Root canal treatment: what it is, and does it really hurt?

Inside each tooth is soft tissue — the pulp — containing the nerve and blood supply. When decay, a crack or repeated treatment lets bacteria reach it, the pulp becomes inflamed or infected and, untreated, dies and forms an abscess. A root canal removes that infected pulp, cleans and disinfects the hollow canals inside the root, and seals them. The tooth stays in place and keeps working; it simply no longer has a living nerve. It's a tooth-saving procedure, not a tooth-removing one.

The signs that a tooth may need root canal treatment include lingering pain to hot and cold, severe toothache or pain on biting, a darkening tooth, a pimple-like spot on the gum (a draining abscess), and swelling. Sometimes there are no symptoms and it's found on an X-ray. The common thread is that the nerve is irreversibly damaged or dead — at which point the realistic choice is a root canal to save the tooth or an extraction to remove it.

Under local anaesthetic, the dentist makes a small opening in the top of the tooth, removes the infected pulp, and uses fine instruments to clean and shape the canals, disinfecting as they go. The canals are then filled and sealed, and the opening closed. Because a root-treated tooth becomes more brittle, it's usually protected afterward with a crown, especially on a back tooth that takes heavy biting force. Simple cases are often done in one visit; others over two.

This is the big myth. The pain people associate with root canals is the infection beforehand — the procedure is what relieves it. Done under modern local anaesthetic, having a root canal feels much like having a filling: you shouldn't feel pain during it. Some tenderness for a few days afterward is normal and settles with ordinary pain relief. The idea that root canals are agonising comes from an era before today's techniques and anaesthetics.

Mild tenderness for a few days is normal; take pain relief as needed and avoid chewing hard on that tooth until any final restoration (often a crown) is in place. After that, a root-treated tooth is cared for exactly like any other — brushing, cleaning between the teeth, and regular check-ups. A well-done root canal followed by a proper crown has a high long-term success rate, and the tooth can last for many years, often a lifetime.