The exterior of our teeth might well be made of the hardest substance in the human body, enamel, but inside each tooth is a complex network of tissues and nerves that are much more delicate. This softer area is called the pulp.
If the enamel becomes damaged bacteria, liquids and food stuffs can come into contact with the delicate inner tooth structure. This can result in infection within the root(s) that are essential to keeping the tooth healthy and in place within the jaw.
Pain and discomfort usually ensues. If this infection is left untreated it can lead to more serious health issues.
Dental professionals can save the tooth, thanks to a treatment called Root Canal Treatment/Therapy (RCT). This treatment may also be referred to as endodontic treatment. Some dentists choose to specialise in treatments of the pulp, and they are called endodontists.
This article explains all you need to know about RCT, covering commonly asked questions such as what is involved, how long will it take, what does it cost and more.
What is root canal treatment?
Root canal treatment/therapy is the name given to a procedure that involves removing decay and infection that exists inside centre and roots of the teeth (the pulp and root canal system).
Often known as a root filling, the tissues inside of the tooth, pulp, is cleaned out and then the tooth filled to preserve it for many years.
Such treatment allows the natural tooth to be kept in place and avoids the need for extraction.
Teeth that have undergone RCT are more fragile and are normally capped with an artificial crown to protect them from the stresses of eating that could damage the tooth further.
Root canal treatment as described by a dentist
To provide further insight we asked Esther Hathorn, founder of Visage Dental Spa, to describe root canal treatment:
Root canal treatment is the removal of the infected nerve tissue of the tooth. The tooth is numbed and the nerve is removed using tiny files. The empty nerve canal is then filled and a filling/crown is placed on top
Esther Hathorn – Visage Dental Spa – GDC Number: 5711
Why would I need root canal treatment ?
A root canal treatment (RCT) is needed to stop the spread of decay from the tooth into the surrounding bone and tissue, but to also save the existing natural tooth.
Teeth can become damaged as a result of trauma, fractures, faulty crowns and fillings, but most common is decay.
Whilst every case is different, if you see a dentist for a regular checkup, the decay can be dealt with, before it makes its way to the sensitive inner tooth structure and an RCT in needed.
Nothing acts or looks as good as a natural tooth, so it is best to keep them if possible.
Initially decay occurs only in the outermost surface of the tooth – the enamel.
If this simple decay is left, it progresses through the tooth, towards the centre of the tooth, where the pulp is. This will cause the nerves in the pulp to react.
The most common symptoms and complaints of those who then need RCT are:
- Sensitivity when eating or drinking, often hot or cold foods
- Pain when biting down
- A loose tooth
- When your tooth has got darker/discoloured
Failing to take note of these warning signs can lead to the spread of the decay and make the situation worse.
Once the infection gets to a certain stage, you will no longer feel the pain or discomfort. This is not a good thing. This means the infection has damaged the nerves within the tooth to such an extent they not longer function correctly.
Failing to treat the spreading infection or a dead nerve may eventually lead to an abscess.
An abscess is an inflamed area in which pus collects and can cause swelling of the tissues around the tooth.
Within a short space of time you can expect:
- Pain when biting or chewing returning
- Swollen gums around the tooth
- Swelling to your face
- Pus draining from the tooth or gum
- Change in colour of the tooth (gets darker)
Going to the dentist might not be fun, but it’s a whole lot less fun to go and have treatment as a result of failing to get regular checkups.
If your tooth is infected it cannot heal itself like a small cut on the surface of your skin can.
Whilst over the counter or shop shelf painkillers such as paracetamol and ibuprofen may ease the discomfort, they are not the solution and should only be used to help manage the pain until such time as you can see a dentist.
Ultimately you need to remove the source of the infection – the tooth decay!
If you think going to the doctor or dentist for antibiotics is the solution, sadly you are wrong.
Antibiotics are not effective in treating root canal infections, because usually there is no longer a blood supply entering the pulp space to reach the bacteria and deliver the antibiotic.
Do I need a root canal treatment?
Ultimately, it will be down to the dentist to make an assessment, present the findings and options open to you, whilst giving their professional opinion on what to do.
Some cases may be borderline whether an RCT is required or not. For example, the infection may be close to the pulp and when it is removed the nerve may be irritated. Sometimes the nerve is able to settle down by itself with time. Sometimes the filling has been left too late, and and RCT is needed.
In many cases where there is infection in the pulp RCT is possible. Sometimes an RCT may not be possible and extraction might be the only option.
During your initial assessment questions will be asked about your symptoms, pain and medical history. The dentist will then look at your teeth and the mouth via a physical examination. X-rays will likely be taken as this can show the extent of any decay and pulp damage.
All of this helps build up a picture of what the problem is and options for treatment.
Dentists wish to preserve your natural teeth. No dentist went into the profession just to pull teeth out.
Extraction is usually a last resort.
RCT is in many respects a last ditch effort to keep the natural tooth in place. Keeping the tooth in place, even if there is no longer any living tissue inside is better than removing it.
However, in some instances, extraction is the only option.
Extraction may be a better option if the infection has passed into the bone surrounding the tooth or the remaining tooth structure is not strong enough to support the root filling or the crown that will be placed over it.
Our guide on tooth extraction goes into much greater detail but what you need to be aware of is that removing a tooth poses new issues.
When a tooth is lost extra pressure is put upon the surrounding teeth. It can affect how you eat and speak, not to mention your confidence with a potential gap in your smile.
If the gap is left, the surrounding teeth can move and change your smile, bite and even cause facial tissue and muscle to sag.
Dentures are often the solution which have their own pros and cons, notably there is an extra cost to get these made.
Nothing is better than your natural tooth, so dentists will always try to save the tooth and opting for root canal treatment is usually best.
The tooth structure
To better understand the procedure and what is involved, it is necessary to look at what exists inside the tooth.
It is not a solid lump of enamel, inside it is a complex network of tissues, nerves and blood vessels.
The image below is a representation of what the internal structure of a tooth looks like.
It is the crown that sits at the top of the tooth and is made of enamel. This enamel is the white top side of the tooth that is exposed to everything in our mouths, and is the hardest structure in the body.
It is the crown that is protected and maintained by daily brushing and flossing.
You then have the neck of the tooth, which runs from the crown, down into the gum.
The remaining part of the tooth, that is normally twice as long as the crown, is the root which anchors the tooth into the jawbone.
Inside each root are the canals. Each root can have 1 or more canals.
There are essentially 3 layers to the tooth – enamel, dentine (or dentin), and the pulp.
On the outside is the hard enamel, followed by something called dentine (a less hard and porous material, that makes up the majority of the tooth), and these both protect the softer pulp chamber that contains the blood vessels and nerves that run through the roots and into the jawbone.
The canals are the chambers inside the tooth that run down to the base of the tooth root and contain the nerves and the associated tissues.
The enamel is broken down by decay also known as dental caries.
Decay is often as a result of poor oral hygiene. The bacteria is not brushed or cleaned away which allows it to stay in place. These bacteria produce acids which break down the enamel.
Only a microscopic amount of the enamel needs to be eroded to put the tooth and the roots, at risk of infection.
Bacteria can very quickly get into the soft dental pulp and spread through to the root(s) of the tooth.
Root canal treatment removes the pulp from the internal tooth structure and involves filling the tooth to give it strength to remain seated in the jaw.
Failure to get treatment at this stage can allow infection to spread to the bone and cause more significant impact on your health, notably the presence of an oral abscess.
How many roots and canals does each tooth have?
The number of roots a tooth has differs.
Normally it will be 1, 2 or 3 although some have 4.
As a general rule, the greater the pressure the tooth has to endure, the more roots it has to keep it in place.
As such, the molars at the back of the both have the most roots.
The images below shows the position and name of teeth, whilst the table lists how many roots each tooth normally has.
|Tooth||Number of Roots|
|Uppers (Top Jaw)|
|Third molar (wisdom teeth)||3|
|Lowers (Bottom Jaw)|
|Third molar (wisdom teeth)||2|
The amount of time taken for treatment obviously depends on which tooth requires root canal treatment. Those with more roots will have more canals and thus need more treatment to properly clean out the infected material.
Endodontist – Root canal specialists
A general dentist is capable of carrying out RCT.
However, the General Dental Council sets out 13 different fields of specialisation within dentistry.
Endodontics is 1 of those specialities.
An endodontist is a dentist who is specially trained in the cause, diagnosis, prevention and treatment of disease and injuries to the tooth root, dental pulp and surrounding tissue. They have undertaken extra training at university.
They are themselves general dentists, but the expertise, clinical skill, equipment and success rates can make them better equipped to deal with your treatment.
Endodontists usually only provide private treatment. However a small number of endodontists work in hospitals, where you may receive treatment from them on the NHS.
As an NHS patient it may not be financially viable to seek out an endodontist, but if you are paying privately, it is certainly worth considering.
In some cases, your normal dentist may refer you.
Cases that a normal dentist may refer you for specialist treatment include: re-treatment of teeth that have already had RCT, teeth with curved or very long roots, adult teeth in children which have not yet finished growing.
The root canal procedure
Every individual patient is different as is the way in which a dentist and their practice works, so the exact steps will vary, but as a guide there a 4 major steps within the root canal treatment process.
Prior to these stages will have been an earlier appointment that diagnosed the need for RCT. In few instances would such treatment be carried out immediately.
They 4 stages are:
- Opening the tooth
- Cleaning the tooth
- Root filling
Depending on the particular case, there is a 5th step that might be necessary to place a crown on the tooth.
In the prior appointment that diagnosed the need for root canal treatment, the dentist will have taken x-rays to determine the extent of the decay and understand the tooth structure. They should too have explained the pros and cons to the treatment, the cost and made you aware of what is involved.
No question is silly. It is important that you feel fully informed before giving your consent for the procedure to go ahead, so do ask any questions you have.
A clean and sterile working environment is paramount, because if anything gets into the tooth during the procedure it can compromise the success rate and may lead to the procedure having to be repeated or the tooth removed.
The dentist will first inject the area around the problem tooth with local anaesthetic. This will numb the area and means that you should not feel any pain. You will be conscious through the treatment as it is carried out in the dentist chair.
What is known as a dental dam (cofferdam) is put place around the tooth. It gives the dentist a safe area to work. This rubber dam prevents chemicals and small instruments going into your mouth, and also prevent bacteria from your saliva getting into the clean tooth.
They can rest easy knowing their tools will not come into contact with any other surface in your mouth, debris from the treatment cannot be swallowed or choked upon.
The dam looks quite dramatic when in place, but the British Endodontic Society believe it contributes to the success of treatment.
Opening the tooth/accessing the root canal
Although there is already a hole in the crown of the tooth caused by the decay, a larger hole must be drilled by the dentist so that they can gain access to the pulp chamber inside the teeth that contain the infected tissue.
On larger teeth such as molars, this hole is usually placed in the top of the tooth. With smaller teeth, like those at the front of the mouth, the hole is drilled at the back of the tooth.
Remember, you will not feel this drilling.
Once complete, the dentist will be able to access the pulp chamber and the root system for the tooth. They will at this point be removing what is left of the pulp and looking for all the canals within the tooth so they know what they are working with.
The dentist will likely be wearing or making use of the best lighting and microscopes available to give themselves a magnified and clearer view of what they are working with.
Not just straight paths from the top to the bottom of the tooth, the canals are often narrow and curved. This makes the job more difficult and time consuming for the dentist to do properly.
Specialist files will be used to help enlarge the canals to give them a regular shape for filling and to allow for reach into the depth of the root to clear out the infected tissue.
This part of the treatment may take several hours to complete. The front incisor and canine teeth usually have a single root containing one root canal, but premolars and back molar teeth (chewing teeth) have two or three roots, each containing either one or two root canals. The more roots a tooth has, the longer the treatment will take to complete.
Once the tissue (pulp) has been removed, the dentist can clean out the inside the tooth and essentially sterilise it ready for filling.
Bacteria and their waste products are removed in two ways. One way they are removed is by physically getting rid of them, using small specialist files. The second technique is chemical removal using special solutions to kill the bacteria in the canals.
A combination of products will be used to flush out any remaining bacteria and debris. It is vital that nothing be left behind.
Syringes are used to push cleaning solutions into the canals, before being sucked back out and repeated several times. The canals are then dried with paper points or suction tips to complete the process ready for filling.
In some cases, or when treatment cannot be completed in a single appointment, medication will be placed into the canals and a temporary filling placed.
This will be left for up to a week, allowing time for bacteria and infection to be killed off by the medication.
In a second visit, the filling will be removed, the canals will be cleaned out again and the final stages of the treatment completed.
This is now the restoration stage.
The dentist now has a clean and perfect environment for the root filling.
The canals must be filled to stop bacteria re-growth and keep the tooth in the best possible condition.
The canals are normally filled with a special type of rubber called gutta percha. In the past other techniques have been used, e.g. silver.
The gutta percha is shaped as thin cones. These are dipped in a calcium hydroxide glue (cement) to help seal very small gaps. The extra lengths of gutta prechar are then heated with special implemtns so that the gutta percha stops at the pulp chamber.
A slightly different technique involves melting the gutta percha. The cones soften and shape to fill the canal and are compressed for a complete and strong filling.
Once the roots are filled, a normal filling will be applied to the crown of the tooth.
In some cases, extra supporting pins will be placed in the the upper part of the canal before the filling of the crown, to give extra strength to the tooth when the treatment is complete.
Whilst the filling adds strength back to the tooth that had been lost as a result of the infection, the tooth is still more fragile than it once was. It is more brittle and so more likely to break under pressure. In addition, bacteria could potentially creep around a regular filling which can cause a RCT to fail.
Where the top of the tooth (crown) is most vulnerable, it may be advised to have an artificial crown (or cap) placed on the tooth, which essentially gives an extra layer of protection.
Those who have a crown placed often see the most successful root canal treatment results.
This part of the treatment may take place several weeks after the root canal treatment, to ensure the the process has worked.
The last thing you or the dentist wants is to find the treatment has not worked and an expensive crown wasted.
For a crown to be placed, some of the tooth and filling will need to be removed with drills to create a space for a crown to be made. When ready for the crown, a mould of your teeth will be taken to ensure the crown is manufactured to fit precisely.
This may be achieved by biting into a special tray mould, or in the most advanced clinics, oral scanners are used to create detailed computer images, measurements and renderings of the teeth, for a cleaner more high-tech approach.
Crowns are made from:
- Metal or porcelain (or both)
- A ceramic material
- Or powdered glass
When paying for the treatment privately you get the most choice as you pick up the bill.
Also known as a cap, the artificial crown is attached to the natural tooth, once it has been shaved down to offer a better fit for the cap and a nice surface area given for cementing it in place.
If there’s only a small amount of tooth left after the root canal treatment, a post can be cemented in the root canal and used to help keep the crown in place.
The following video summaries the written content above.
How long does the RCT procedure take?
The time taken for will vary from one patient to another.
It will depend on the extent of the infection and which tooth is being treated.
Teeth with fewer roots will normally take less time to treat than those with multiple roots.
Some treatments can be carried out in 1 visit, whilst other treatments may require a 2nd visit.
Your dentist can advise, but as a general guide expect approximately a total of one hour per root for a simple tooth.
How long does treatment last?
In an ideal scenario, where all has gone to plan and you look after the tooth once treated, there is no reason why it cannot remain in place for the remainder of your life.
This is something we confirmed with Esther Hathorn of Visage Dental Spa, who told us successful root canal treatment “should last forever if all nerve tissue is removed”.
Those with poor brushing routines and those who smoke will be at greatest risk of the treated tooth not lasting this long.
Investing in perfecting your cleaning and giving up smoking are only going to help.
However, personal circumstances and health conditions may affect this and the treatment may need to be completed again or the tooth removed entirely.
Failure typically occurs in 10% of cases. Failure means the tooth experiences pain or breaks.
How much does root canal treatment cost?
The cost of treatment for root canals varies depending on whether you are getting treatment on the NHS or privately.
As dental treatments go, it is not the most expensive, but is more expensive than most because it is a more complex and time consuming procedure to carry out.
NHS treatment in the UK
Within the UK, if you are eligible for NHS dental care, then a root canal treatment falls under Band 2, which at the time of writing costs £59.10 (England), £45 (Wales), whilst the cost varies from approx £39 to £50 upwards in Scotland and Northern Ireland.
It often best to take the professionals advice, so if they feel a crown is necessary, you probably should opt for this.
A crown will impact the cost and will mean the work will fall under band 3, at a cost of £265.50 (England) or £45 (Wales). In these countries, the price includes the crown and RCT.
Private treatment in the UK
Getting root canal treatment privately within the UK will cost anywhere between £100 through to £700 as a rough guideline.
Those teeth with less roots and more easily accessed will generally be cheaper to treat.
Surgery on a back molar will be more complex, involve more time and therefore incur more cost.
Additional costs will come from the x-rays and if a crown is required. Multiple visits may also have an impact too.
A crown on its own can cost anywhere from £350-1000 so in the most complex cases its not unreasonable to expect dental costs of over £1500.
Dentists and the surgeries in which they work can typically offer an accurate costing as part of the consultation process and there should be few surprise or unexpected costs.
When being treated privately you will have more choice, particularly when it comes to the materials the crowns are made from.
Aside from the actual act of treatment itself, the dentists location, training, reputation and popularity can also influence the cost.
Overseas treatment for root canals
As we have seen with dental implants, there can be big savings for getting dental work done overseas in countries such as Hungary, Poland and Spain.
Even when factoring in the cost of flights and accommodation the costs can be 50-70% less, but still completed to a very high standard as you would get within the UK.
You will need to make your own assessment as to whether overseas treatment is something you wish to consider.
The complication here is that usually you will want the treatment carried out fairly quickly and this can affect the ease with which you can arrange such overseas treatment.
For a few days post treatment, the area around the tooth will likely be swollen, inflamed and sensitive.
This may extend for a week or so if you are having to make a couple of visits to complete the root canal.
During this time, you will also find that pressure from chewing will result in extra sensitivity.
It will be advised that you eat soft foods as the area heals.
Within 72 hours or so, this will subside and you will hopefully feel normal again.
To help manage any pain or sensitivity you can use over the counter painkillers to provide relief.
Should you find these are not working or you are concerned, speak to your dentist for more information and guidance on what to do.
Root canal complications and problems
All dental procedures have an element of risk attached to them and not all will go perfectly.
Risks vary from one patient to another, but the dentist will take the appropriate action to minimise the risks to yourself.
Root canal treatment is according to the NHS successful about 90% of the time (9 out of 10 cases).
Possible complications and problems include:
- Damage to the root canal or the tissue surrounding the tooth
- Damage to the nerves around the tooth
- A canal not being filled (missed) during the first treatment
- The canal not being properly cleaned and filled (tissue and bacteria remains)
- A fracture in the root
Your dentist might get you to return for a checkup a week or so after initial treatment to check it has worked, but more often than not you will instinctively know.
If the pain or symptoms that caused you to fist get the work done have not gone away within about a week of the work being done, it will likely have failed.
Although it is most common for the root canal to fail pretty much straight after the first attempt, it can fail later if preventative care (brushing and flossing) is not followed.
Where it does not work you may be advised to have what is known as re-treatment.
Pros and cons of root canal treatment
There is lots of information on this topic provided within this article. What are the main positives and negatives?
- Saves the natural tooth – Nothing can replace a natural tooth, RCT save it.
- Gives confidence – The treatment does away with the pain causing infection and allows you to live life normally once treated.
- Safe – Used for a long time it is a tried and tested procedure.
- Success rate – 90% of RCT are successful.
- No gaps – Extraction is the alternative, that will leave you with a gap in the teeth unless dentures are purchased.
- No denture required – With the tooth saved no dentures will be required to replace what could otherwise be a missing tooth.
- May not work – The treatment many not work in all cases, typically 1 in 10.
- Time – It is a more time consuming procedure than tooth extraction.
- Cost – It will likely be more expensive than extraction if you do not factor in the cost of dentures to replace a missing tooth.
- Recovery – There will be a bit of recovery time, it is a surgical procedure
Preventing further treatment
The best methods to prevent the need for any further treatment to that teeth or others in the mouth is to:
- Maintain good oral hygiene – Brush twice a day, floss once.
- Not consume too much sugary food
- Give up smoking, if you smoke
- Get regular dental checkups
There are lots of claims and suggestions on the internet and amongst the general population that root canal treatments are dangerous and should be avoided at all costs.
This is particularly rife amongst those who believe in more natural or holistic approaches to health, wellbeing and medicine. The suggestion if often to avoid surgery.
Some of these claims are based on poor or old information as well as misunderstanding of the treatment process.
The following video gives a little insight into the safety of this procedure, from the point of view of trained endodontists.
The only alternative to this endodontic treatment is removal or extraction of the tooth.
It sounds dramatic, but that is the reality of the situation.
It is not an option dentists like to take unless absolutely necessary, hence the desire to attempt root canal treatment first.
Removal of a tooth can cause problems with chewing as well as having an impact on your smile and the way your remaining teeth look.
Most wish to replace the missing tooth, but restoring this involves obtaining an artificial (prosthetic) replacement, such as a denture, bridge or a dental implant. The costs of such can vary considerably.
Root canal treatment is a process that removes the infection and decay that exists inside a tooth.
Removing the soft inner tissue before it spreads further, the tooth is artificially restored by filling it with compounds that give the tooth strength.
When completed successfully and well managed thereafter, there is no reason why the tooth will not remain in the mouth for a lifetime.
It is a surgery few wish to go through with, but is one that is effective and much better alternative of tooth extraction.
A direct result of decay, regular dental checkups and good daily oral hygiene practices can prevent the need for such treatment.
Root Canal FAQ
All being well many questions you may have had have been answered in the contents of the article above.
However, here are some commonly asked questions, complete with answers.
Does a root canal hurt?
You are not alone in you are one who fears going to the dentist, 1 in 4 of us do according to the NHS.
However, the good news is that the treatment for a root canal is not painful.
Local anaesthetic is used to numb the area during the procedure so that you do not feel anything.
The dentist and support staff will be on hand if you feel pain and you will normally be advised to alert them.
Depending on the length of treatment required, extra anesthetic will be used to ensure the area remains numb until the treatment is complete. Most dentists will let you know what is going on at key stages such as this.
And although post treatment there will likely be a bit of discomfort, this will soon ease.
Failing to get the treatment will result in more pain, discomfort and worry than not getting it dealt with at all.
How many appointments are necessary for root canal treatment?
The number of appointments will vary depending on the severity of the decay and infection.
A large proportion are carried out in just 1 sitting.
Most are completed within 2, but a third may well be required, particularly if a crown is being fitted.
Your dentist will often advise in the first consultation if they feel multiple visits will be necessary.
How long will the tooth last following root canal treatment?
Providing good care of the tooth is taken, with regular checkups following the RCT, then it can last a lifetime.
Other factors such as diet and smoking may affect the long term stability and success.
Can all teeth be treated with root canal treatment?
In many cases the answer is yes. However, there are occasions where reluctantly, tooth extraction is the best option.
These instances are where the infection and decay has existed too long for the tooth to be saved, if the canals cannot be properly cleaned and sealed and there must be sufficient bone to support the tooth.
Can the treatment fail?
Yes, 1 out of 10 cases will fail.
The circumstances for the failure differ.
It can be possible to reattempt the treatment or it might be necessary to remove the tooth.
What will my tooth look like after treatment?
All being well the tooth will look as it did (or as close as) prior to any decay and treatment.
The idea of the treatment it to retain the natural tooth as nothing looks or performs as well.
It is possible that the tooth will darken, but this is much less common and treatments such as chemical whitening can be completed to match the tooth in with the others in your mouth.
Where is root canal treatment carried out?
The procedure is carried out in your dentists/endodontists office. It does not require admission to hospital.
What is Endodontic Retreatment?
This is the process of providing root canal treatment to teeth that have previously undergone the procedure.
It tends to be a more complicated and longer procedure due to the fillers that have been placed in the teeth during prior treatments.
Your comments and opinions
If you should have any questions, comments or opinions you would like to add to this guide, please do so, by commenting below.
Should you have or be going through the process of implants yourself, why not share some feedback for others to take advantage of.
- Levinsons Textbook for Dental Nurses
- British Endodontic Society
- American Association of Endodontists
- Oral Health Foundation
- Burgess Hill Dental
- Foxhall Dental Practice
- Cygnet Dental Practice
- City Dental
- King Lane Dental Care
- Perfect Profiles
- Jamie the dentist