Root Canal Procedure: What to Expect, Step-By-Step & Cost

Root Canal Procedure: What to Expect, Step-By-Step & Cost

 Whitney DiFoggio MA, RDH
Written by Whitney DiFoggio MA, RDH
Medical Reviewed on Nov 8, 2022
byDr. Matthew Hannan DDS
🔬 Evidence Based
Root Canal Procedure: What to Expect, Step-By-Step & Cost

Do you have a root canal procedure coming up? Aside from the length, what to expect, and root canal cost, you’ve probably got a lot of questions. Especially if you’ve heard all of the rumors and old wives’ tales about root canal treatments. Fortunately, modern endodontic therapy (that’s the clinical term we to describe a root canal) can be completed comfortably and efficiently. The better you’re educated about what to expect, the less anxiety you should have about your upcoming appointment.

A root canal procedure (endodontic treatment) is one of the last lines of defense when it comes to tooth preservation. Instead of extracting a tooth, the damaged nerve tissues inside of it are removed and sealed off. The root canal cost and length can vary, depending on which tooth is involved. Some teeth have more roots/canals than others. Fortunately, root canals are a smart investment and can be completed comfortably with modern rotary equipment.

What Is A Root Canal? 

A root canal procedure is typically your last option for preserving a damaged, dying, or severely decayed tooth. Instead of extracting the tooth altogether, the nerve tissues are removed and the hollow chambers are sealed off. This process prevents bacteria from re-entering the nerve canals and causing recurring abscesses or gradual erosion of the tooth. 

If you hear your dentist use the words “endodontic treatment”, what they’re talking about is a root canal. Depending on which tooth in your mouth is being treated, the process (and root canal cost) will vary; some teeth only have one canal because there’s just one root. Other teeth have three or four canals, or curved and twisted roots to work with. All of these factors — combined with your dentist’s own personal experience and resources — will determine whether you want to schedule the treatment at your usual dentist’s office or see an endodontist, which is a root canal expert.

Since root canals treat the inside of the tooth and the overall structure is no longer “alive” per se, your remaining tooth enamel can start to get a little brittle. That’s why most dentists will recommend that you also have a crown placed over the tooth, once your root canal procedure is complete.

Why Might You Need A Root Canal? 

The reasons for getting a root canal vary, but typically they involve some sort of trauma or infection of the nerve of your tooth. Root canals come into play when a smaller and more modest treatment (such as a tooth filling or dental crown) isn’t enough to provide support. The only other option would be to extract the tooth, which would lead to a host of other issues. Instead, you can preserve the tooth and your bite alignment by treating it from the inside with an endodontic procedure.  

Here are a few situations where a root canal will be required:

1) Abscessed Teeth

Dental abscesses are caused by bacterial infections and swelling inside of the tooth. They typically create a cyst or area of drainage out the tip of the root, which then seeps through the bone and gum tissues. You may notice a small little pimple on your gums — something called a fistula — where the pus is working its way out of the tooth. Fistulas can come and go, but the abscess will remain until a root canal is completed.

2) Tooth Decay 

Typically, your dentist will want to repair cavities with a small, minimally-invasive filling. But you need enough healthy tooth structure to surround the filling to keep it in place. If the decay has grown so large that it reaches into the nerve, there’s no way to cover the tooth without trapping the infection inside. At that point, only a root canal can prevent total tooth loss. Once the root canal procedure is complete, your dentist will place a crown over the compromised enamel so that you can continue using the tooth as normal.

3) Hypersensitivity

Sometimes teeth are extremely hypersensitive for no apparent reason. It could be due to a hairline fracture, unknown trauma, or referred pain. Your dentist can run special temperature tests on your tooth to pinpoint the source of your discomfort or refer you to a specialist for further evaluation. If the pain is because of a nerve issue, then a root canal may be necessary.

4) Injury/Trauma 

Traumatic injuries — like getting hit in the mouth during a baseball game or being in an automobile accident — can catch you by surprise. It’s not uncommon to be perfectly fine and then years down the road start to see your tooth begin to die. Typically, the dying tooth will start to look discolored compared to its neighbors. There may or may not be sensitivity. The trauma from the past can cause gradual nerve death. If it does, the only way to save the tooth is to perform a root canal procedure.

Signs & Symptoms You Need A Root Canal  

If you’re not sure whether you need a root canal or you suspect that’s what your dentist is going to recommend, be on the lookout for:

Any of these symptoms could indicate a dying nerve inside your tooth. But the only way you’ll be able to know for sure whether you need a root canal is to have your dentist take an X-ray of the full tooth root. This image will show the space inside of your nerve canal as well as the area around the root tip. Dying, traumatized, and abscessed teeth may have large hollow areas inside of them or evidence of a cyst around the root itself.

Dying or abscessed teeth can be extremely obvious and painful, or asymptomatic. So never, ever let the level of your discomfort be the determining factor when it comes to seeking out dental care. The sooner you see your dentist, the better chances you have of saving your tooth.

Step By Step Procedure 

What’s exactly happening during the actual root canal procedure? Depending on the specific dentist’s office you’re at, the step-by-step process will look something like this:

1) Local Anesthesia

Your dentist will use a topical gel to gently numb your gum tissues. A few minutes later, they’ll inject a local anesthetic near the nerves that supply your tooth/teeth in that area of your mouth. This step will ensure that you’re fully numbed and don’t have to feel anything other than a little pressure.

2) Dental Dam Placement

A protective barrier called a “dental dam” is placed over your tooth to isolate it from the rest of your mouth. This thin sheet of stretchy material also prevents anything else from going into your mouth. If you tend to feel a little claustrophobic or have a sensitive gag reflex, you may want to consider sedation to keep you comfortable. Otherwise, most people just feel like they’re holding something in their mouth. As long as you’re able to take deep breaths in and out of your nose, you’ll do just fine! Be sure to communicate with your dentist if you have any allergies or sinus issues.

3) Opening Up The Tooth

Your dentist will use a small, high-speed handpiece to create an opening large enough to access the nerve canal. A small amount of pressure and some high-pitched sounds are probably the only sensations you’ll experience at this point. Some people prefer to bring headphones or earbuds to listen to music and help tune out what’s going on. Any decayed enamel, old fillings, or other compromised structures will also be removed during this point in the appointment.

4) Remove Pulp/Nerve Tissue

After the tooth is opened, the nerve tissues inside are lifted up and out of the main chamber and corresponding root canals. The result is a hollow space inside the tooth and down the length of each root.

5) Disinfecting The Nerve Chambers

A disinfection solution is placed down into the canals of the tooth to help neutralize any residual bacteria from decay or abscesses. The goal is to create a sterile environment that can be sealed off. Any remaining debris or infection could put the root canal at a risk for failure, so disinfection is essential. In addition to the disinfection solution, your dentist might also place medication down into the tooth.

6) File

Filing the inside of the canal ensures that they’re thoroughly clean and all nerve tissues are removed. Fortunately, a lot of root canal specialists and general dentists use rotary files. These devices make filing gentler, more effective, and expedite the treatment process. Filing can also be performed by hand. If you have teeth that are hard to reach or the root anatomy is twisted/curved, the filing process can take a little longer to complete.  

7) Filling The Canal

Now comes one of the most important parts of the root canal process: filling the nerve chambers. Most dentists will use some type of gutta-percha material that flows down into the canals to seal them off. They’ll probably use some special instruments to record the depth of the canal or take an X-ray to ensure that the filling reaches down to the root tip. Ultimately the entire length of the canal will need to be filled for the root canal to be successful.

8) Dental Crown

Now that the tooth is repaired on the inside, it needs a protective exterior cover to prevent the non-vital enamel from breaking down during everyday use. Your dentist will usually place a temporary crown and then a permanent one about two weeks later. Or you can get a crown on the same day if your dentist’s office is equipped with that type of technology. If the tooth is fairly short, the dentist might also need to add some pins or posts to add extra reinforcement for the crown.  

Until your permanent crown is placed, be extremely careful chewing on that side of your mouth. Temporary crowns are meant more for avoiding infection or sensitivity; they’re not designed to last for an extended period of time.

Recovery & Aftercare

Is there a long recovery time after getting a root canal? Nope! Aside from giving the local anesthetic a few hours to wear off, things won’t be that much different than other routine dental work. However, it’s important not to chew hard, sticky, or crunchy food on that side of your mouth until after your dentist installs a permanent crown over your tooth. This restoration will usually be placed about two weeks after your endodontic appointment.

If you’re sore, it will probably be from a) the injection site or b) keeping your mouth open for a longer time than normal. To help with the discomfort, take an over-the-counter anti-inflammatory medication like Motrin as directed. Applying a cool compress to the side of your face every 20 minutes can also ease lingering soreness. Otherwise, you should feel back to your normal self within a couple of days.

After the final crown is placed on your tooth, it’s vital to floss and brush around it daily. That’s because plaque can still accumulate around the edges of your dental crown and potentially cause cavities or gum disease in those spaces. Oral hygiene is essential!

Are Root Canals Painful? 

Surprise! Root canal treatments don’t actually hurt. They feel like getting any other type of routine dental treatment. In fact, getting a root canal helps combat the source of your pain rather than cause additional discomfort. The entire procedure can be completed with local anesthetic (numbing medication.)

Speaking of local anesthetic, it can be incredibly challenging to numb an abscessed tooth if the infection is severe. The more swelling there is, the harder it is for the anesthetic to work. That’s why your dentist might prescribe an antibiotic just leading up to the planned root canal procedure. Reducing the inflammation ahead of time will help to keep you comfortable at the time of your appointment. And if you want, you can always request sedation.

Risk Factor With Root Canals

The risk factors for endodontic treatment are similar to what you would see in other basic dental procedures. Whether you’re having a tooth pulled or a filling placed, there are always risks associated with injecting local anesthetic or triggering an underlying medical condition. That’s why your dentist will screen you for other health issues first, such as hypertension or recent surgeries.

If you were to ask what the biggest risk of getting a root canal is, it would either be having to re-treat the tooth again if the root canal fails or having a file break off in the tooth. Although both are extremely rare, they can happen from time to time. In the case of a file breaking off, your dentist will need to remove it before the root canal can be completed.

Re-treatments are required if the canal isn’t completely sealed off, there’s an extra canal somewhere, or the filling material doesn’t reach all the way down into the root. Fortunately, modern technology makes it easier for dentists and root canal specialists to accurately pinpoint the length of the canal and thoroughly clean it out.  

Root canal complications are rare, especially if you’re working with an endodontist.

Are You Awake During The Procedure?

If you’re someone who just wants to be totally “knocked out” during your dental treatment, then it’s best to work with a dentist who offers sedation in their practice. Oral sedation can make you feel like you’re dosing off and usually prevents you from remembering much — if anything — about the appointment.  

But if you’re fairly comfortable seeing the dentist for other basic treatments, you don’t necessarily need to have dental sedation during a root canal procedure. Especially if it’s a simple case. It’s really up to you and what you’re comfortable with. Now if you’re someone with a curved root or multi-rooted tooth that requires additional time to treat, it’s understandable why you might want to elect to have it done under sedation. Otherwise, local anesthetic and a little laughing gas are usually just fine.

How Much Do Root Canal Treatments Cost 

Root canal costs depend on several factors, such as:

  • The cost of living in your area
  • Whether you’re seeing a general dentist or endodontist
  • Which tooth it is and how many roots there are
Root Canal LocationPrice Range*Average Fair Price
Front  Tooth$300 - $1,500 $762
Bicuspid$400 - $1,800$879
Molar$500 - $2,000$1,111

*FAIR Health, a non-profit organization, estimates a reasonable and fair cost for root canal treatments.

A tooth with 3-4 roots will typically have a higher root canal cost than one with a single root. Similarly, treatment with a specialist could cost a little more than if you were seeing your general dental provider. But the overall root canal cost can actually save you money (and time) when compared to extracting the tooth and then getting a dental implant placed in that site. They’re a smart investment to make.

Does Insurance Cover Root Canals?

Most dental insurance policies will cover root canal treatments. However, not all of them do. Or you might have a plan that covers alternative treatments like a tooth extraction. Since dental insurance varies from person to person (even within the same insurance company) your dentist’s office needs to verify your coverage before the root canal procedure is scheduled. Once they get a breakdown of your policy, co-pays, deductibles, and know how much of the root canal cost is covered, you can have a general idea of what your out-of-pocket costs will be.

Are Root Canals Safe?

Absolutely. Root canal treatments utilize safe, high-quality materials that are designed for long-lasting support. It’s safer to get a root canal than it is to avoid treating your infected tooth. Especially when you consider that an untreated abscess could potentially put you in the hospital or cause a brain infection. Endodontic treatment is just as safe as getting a dental crown or filling.

Root Canal Recap

A root canal procedure is extremely safe and one of the best ways to preserve an abscessed or dying tooth. The process itself can be performed with sedation if you want, but local anesthetic may be all that you need. Your dentist will clean the tooth out, seal it off, then top it off with a crown. The overall length and root canal cost will depend on how many roots are involved and what your insurance coverage looks like. The best thing to do is talk to your dentist or endodontist for an itemized care plan!

 Whitney DiFoggio MA, RDH
Written by Whitney DiFoggio MA, RDH"Teeth Talk Girl," is a registered dental hygienist. She started her dental health journey on YouTube, educating the public through videos.
Dr. Matthew  Hannan DDS
Medical Reviewed byDr. Matthew Hannan DDSDr. Matthew Hannan is a board-certified dentist and graduate of UT Health San Antonio School of Dentistry.
Last updated onDecember 16, 2023Here is our process

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