Dr. Nora HaldenDental practice
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A gloved hand picks an endodontic file from a stand, with a masked clinician blurred behind

TreatmentsRoot canal treatment

When the soft centre of a tooth is inflamed or infected, the tooth can usually still be saved. This is how it's done, step by step, and what you'll feel at each step.

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Visits
Usually two
Each visit
1 to 2 hours
Anaesthetic
Local: you're awake, the tooth is numb
Afterwards
Tender for 3 to 4 days, as a rule
Fee
From £350 (front tooth) to £650 (molar)
Inside a tooth

Beneath the enamel and dentine is the pulp: nerves and blood vessels that run down each root canal into the jaw. Deep decay, a crack or an old injury can let bacteria in. Once the pulp is infected it can't heal on its own, and the infection can spread to the bone at the root tip.

123456789101112131415161718
  1. 1Enamel
  2. 2Dentine
  3. 3Pulp: nerve and blood vessels
  4. 4Root canal
  5. 5Gum
  6. 6Jawbone
  7. 7Ligament holding the root
  8. 8Decay reaching inwards
  9. 9Inflamed or infected pulp
  10. 10Infection at the root tip
  11. 11Tooth and gum numbed
  12. 12Rubber dam keeps it dry
  13. 13Small opening in the crown
  14. 14Fine files clean each canal
  15. 15Temporary filling on top
  16. 16Medicine rests in the canals
  17. 17Gutta-percha fills each canal
  18. 18A crown protects what's left
Step by step

  1. We tap and cold-test the tooth, check your bite and take an X-ray to see the roots and any infection at their tips.

    What you'll feelA brief tap or a cold touch. No injection yet.

    456789101231112131415161718
    1. 4Enamel
    2. 5Dentine
    3. 6Pulp: nerve and blood vessels
    4. 7Root canal
    5. 8Gum
    6. 9Jawbone
    7. 10Ligament holding the root
    8. 1Decay reaching inwards
    9. 2Inflamed or infected pulp
    10. 3Infection at the root tip
    11. 11Tooth and gum numbed
    12. 12Rubber dam keeps it dry
    13. 13Small opening in the crown
    14. 14Fine files clean each canal
    15. 15Temporary filling on top
    16. 16Medicine rests in the canals
    17. 17Gutta-percha fills each canal
    18. 18A crown protects what's left
    A periapical dental X-ray of molars on a monitor in the surgery

  2. A local anaesthetic numbs the tooth and gum. A thin rubber sheet on a small clip goes round the tooth, so only that tooth is open to work on.

    What you'll feelA small sting, then numbness. You breathe and swallow normally.

    345678910111212131415161718
    1. 3Enamel
    2. 4Dentine
    3. 5Pulp: nerve and blood vessels
    4. 6Root canal
    5. 7Gum
    6. 8Jawbone
    7. 9Ligament holding the root
    8. 10Decay reaching inwards
    9. 11Inflamed or infected pulp
    10. 12Infection at the root tip
    11. 1Tooth and gum numbed
    12. 2Rubber dam keeps it dry
    13. 13Small opening in the crown
    14. 14Fine files clean each canal
    15. 15Temporary filling on top
    16. 16Medicine rests in the canals
    17. 17Gutta-percha fills each canal
    18. 18A crown protects what's left
    Blue-gloved hands hold a dental cartridge syringe in a bright treatment room

  3. A narrow opening is made through the enamel and dentine into the pulp chamber, and the inflamed or infected pulp is removed.

    What you'll feelVibration and pressure, but no pain.

    234567891011121311415161718
    1. 2Enamel
    2. 3Dentine
    3. 4Pulp: nerve and blood vessels
    4. 5Root canal
    5. 6Gum
    6. 7Jawbone
    7. 8Ligament holding the root
    8. 9Decay reaching inwards
    9. 10Inflamed or infected pulp
    10. 11Infection at the root tip
    11. 12Tooth and gum numbed
    12. 13Rubber dam keeps it dry
    13. 1Small opening in the crown
    14. 14Fine files clean each canal
    15. 15Temporary filling on top
    16. 16Medicine rests in the canals
    17. 17Gutta-percha fills each canal
    18. 18A crown protects what's left
    Gloved hands prepare a green rubber dam sheet with a clamp forceps

  4. Fine files clean and shape each canal down to the root tip, measured as we go. The canals are rinsed again and again with a disinfecting solution.

    What you'll feelPressure, and the jaw gets tired. We stop for breaks.

    234567891011121314115161718
    1. 2Enamel
    2. 3Dentine
    3. 4Pulp: nerve and blood vessels
    4. 5Root canal
    5. 6Gum
    6. 7Jawbone
    7. 8Ligament holding the root
    8. 9Decay reaching inwards
    9. 10Inflamed or infected pulp
    10. 11Infection at the root tip
    11. 12Tooth and gum numbed
    12. 13Rubber dam keeps it dry
    13. 14Small opening in the crown
    14. 1Fine files clean each canal
    15. 15Temporary filling on top
    16. 16Medicine rests in the canals
    17. 17Gutta-percha fills each canal
    18. 18A crown protects what's left
    Colour-coded endodontic files stand in a steel sterilisation box

  5. If a second visit is needed, a medicine is left inside the canals and a temporary filling seals the top. Done in one visit, this step is skipped; studies find no clear difference in outcome.

    What you'll feelSome tenderness for a few days is common.

    345678910111213141516121718
    1. 3Enamel
    2. 4Dentine
    3. 5Pulp: nerve and blood vessels
    4. 6Root canal
    5. 7Gum
    6. 8Jawbone
    7. 9Ligament holding the root
    8. 10Decay reaching inwards
    9. 11Inflamed or infected pulp
    10. 12Infection at the root tip
    11. 13Tooth and gum numbed
    12. 14Rubber dam keeps it dry
    13. 15Small opening in the crown
    14. 16Fine files clean each canal
    15. 1Temporary filling on top
    16. 2Medicine rests in the canals
    17. 17Gutta-percha fills each canal
    18. 18A crown protects what's left
    A gloved hand holds a lit curing light over the chair

  6. The canals are filled with gutta-percha, a rubbery material from a tree sap, and an X-ray checks the fill. Back teeth usually need a crown afterwards to stop them cracking.

    What you'll feelNumb again. Biting feels normal once the tooth is restored.

    345678910111213141516171812
    1. 3Enamel
    2. 4Dentine
    3. 5Pulp: nerve and blood vessels
    4. 6Root canal
    5. 7Gum
    6. 8Jawbone
    7. 9Ligament holding the root
    8. 10Decay reaching inwards
    9. 11Inflamed or infected pulp
    10. 12Infection at the root tip
    11. 13Tooth and gum numbed
    12. 14Rubber dam keeps it dry
    13. 15Small opening in the crown
    14. 16Fine files clean each canal
    15. 17Temporary filling on top
    16. 18Medicine rests in the canals
    17. 1Gutta-percha fills each canal
    18. 2A crown protects what's left
    A glass of water on a white table beside a curved plywood chair

About 96%

of root canal treatments done to today's standard succeed when the root tip isn't yet inflamed; about 85% when it is.

Source: Leeds Teaching Hospitals NHS Trust

Afterwards
  1. 01Wait until the numbness has worn off before eating, so you don't bite your cheek.
  2. 02Expect the tooth to feel tender for 3 to 4 days. Paracetamol or ibuprofen usually helps.
  3. 03Chew on the other side until the final filling or crown is in place.
  4. 04Call us if the swelling grows or the pain gets worse after the third day.
Questions
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