Root Canal

If a tooth’s pulp, which contains nerves and blood vessels, becomes infected or damaged because of decay or injury, root canal treatment is often the only way to save your tooth and repair the damage. Endodontic treatment cleans out the infected pulp chamber and repairs the damage.

How can I have pain after the nerve is dead or removed?
Much of the time pain is due to pressure or irritation of the bone and ligament outside the end of the root of the tooth (deep within the jaw), rather than the nerve itself. This can happen during or after the root canal therapy, even though the tissue has all been removed. Rarely, the canals diverge abruptly, and the tissue in the canals cannot be removed. This can become an irritant. Sometimes the tooth is actually fractured and since the symptoms are often the same as a nerve problem, it may go undetected and continue to cause pain with chewing.

Indications for Endodontics:

  • Spontaneous or throbbing pain during or after chewing
  • Sensitivity to hot and cold foods or liquids
  • Severe decay or an injury (which can lead to an abscess or infection)

Treatment usually takes from one to three appointments, depending on the tooth and circumstances. There may be some pain or discomfort after each appointment, (though minor and rare) which can usually be controlled.

Root canal therapy is simply the removal of diseased or non-viable nerve and blood supply tissue from inside the tooth and roots.

1. An opening is made from the top of the tooth into the pulp chamber.

2. The canal opening(s) is/are identified.

3. The canal(s) is/are shaped with progressively thicker “files” to remove diseased tissue. These files are smaller than a typical needle.

4. X-rays are taken to be sure we have reached the end of the canal (the bottom of the root) with the files.

5. The canals are then shaped to allow access for filling material to seal the end of the tooth (final shaping).

6. The canals are sealed with Gutta Percha (a thermoplastic material) and a cement.

7. The tooth is built up for a crown or the opening is temporarily sealed. A crown will eventually be needed.


  1. Initial root canal therapy may fail (sometimes within several weeks, sometimes after many years) necessitating secondary procedures, which could also fail. Though the procedure is very predictable and the success rate very high, you should be aware that failures do happen for any number of reasons. We are dealing with an individual response to healing procedures, and everyone’s response to treatment is different.
  2. Occasionally a tooth will feel sensitive or sore for an extended period of time after treatment. Sometimes this can be treated. Sometimes the tooth will gradually heal on its own. Sometimes, however, this is a sign of an undetectable fracture within the tooth and the tooth may have to be removed.
  3. Most importantly, a tooth will become more brittle after root canal therapy and must be crowned as soon as possible after healing to prevent fracture and loss of the tooth. You should avoid chewing on that tooth until the crown is placed, if possible.

The American Dental Association has an online video about root canals, click here.