Myths about root canal treatment: Having endodontic therapy hurts.

For most people, their experience during root canal treatment will be no different than what they experience when having other types of dental procedures performed, such as having a filling placed. The dentist, or endodontist, will first "numb up" the tooth with a local anesthetic ("novocaine"). Having done so, the remainder of the appointment should be a non-event, even to the point of being boring. As testament of this fact, it is somewhat common that a patient will fall asleep while their root canal treatment is being performed (which can be a modest nuisance for the treating dentist).

A patient may have some apprehension about their pending endodontic treatment but that is really a different issue. That is an issue of patient management as opposed to pain management. If you are up front with your dentist about your fears and apprehensions, they can address these issues too. Either with some type of medication that you take before your appointment (possibly Valium) or else a drug administered by the dentist in-office (such as nitrous oxide, also known as laughing gas).

Don't confuse having root canal treatment with the management of those events that signaled its need.

There can be times that the final (and possibly only) sign that has signaled that root canal treatment is needed (or the signal that finally motivates the patient to seek their dentist's assistance) is a toothache. And it would be a fallacy to suggest that during this period of discovery (a time when tissues are agitated and inflamed and the patient is ill at ease and stressed) that every case is treated without any association with discomfort.

Having said all that, with these types of cases where there has been some type of painful toothache, the steps that the dentist takes in preparation for performing root canal treatment are those very steps that make immediate pain relief possible and initiate the tooth's healing process. We will also state that in this type of case a patient would find any other type of dental treatment, such as an extraction (if during this time frame one could be performed at all), similarly unpalatable.

This is not to suggest that the only signal that root canal treatment is needed is a toothache. The need for endodontic treatment is identified in a number of different ways, many of which are painless. And this is why for many patients their entire root canal experience (diagnosis and treatment) is a non-event.

There can be postoperative pain.

Any discussion about root canal treatment and its association with pain needs to address the potential for post-treatment discomfort. As uneventful as having root canal treatment can be, any endodontic appointment has the potential to trigger a period of postoperative discomfort. In those cases where it is experienced, the pain might be as mild as that transient type that is easily managed with an over-the-counter analgesic such as ibuprofen or acetominophen. At the other extreme, it might be more severe, prolonged, involve tissue swelling and require the attention of your dentist or endodontist.

Tsesis (2008) evaluated published research regarding this topic and determined that an incidence rate for endodontic post-treatment flare-up lay on the order of about 8%. (Flare-up is typically defined as the development of pain or swelling associated with an initiation or continuation root canal treatment appointment that necessitated an unscheduled dental visit for attention.) We were hesitant to cite this study because this number seemed high to us. In light of this information however, we would like to point out that the alternative to having root canal treatment is tooth extraction, a procedure also associated with producing postoperative pain.

As further explanation of what you might expect, another study, Al-Negrish (2006), followed a group of 112 patients for a period of one week after the completion of their root canal therapy. We chose to cite this study because to some degree it quantified the level of pain the patients were experiencing. This study found that at two days 90 patients had no pain, 9 had slight pain, and 13 had moderate to severe pain. At day 7, 104 patients had no pain, 4 had slight pain, 3 had moderate pain and one was experiencing severe pain.

Your mileage may vary, and probably will.

Don't just expect the worst outcome from your root canal treatment. Instead become educated. There are a lot of variables involved with predicting the incidence of post-treatment discomfort. Your source of information is your dentist or endodontist. They are the one who, based on their knowledge and clinical experience, can interpret the findings associated with your case and provide you with an informed opinion about what type of postoperative disomfort to expect.