You've heard a root canal treatment can be painful, and you want to know what you can expect. The good news is, you can put your mind at rest. Despite all the stories about how painful they are, the procedures usually aren't all that bad.
An Overview
The tiny canals inside the root of a tooth sometimes become infected. If the tooth's pulp also becomes infected, inflamed or is otherwise damaged it must be removed through what's often referred to as a root canal procedure. The purpose of the procedure is to save the patient's tooth by removing the infected or damaged pulp, treating any infection that might be present, and then filling the empty canals with a flexible plastic material called gutta percha. The tooth itself is then filled or crowned. In most cases, a crown is preferred because the treatment weakens the tooth and the crown helps restore its strength and prevent it from cracking. Typically, the entire process requires one or two appointments.
Step by Step
After numbing the area around the affected tooth, your dentist or endodontist will stretch a sheet of rubber (referred to as a "rubber dam") around the tooth. The rubber dam is secured in place by a small clamp that grasps the tooth. Its purpose is to keep the tooth and the surrounding area free of saliva during your procedure. This step is important because saliva contains bacteria which could contaminate the area. The purpose of a treatment is to clean bacteria out, not introduce more.
Your dentist will then drill a hole into the top or the back of the tooth to provide access to the pulp chamber that's located in the tooth's interior. For a tooth located toward the rear of the mouth the hole is drilled on the top (chewing) surface of the tooth, but for a front tooth the access hole is drilled on the back surface.
The next step involves cleaning out the tooth's pulp chamber to remove the pulp and nerve tissue along with any bacteria, their toxins and any remaining debris. The root canals themselves are measured after a portion of the tooth's pulp has been removed. A file (described in more detail below) can be used to measure the length of a canal by placing it inside and then taking an X-ray of the tooth with the file inside. These measurements are important for two reasons: (1) your dentist must clean out the entire length of the canal (but not beyond it); and (2) your dentist must use enough gutta percha to completely fill the empty space. Without accurate measurements the canal cannot be cleaned or filled thoroughly, and if the area becomes re-infected, the entire procedure will need to be repeated.
Your dentist will use a set of small devices known as "root canal files" during your root canal procedure. These tiny files resemble straight pins but have rough surfaces instead of smooth. Each root canal file in the set has a slightly larger diameter than its predecessor. Beginning with the file with the smallest diameter and moving up in size sequentially, the root canal files are moved up and down inside the canal using a twisting motion to remove the majority of the pulp.
After the files have done their job of removing most of the pulp, the remaining pulp and any debris is flushed out by irrigating the canals with an antiseptic solution. The empty canals are then filled with gutta percha and a temporary filling is put in place. Once your dentist is sure there's no sign of infection (typically within a month or less), he or she will add a crown or a permanent filling.
You can expect a few days of soreness after your treatment, but the treatment itself should be relatively painless. Not including fees for the eventual crown or permanent filling, root canal procedures typically cost from $400 to $600 for a front tooth and from $500 to $800 for a molar, depending on the dentist and the complexity of the specific procedure.
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