreated tooth infections don’t resolve spontaneously. The infection will spread, potentially causing facial swelling, bone loss, and systemic health issues. Eventually, extraction becomes the only option, requiring more complex and expensive tooth replacement.