Toothache can be confusing—is it a temporary sensitivity or a signal of a more serious dental issue? One of the most common and often misunderstood procedures in dental medicine is root canal treatment, also known as endodontic therapy. This article explains when this procedure is necessary, what symptoms may indicate it, how the treatment works, how long recovery takes, and what long-term results to expect.
When and why is root canal treatment necessary?
Root canal treatment becomes necessary when the dental pulp—the soft inner tissue of the tooth containing blood vessels, nerves, and connective tissue—becomes inflamed or infected. While pulp plays a key role in the development of the tooth, once the tooth is fully formed, it can survive without it.
Pulp damage can occur for several reasons, most commonly:
Deep cavities reaching the pulp – If cavities are left untreated, bacteria penetrate through the enamel and dentin into the pulp chamber, causing infection. At this stage, brushing and toothpaste are no longer effective—endodontic therapy is the only solution.
Cracks, fractures, or worn teeth – A tooth may appear healthy from the outside, but microfractures (often invisible to the naked eye) can allow bacteria to enter the pulp. Over time, this leads to pulp inflammation and surrounding tissue infection.
Dental trauma – Blows or falls can damage blood vessels inside the tooth, cause bleeding in the pulp, and eventually lead to its death. The tooth may not hurt immediately, but colour changes, pain, and swelling may appear later.
Repeated dental procedures – Multiple fillings, large restorations, or frequent treatment on the same tooth can irritate the nerve and cause pulp degeneration. Sometimes, even if the treatments were technically correct, the tooth simply can’t withstand further work.
Ageing and natural wear – As we age, teeth become more vulnerable to damage, and enamel becomes thinner, allowing easier bacterial penetration. Additionally, root canals narrow with age, complicating diagnosis and treatment.
If the infection isn’t treated, it can spread beyond the tooth and cause:
• Spread of bacteria to the surrounding tissue, including bone
• Formation of abscesses, cysts, or granulomas—leading to pus and tissue destruction
• Loss of supportive tissue and tooth mobility
• Pain and swelling, potentially spreading to the face, jaw joint, or even distant organs
• Tooth loss, which may require an implant, bridge, or denture
Timely treatment plays a key role—not only in saving the tooth but also in preventing serious complications that could affect overall health.
What are the symptoms that indicate root canal treatment is needed?
Teeth don’t “speak,” but they do send signals when something’s wrong. Recognising symptoms of pulp inflammation or infection can significantly increase the chances of successful treatment and tooth preservation.
Here are the most common signs that may indicate the need for endodontic therapy:
• Persistent or throbbing toothache, especially when chewing or applying pressure—pain may be dull but constant, or sharp and unpredictable. It may appear spontaneously, without a clear cause, and doesn’t subside even with painkillers. This is a strong indicator that the tooth nerve is compromised.
• Prolonged sensitivity to hot or cold—brief discomfort is normal, but pain that lingers for several seconds after the stimulus is gone (e.g. hot drink) may suggest a deeper issue.
• Tooth discolouration—if the tooth turns dark, greyish, or black, it’s not just a cosmetic issue. It may mean the pulp has died and the tissue inside has deteriorated.
• Swelling of the gums or the appearance of a fistula (a small pimple on the gums)—the body tries to release the infection through a small drainage channel. These “sores” are usually painless but signal an infection beneath the surface.
• Discomfort or pain when biting—especially if it’s localised to one side, possibly indicating inflammation inside or around the tooth root.
• Bad taste or persistent bad breath, even after brushing, may suggest the presence of pus and bacteria inside the tooth.
• Visible tooth fracture or deep cavity—teeth with visible damage or extensive decay often require root canal treatment, even if they aren’t currently painful.
What if the pain goes away?
A common misconception is that when the pain stops, the problem is gone. Unfortunately, this often means the tooth nerve has died, and the infection has entered a silent but more dangerous stage. At this point, inflammation can spread to surrounding tissue and bone, leading to complications that may not be immediately visible.
That’s why it’s important not to wait until pain becomes unbearable or swelling appears. The earlier you act, the less invasive the procedure, and the higher the chance of saving the tooth.
What does the root canal procedure look like?
Root canal treatment is a standard dental procedure performed under controlled conditions and local anaesthesia, making it painless for most patients. Thanks to modern techniques and precise instruments, the process is safe, predictable, and highly effective.
The treatment consists of several steps, each with a clear role in removing infection and preserving the tooth:
Diagnosis
Before starting treatment, the dentist performs a clinical exam and takes a digital X-ray (RVG) to assess the extent of the infection, the number of canals, and their curvature. In complex cases, CBCT (3D imaging) may be used.
Tooth isolation
During the procedure, a rubber dam is used to isolate the affected tooth from the rest of the mouth, preventing contamination from saliva and ensuring a clean and safe working area.
Opening the tooth and removing the infected pulp
After anaesthesia, the dentist removes decay and opens the pulp chamber. The infected pulp is carefully removed from the root canals using fine instruments to eliminate all diseased tissue and prevent further spread.
Mechanical and chemical canal cleaning
The canals are thoroughly cleaned and shaped using manual and rotary instruments, then flushed with antiseptic solutions (usually sodium hypochlorite) to destroy remaining bacteria and debris.
Canal filling
Once clean and dry, the canals are filled with biocompatible materials—most commonly gutta-percha and special sealers—to seal the canal and prevent reinfection.
Tooth sealing
Depending on the treatment plan, the tooth is either temporarily sealed or restored immediately. In most cases, a crown or permanent restoration is recommended after endodontic treatment to protect the weakened tooth from breaking.
How long does root canal treatment take?
Treatment duration depends on:
• Number of root canals (front teeth typically have one, molars up to four)
• Severity of infection and presence of pus or swelling
• Canal curvature and access
• Need for additional medication or temporary fillings
Simple cases can be completed in one visit (“single-visit endodontics”), while more complex ones may require two or three appointments, especially if there’s active infection or a fistula.
At Esthea Polyclinic, all treatment stages are performed with precision and a focus on patient comfort. Patients are thoroughly informed at every step.
What to expect after treatment?
Mild discomfort or sensitivity may occur after treatment, especially when biting, and usually subsides within 2–5 days. In the first 24 hours, it is recommended to:
• Avoid hard or sticky foods
• Take pain relievers as prescribed by your dentist
• Maintain excellent oral hygiene
If you experience increased pain, swelling, or fever, contact your dentist immediately to assess the healing process.
When is a crown needed?
Endodontically treated teeth often lose part of their structure and become more susceptible to fracture. For back teeth, which endure stronger chewing forces, a crown is recommended to:
• Restore strength
• Prevent fractures
• Ensure long-term function and appearance
For front teeth, reconstruction with a filling may suffice, depending on your dentist’s evaluation.
How long do the results last?
If done properly and the tooth is protected, root canal treatment results can last decades or a lifetime. Long-term success depends on:
• Maintaining oral hygiene
• Regular dental checkups
• Quality of restoration (filling or crown)
• Avoiding harmful habits (e.g. teeth grinding)
What happens if the treatment isn’t done?
An untreated infection can lead to:
• Formation of a cyst or granuloma
• Tooth loss
• Infection of the surrounding bone or sinus
• Spread of bacteria to other body parts via the bloodstream
In some cases, surgical options like apicoectomy may help, but often the only option is tooth extraction and replacement (bridge, implant, or denture).
How much does root canal treatment cost?
The cost depends on:
• Number of root canals (front teeth: 1, molars: up to 4)
• Additional procedures needed (X-rays, medication, crown)
• Materials and technology used
Special cases in root canal treatment
Pregnant patients
Endodontic treatment is safe during pregnancy, especially in the second trimester. Local anaesthetics and antibiotics used are safe for the fetus, and X-rays are performed with protective measures.
Patients with chronic illnesses
People with diabetes, hypertension, or heart conditions can undergo root canal treatment safely, with proper medical preparation and monitoring.
Prevention: How to avoid root canal treatment?
Although trauma can’t always be avoided, most cases can be prevented with proper oral care:
• Brush teeth with fluoride toothpaste twice daily
• Use dental floss and interdental brushes
• Limit sugary and acidic foods/drinks
• Visit the dentist every 6 months
• Treat cavities and damage early
Root canal treatment as a pain-free solution
Root canal therapy allows you to preserve your natural tooth, eliminate infection, and avoid complications. Today, it is a relatively painless and predictable procedure with long-lasting results, provided it is performed and maintained properly.
If you notice pain, sensitivity, or changes in a tooth, don’t wait. Timely treatment can make the difference between a simple procedure and tooth loss.
The Esthea team is here for all types of endodontic diagnostics and treatment—professional, safe, and tailored to your needs.