Most people who dread a root canal are remembering the toothache, not the treatment. An inflamed or infected nerve inside a tooth can throb for days, and the root canal is the procedure that removes that source of pain. With the tooth properly numbed, the appointment usually feels much like a long filling, and any tenderness afterwards tends to fade over a few days.
The pain usually comes before treatment, not during it
A tooth needs root canal treatment when the pulp, the soft tissue in the centre of the tooth, becomes inflamed or infected. That is what causes a lingering ache, sharp reactions to hot and cold drinks, or pain when you bite down. By the time many people book in, they have been uncomfortable for a while, and that memory attaches itself to the treatment.
The research reflects this pattern. A systematic review by Pak and White in the Journal of Endodontics (2011) pooled studies of pain around root canal treatment. On average, about 81% of patients had pain before treatment. That fell to about 40% one day after treatment and about 11% a week later, and the severity of pain dropped to minimal levels over the same week.
What you are likely to feel in the chair
The tooth is numbed with local anaesthetic, the same type used for fillings. You may notice a brief sting as it goes in. After that, most people describe pressure and vibration rather than pain. A thin rubber sheet, called a dam, sits around the tooth to keep it clean and dry while the canals are cleaned and shaped.
A very inflamed tooth can be harder to numb than a healthy one. The same review found that extra anaesthetic was often needed during treatment, so tell your dentist straight away if you feel anything sharp. Topping up the anaesthetic is routine and nothing to apologise for. If you are anxious about dental work in general, ask us about sedation options, including happy gas (nitrous oxide).
Tenderness afterwards is common and usually short lived
When the anaesthetic wears off, the tooth and the gum around it may feel bruised, especially when you bite. The tissues at the tip of the root were already irritated by the infection, and treatment can inflame them a little more for a short time. For most people this is mild and improves day by day.
A few things help while it settles:
- Use over the counter pain relief, such as paracetamol or ibuprofen, if they are suitable for you and as the packet directs.
- Chew on the other side until the tooth feels comfortable.
- Avoid hard or very chewy food on the treated tooth, particularly if it only has a temporary filling.
Our article on root canal recovery goes through the first days and weeks in more detail.
Signs that need a call rather than a wait
Some soreness is expected. Contact your dentist promptly if the pain is getting worse after about three days instead of better, if your face or gum swells, if you develop a fever, or if the tooth feels high when you bite together. These can point to infection that has not settled or a filling that needs adjusting. If the tooth is keeping you up at night while you wait for an appointment, our guide to toothache at night has some practical suggestions.
Most treated teeth are still there years later
A systematic review by Ng and colleagues in the International Endodontic Journal (2010) found that between 86% and 93% of teeth were still in place two to ten years after root canal treatment. A crown placed after treatment was the factor most strongly linked with a tooth lasting longer. That is one reason your dentist may recommend one, which we explain in does a root canal tooth always need a crown.
Keeping the tooth is often the better choice, but not in every case. A tooth with a deep crack or very little sound structure left may be better removed. Our comparison of root canal versus extraction sets out how that decision is made, and our root canal treatment guide explains each stage of the procedure.
Common questions
Is it more painful than a filling?
For most people it feels similar, because the tooth is numbed in the same way. The appointment is longer, and you may need more than one visit, but longer does not have to mean more uncomfortable.
Can I go back to work the same day?
Usually, yes. Most people return to normal activities the same day or the next. The main thing to avoid is chewing on the treated side until it settles.
Will I need antibiotics?
Not usually. Cleaning out the infected tissue is what treats the problem. Antibiotics are kept for particular situations, such as swelling that is spreading or a fever.
If worry about pain is holding you back
Putting off a sore tooth often lets the problem grow, and a clear explanation of what treatment involves can make the decision easier. You can book with a general dentist at Lumi Dental in Melrose Park to have the tooth assessed, or see current new patient offers on our current deals page.
This article is general information and is not a substitute for personal dental advice. For advice about your own teeth, please see a dentist.
