Many people expect a root canal to be the painful part, when the worst pain is usually the infected tooth beforehand. A systematic review (Pak and White, Journal of Endodontics, 2011) found pain was common before treatment, eased substantially within a day of treatment and had dropped to minimal levels within a week. Root canal treatment lets you keep a tooth whose nerve is inflamed or infected, and for back teeth it is usually followed by a crown.
Written by Dr James Tran, dentist at Lumi Dental.
The nerve inside the tooth is what gets treated
Under the hard enamel and dentine, every tooth has a soft core called the pulp, made up of nerves and blood vessels. It runs from a chamber in the crown down through narrow channels in each root, the root canals. Front teeth usually have one canal, while molars usually have three or more.
Deep decay, a crack or repeated work on the same tooth can let bacteria reach the pulp. Once the pulp is badly inflamed or infected, it cannot recover on its own. At that point the usual choices are to clean out the pulp and seal the tooth, which is root canal treatment (endodontic treatment), or to remove the tooth.
Symptoms that can point to a pulp problem
Common warning signs include:
- a deep, persistent ache that may be worse at night or when lying down
- sharp pain when biting on one tooth
- sensitivity to hot or cold that lingers after the drink or food is gone
- a small pimple on the gum near a tooth, which can be a draining infection
- a tooth that has turned darker than its neighbours
- swelling of the gum, face or jaw
None of these is proof on its own. A cracked tooth, a high filling or gum problems can feel similar, and some infected teeth cause no pain at all. Diagnosis needs an examination and X-rays, and sometimes tests of how the tooth responds to cold. Our guides to a tooth that hurts when biting down and tooth pain at night cover other possible causes.
What happens in the chair
Root canal treatment is usually completed in one or two visits, depending on the tooth and whether there is active infection. Before starting, the dentist examines the tooth, reviews X-rays and explains the plan and expected costs.
The tooth is numbed with local anaesthetic, as for a filling. A thin rubber sheet called a dental dam is usually placed around the tooth to keep it dry and free of saliva. The dentist then makes a small opening in the top of the tooth, removes the pulp, cleans and shapes each canal, disinfects it, and fills it with a rubbery material called gutta-percha. The opening is closed with a temporary or permanent filling.
Sometimes a 3D scan is useful for complex root shapes or to look more closely at infection around a root. Lumi Dental has an Orthophos 3D X-ray unit for OPG and 3D scans when they are needed.
Comfort during and after treatment
With the tooth properly numbed, most people find the procedure feels much like having a large filling. Afterwards, tenderness when chewing for a few days is common and usually eased by over-the-counter pain relief. Pain that is severe or getting worse is not expected and should be checked.
If anxiety makes dental visits difficult, sedation can help. IV sedation is available at Lumi, along with happy gas (relative analgesia). Our IV sedation guide explains how it works. If you have IV sedation, you will need a responsible adult to take you home.
Antibiotics are not a substitute for treatment
Many people expect antibiotics for a painful tooth. A 2019 American Dental Association guideline (Lockhart and colleagues, Journal of the American Dental Association) recommended against antibiotics in most cases of tooth pain from the pulp or a localised infection, because benefits are likely negligible and harms can be large. It advised reserving them for people with signs of spreading infection, such as fever or feeling unwell, and prioritising dental treatment.
Keeping the tooth or taking it out
Extraction is cheaper on the day and quicker. A kept tooth, though, keeps your natural chewing surface and avoids the need to replace it. When a back tooth is removed, many people go on to replace it with an implant, bridge or partial denture so the bite stays stable, and those options usually cost more than saving the tooth.
Some teeth cannot be saved, for example when the root is split vertically, too little tooth is left to rebuild, or there is advanced bone loss around the root. Your dentist should show you the X-rays and talk through both paths. Our article on root canal versus extraction goes further.
What root canal treatment typically costs
As a general Australian market range, root canal treatment costs about $1,000 for a front tooth up to about $3,000 for a molar. These are not Lumi fees. Retreatment of a previously root-filled tooth, extra imaging and referral to a registered specialist endodontist for a complex case can all add to the cost. A crown afterwards typically costs $1,500 to $2,500, depending on the material. Our root canal cost guide compares these figures with the cost of extraction and replacement.
Private health funds with dental extras usually cover part of root canal treatment, but rebates vary widely by fund and level of cover. Ask for the item numbers on your quote so your fund can tell you the rebate. At Lumi Dental, health fund rebates are claimed on the spot through HICAPS, so you pay only the gap, and payment plans are available through Afterpay and humm.
Looking after the tooth afterwards
- Avoid eating until the numbness has worn off, to prevent biting your cheek or tongue.
- Choose soft food for the first day and chew on the other side until the final restoration is in.
- Brush and clean between your teeth as usual.
- If antibiotics were prescribed for a specific reason, take them as directed.
- Book the permanent filling or crown within the time your dentist recommends, because a temporary filling is not designed to last.
For back teeth, a crown or onlay that covers the biting cusps is usually recommended. A US study of root-filled teeth (Aquilino and Caplan, Journal of Prosthetic Dentistry, 2002) found that, after allowing for tooth type and decay, teeth that were not crowned were lost at about six times the rate of crowned teeth. Front teeth with a small access opening can often be restored with a bonded filling alone. Our root canal recovery guide covers the first week in more detail.
Questions patients ask
How long does a root-filled tooth last?
A well-treated, well-restored tooth can last many years. How long depends on how much natural tooth remains, the quality of the final restoration and how well the tooth is cared for.
Can I drive home afterwards?
Yes, if you had local anaesthetic only. After IV sedation you will need someone to take you home and stay with you for the rest of the day.
Can a root canal fail?
It can, if bacteria remain in the canals, a crack develops or the final restoration leaks. Retreatment or a small operation at the root tip can often help.
About the author
Dr James Tran is a dentist at Lumi Dental in Melrose Park, Sydney. He writes plainly about dental care so patients can make informed decisions without hype. Read more at drjamestran.com.au.
About Lumi Dental
Lumi Dental is an independent general and cosmetic dental practice at Melrose Central, Melrose Park NSW 2114, with free undercover parking and lift access. We see patients from Melrose Park, Meadowbank, Ryde, Ermington, West Ryde, Denistone and the wider area for general and family dentistry, cosmetic dentistry, clear aligners and braces, dental implants, IV sedation and emergency appointments.
To book an assessment or ask a question, book online or contact the practice.
This article is general information and does not replace individual clinical advice. Fees are typical Australian market ranges, not Lumi fees, and vary by individual case. Any treatment should be based on your own assessment and discussion with a qualified dental practitioner.
