Root Canal Treatment: Procedure, Aftercare, and Complications Explained

the different tooth layers: enamel, dentin, and pulp
Our teeth are covered with two hard layers: the outermost is called enamel, followed by dentin. In the center of the tooth is a soft tissue called the pulp. It contains the nerves and blood vessels that feed the tooth throughout its life. It runs through the roots like tiny tubes. We call these root canals.

If the pulp is infected or injured, the nerves should be removed to save the tooth. This procedure is known as a root canal or endodontic therapy.

In this article, find out everything you know about root canal treatment, including the reasons for its need, the procedure involved, and what to expect during and after the treatment.

Symptoms that indicate the need for a root canal:

Some of the common symptoms that indicate the need for a root canal include:

  1. Severe toothache or pain when biting or chewing.

  2. Extreme pain to hot or cold temperatures.

  3. No sign of life in the tooth (the tooth is dead).

  4. Darkening or discoloration of the tooth.

  5. Swelling or tenderness in the gums near the affected tooth.

  6. Pimple or bump on the gums near the affected tooth.

  7. Pus discharge and bad breath or taste in the mouth.

  8. A broken or cracked tooth.

  9. A tooth that has had previous fillings or dental work.

How do you confirm that a tooth needs root canal treatment?

Your dentist will carry out multiple tests to ensure the tooth needs root canal treatment.

First, he will take an X-ray to assess the extent of the decay or fracture (whether it has reached the pulp or not). He will lightly tap the tooth to assess its sensitivity. Abscessed or infected teeth tend to be more sensitive when you apply pressure to them.

Your dentist will also expose the tooth to cold. If the tooth responds with severe pain, it could indicate that it is irreversibly damaged. On the other hand, if the tooth does not respond at all, it could mean it is dead. In both cases, the nerve must be removed to avoid further complications.

What are the steps involved in the procedure?

The root canal procedure typically involves the following steps:

  1. Anesthesia: The dentist will numb the affected area with a local anesthetic to increase your comfort during the procedure.

  2. Accessing the Tooth: An opening is made through the top of the tooth to access the infected or damaged pulp.

  3. Removing the Damaged Tissue: Using special tools, the dentist removes the damaged or infected pulp, nerves, and blood vessels from the inside of the tooth.

  4. Cleaning and Shaping the Canals: The dentist cleans and shapes the inside of the tooth to prepare it for filling.

  5. Filling and Sealing the Canals: The dentist fills the canals with a special material, called gutta-percha, to prevent further contamination. The opening is then sealed.

  6. Restoration: If necessary, the dentist may place a temporary filling or crown on the tooth to protect it while a permanent crown is made.

How long does the treatment take?

The length of the root canal treatment depends on many factors, including the tooth involved and the severity of the damage. But it usually takes one to two hours for a single appointment.
In some cases, multiple appointments may be necessary. The dentist will provide a timeline for the treatment and any necessary follow-up appointments.

What are follow-up appointments?

After the root canal treatment, your dentist will schedule additional appointments to assess the symptoms and monitor the healing process. The follow-up appointments may include:

  • Check-ups: A few weeks after the root canal treatment, your dentist will examine the treated tooth to ensure it's healing correctly and check for any signs of infection or other complications.

  • X-rays: Your dentist may also take x-rays to assess the injury recovery.

After the treatment, the intense and throbbing pain should disappear. The tissue destroyed by the bacteria will begin to recover, and your tooth will become functional again.

Know that a slight pain a few days after the procedure should not be a cause for concern. It indicates inflammation, which is an essential step for proper healing. The discomfort should gradually subside and disappear after the first week.

Care after the procedure:

After the root canal treatment, it's important to follow your dentist's instructions to ensure the best possible outcome. Some aftercare instructions include:

  • Avoid chewing on the treated tooth before the final restoration is placed.

  • Take over-the-counter painkillers as prescribed by your dentist.

  • Rinse your mouth with warm salt water to reduce swelling and promote healing.

  • Avoid hot, cold, hard, or sticky foods and drinks for the first few days after the procedure.

  • Maintain good oral hygiene by brushing and flossing to ensure proper healing and avoid complications.

Tooth restoration after root canal treatment:

After a root canal, your dentist will restore your tooth to give it its natural shape, function, and appearance. There are different options available. The one to choose depends on many factors, including the tooth involved (incisor or molar), the remaining structure, and the extent of the damage.

For the front teeth:

Whenever possible, front teeth are restored with a tooth-colored filling. This option is usually sufficient for moderately damaged front teeth. However, if the remaining tooth structure is too weak, a dental crown that will cover its entire visible portion will be needed to restore it and protect it from further damage.

For the back teeth:

Because the back teeth receive more chewing pressure, their restorations usually consist of dental crowns. Sometimes a post that fits inside the root canals is needed for extra strength and hold.

The success of root canal treatment:

Many studies demonstrate the high success rate of root canal treatment and its ability to save damaged or infected teeth for years to come.

A study by Salehrabi and Rotstein on the survival of root canal treated teeth in 1.1 million patients showed that 97% of the teeth were healthy 8 years after treatment.

Another study published in the Journal of Endodontics found that the success rate of root canal treatment was over 90% after a follow-up period of five years.

However, remember that the success rate can depend on several factors, including the extent of damage or infection, the type of tooth being treated, and the skill and experience of the dentist.

Complications of root canal treatment:

Root canal treatment does not protect your tooth from other conditions. There is always a potential risk of tooth decay or gum disease after treatment, especially if your oral hygiene is poor. The complications more likely to occur after a root canal treatment are:

  • Cavities and gum disease: It's essential to practice good oral hygiene and to attend regular dental check-ups to prevent these dental conditions from occurring.

  • Infection: In some cases, the root canal treatment may not completely eliminate the infection in the tooth. The same symptoms may persist or return after the procedure, requiring re-treatment or surgery.

  • Fracture: Root canal-treated teeth can be more fragile than other teeth and may be more prone to fracture. To minimize this risk, avoid biting or chewing on hard objects and get your final restoration as soon as possible.

What if the root canal treatment fails?

Although root canal treatment is successful in most cases, sometimes symptoms can persist, requiring an additional procedure:

1. A second root canal treatment:

If the first root canal treatment is unsuccessful, your dentist may consider doing it a second time to better treat the infection.

2. Periapical surgery:

It is needed when conventional root canal treatment cannot be performed properly. It involves direct access to the root tip to clean this area and remove any persistent infection.

3. Tooth extraction:

In some cases, an extraction may be recommended if the tooth is too damaged to be saved with a root canal. It may also be required if the tooth has fractured or there is significant bone loss.
This option involves removing the damaged or infected tooth and replacing the gap with an implant or dental bridge.


Root canal treatment is a common and effective way to save damaged or infected teeth. If you are experiencing symptoms that suggest you may need a root canal, it's important to seek treatment as soon as possible to ensure the best possible outcome. Your dentist can give you more information about the procedure and any alternatives that may be available.
Taking good care of your teeth and maintaining good oral hygiene can also help prevent the need for root canal treatment in the future.