Root canals are among the most intimidating of dental procedures, so much so that the expression “I’d rather have a root canal than …” is meant to indicate something really unpleasant. Yet despite its role in popular speech and its fearsome reputation, root canals are actually far less dreadful than they are imagined. First, they are fairly quick procedures and, depending on the dentist, can take a grand total of two hours to perform in their entirety. Secondly, root canals are always performed under anesthesia, making them no more unpleasant than any other dental procedure. In fact, as far as pain is concerned, most people who undergo a root canal end up feeling much less pain than before. Why is this?
The need for root canals
Essentially, the need for a root canal is caused by dental decay that has progressed past the point where a cavity can be patched up with a simple filling. Such decay has usually worn through the enamel (the hard, white exterior shell of the tooth) and has penetrated the underlying tissue, called dentin. This exposes the dental nerve to temperature variations, and the decay may have even caused an inflammation of the nerve itself.
While it is possible for such decay to go unnoticed by the patient, usually he or she is well aware that something is wrong. While there are a variety of symptoms of this, most of them involve pain of varying intensities: sensitivity to hot or cold which persists after the source of heat or cold is removed; swollen, tender gums; and severe pain while chewing or biting. A successful root canal is not entirely without discomfort, but once it is over, the patient’s mouth will already feel much – and permanently – better.
What happens in a root canal?
Whether the professional conducting the procedure is a dentist or an endodontist (a specialist in matters of the interior of teeth), the first step in a root canal is the application of an anesthetic, which will make sure the patient experiences no pain. While this takes effect, a latex dam is put around the tooth to keep it dry and clean.
Once the patient is fully anesthetized, the endodontist will use a device that looks like a miniature drill to create an opening into the tooth. The inside will then be rinsed with fluid designed to kill any remaining infection, and then the pulp and the nerve are removed from the tooth. This should not cause distress: an adult tooth does not actually need either of these and will function perfectly without them. Furthermore, the anesthesia will keep the patient from feeling any of this. The removed pulp and nerve leave behind an aperture which is cleaned and enlarged with another tool, creating a canal.
Any remaining debris is then removed, and the canals are sealed with an antibacterial rubber-like substance known as gutta-percha. A temporary filling is placed over the hole, and then the entire tooth is covered with a temporary crown. This will allow the patient to eat and speak normally after the anesthesia wears off while awaiting a permanent crown. This crown, made of materials like porcelain or porcelain over metal, will be placed in a follow-up appointment, or, if the dentist’s office has laser-printing technology, during the same visit.
Root canals: myths and reality
Nowadays, there is nothing about a root canal that would make it any more painful than any other dental procedure, and in fact, a successful root canal will often greatly reduce dental pain. So why is there such a fixation on root canals and the pain they cause?
Likely, this dread dates to the early days of the procedure. The first recorded root canal seems to have been performed in 1766, but surgical anesthesia did not come about until 1842. An operation performed without anesthetic in which the tooth was drilled and the pulp removed may very well have been excruciating in the 1800s, especially since these were conducted with far less precise and sophisticated tools. Almost two centuries later, however, the instruments, techniques, and anesthesia involved in root canals in 2023 have made them quick, efficient, and nearly painless.
In a similar manner, root canals are sometimes feared as causing illness. This may well have been true in the 1780s: when they were first performed, the inside of the tooth was not rinsed to clear out the infection during a root canal, nor sealed with gutta-percha or anything else. Whatever infection was cleaned out in early root canals could return and might even be made worse. But just as tools and anesthesia have made significant strides, so have antiseptic techniques. No study performed over the last century shows any illness caused by a root canal.
Taking the fear out of root canals
Although there might be some residual aching just after a root canal, the procedure and its recovery period will not be particularly painful. In fact, many dentists suggest that patients can return to work shortly after, though their mouths may be numb. As a technique for saving a tooth and bringing relief to any pain it might cause, the root canal is a fast and effective procedure that does not deserve the anxiety surrounding it.