Does having root canal treatment hurt?

Menu

Does having a root canal hurt?

It shouldn’t.

For the average person and the average case, what’s experienced when having root canal therapy shouldn’t be that much different than when other routine dental procedures are performed, like having a filling placed. So, overall, you shouldn’t expect pain to be a significant factor during your appointment.

Of course, and just as you would expect, exactly what you do feel, or have the potential to feel, will depend on your situation and circumstances. So, let us explain …

1) There’s no reason to expect that regularly scheduled appointments will hurt.

When it comes to having endodontic therapy performed (like the case where your dentist has already diagnosed your tooth’s nerve problem and has reappointed you for your tooth’s work), experiencing pain really shouldn’t be much of a factor.

If you’ve heard remarks to the contrary, what you’ve been told is probably more rumor than fact. Consider these findings:

A survey conducted by the American Association of Endodontists (root canal specialists) found that people who had actually had root canal therapy were 3 times more likely to say the process was painless as opposed to those who had never had the procedure performed.

Isn’t that interesting? Conventional wisdom about how painful root canals always are doesn’t seem to be based on real experiences at all. It’s more myth than fact.

▲ Section references – AAE

Root canal appointments as compared to having other dental procedures.

• For routine cases, most people would probably consider having a root canal no more an ordeal than having a relatively large dental filling placed.
• And when compared to tooth extraction (the only other alternative to having this procedure Why?, while it does take longer, it’s certainly a more civilized process.

2) Statistics about how badly root canal treatment hurts.

If instead of opinion you want some firm facts, here’s what some research studies have reported about the level of discomfort patients felt when having their endodontic therapy performed.

Study #1 –

This paper by Segura-Egea (2009) specifically evaluated the issue of pain experienced by patients during their root canal procedure.

• Its findings were that 54% felt no pain. Of the remaining subjects, 34% experienced slight, 9% moderate and 3% felt severe pain. No cases involved unbearable discomfort.

All of the cases in which subjects reported intense pain involved teeth that were acutely inflamed (the tooth was painful before the procedure was begun). Of the cases involving teeth that had no preoperative symptoms, very few patients experienced moderate and none reported intense pain.

▲ Section references – Segura-Egea

Study #2 –

As another example of what you can expect, a historic study by Lobb (1996) followed up with patients one year after they had had their root canal procedure completed.

• 90% of subjects stated that they would choose to have endodontic treatment again.
• Cost, which was distantly followed by experiencing pain, was the most important factor for the 10% who would not opt for this treatment approach again.

▲ Section references – Lobb

3) Steps dentists take to make sure your procedure is comfortable.

Your dentist will be just as eager as you for you to have a pain-free experience. So, toward this shared goal, here are some of the things they will do to help to ensure that that happens.

a) Appointment timing.

Regular endodontic visits (as opposed to emergency ones) are generally targeted for a period when your tooth is expected to be relatively “quiet” (having no or just minimal symptoms). That’s because this time frame offers a window during which the tissues associated with your treatment will respond most predictably.

For people whose tooth has never been bothersome, this point isn’t much of an issue. But if a recent flare-up has occurred, your dentist will want to wait until a point when the inflamed tissues involved have had a chance to settle down substantially.

b) Numbing your tooth.

Of course your dentist will numb up your tooth for its procedure. Doing so will involve their administering a local anesthetic, as in, they’ll need to give you a “shot.”

Giving a dental injection.

Some things to know.

For the most part, the injection(s) they give will be the same as those given if your tooth instead required a filling or even a restoration like a dental crown. So, you probably won’t be experiencing anything you haven’t been through before.

One thing that is somewhat unique to root canal procedures is the use of a rubber dam. And so you don’t feel the pinch of the rubber dam clamp What’s this? that’s used, your dentist may need to numb up your tooth’s surrounding gum tissue. And, compared to a filling procedure, this may mean getting an extra shot.

As good news, for the large majority of patients, once their injections have been administered the remainder of their appointment can be expected to be relatively pain-free (see Statistics section below).

FYI: If you’d like more information about dental injections, like why some pinch more than others and which ones tend to hurt the most, check out our page: Dental shots – Why do some hurt? Jump

More things to know about being numbed up for a root canal appointment.

In an effort to be forthright and complete, we feel we should mention the following additional points.

It will likely take giving you more than one injection (stick of the needle) to adequately anesthetize everything that needs to be numbed up.

(One or more pricks for the tooth itself, and then one or more additional ones to anesthetize its surrounding gum tissue.)

The kinds of injections dentists use to numb up the gums on the palate side of upper teeth (to prevent rubber dam clap discomfort during its use) tend to pinch. And in some locations, even quite a bit.

Lower back teeth are usually the most challenging to numb up. But even for them, using standard techniques, success rates for local anesthesia run on the order of 75 to 90%. Of course, if your initial shots did not provide adequate numbness, your dentist will administer additional anesthetic so success is achieved.

Anesthetics tend to be less effective when administered in inflamed tissues (like tissues affected by endodontic flareup/tooth abscess) and that can present a challenge for the dentist. (That’s one reason why your dentist will want to give your tooth some time to settle down before beginning its endodontic treatment.) But they have adjunct techniques they can use to get the job done.

▲ Section references – Rosenberg

Pre-procedure numbness testing your dentist can perform.

Each type of injection that a dentist gives produces effects in a characteristic way. For example, when lower molars are numbed up, the corner of the patient’s lower lip on the same side feels numb too.

So if the patient confirms that “lip signs” are present, the dentist can generally assume that the tooth’s nerve is numb too. However, and as mentioned above, this isn’t always the case.

More conclusive testing.

In cases where the tooth slated for endodontic therapy has some remnant of vital (live) tissue remaining in it, the profoundness of its anesthesia can be evaluated directly, and more accurately.

Thermal (cold) How it works. and electric pulp testing How it works. are two common methods dentists use to evaluate the status of a tooth’s nerve (teeth with live nerve tissue typically respond with sensitivity to both tests).

The plan would be one where the tooth due to receive treatment is tested before its anesthetic is given (so the dentist has baseline readings) and then after. If the repeated tests are negative (nothing is felt), it’s a strong indication that profound pulpal anesthesia has been achieved.

c) Managing your dental anxiety can help to improve your experience.

Different from pain management is the issue of patient management (a behavioral issue).

• Research has shown that there is a relationship between the degree of pain a patient experiences and the level of stress, anxiety, or pessimism that they hold.
• The higher the level of these factors, the more likely the patient is to interpret the sensations they feel as pain.

Don’t keep your dentist in the dark.

That means you need to be upfront with your dentist about your fears or concerns with your upcoming procedure. Doing so will give them a chance to figure out a solution. Here are some of the things that can help.

• Conscious Sedation. – This technique involves the use of medications (laughing gas, oral or IV sedatives Common sedation options.) that help to place the patient at ease.

  You remain awake, in the sense that you can respond to questions and commands, you just care less about what’s going on.

  As a side note, you’ll still also respond to pain sensations. And for that reason, your tooth and gums must still be numbed up. However, if getting an injection is the hard part for you, ask if the sedation medication can be administered first.

• Hypnosis. – The use of hypnosis as a means of relieving anxiety has a long history in both medicine and dentistry. At an extreme, the use of mediation-hypnosis has been documented as the sole anesthesia used for a root canal case (Morse 1979).

• Information. – Knowing the details about your upcoming dental procedure can be an important anxiety reduction technique. (Looking for this type of input may be one reason why you’re reading this page right now.)

  But don’t just read, ask your dentist questions too. If concerns about pain are an important consideration for you, let them explain what steps they plan to take and why it’s unlikely to become an issue.

• Distraction. – Coming up with ways to take your mind off your procedure can help to alleviate anxiety and as a result, minimize the level of discomfort you experience.

  As a plan, take your music player or favorite video game (and headphones please) with you to your appointment.

▲ Section references – Morse

4) There is some potential for post-treatment pain.

We wouldn’t be telling you the whole story if we didn’t mention that after your root canal appointment there is some potential that your tooth might hurt (it really should just be minor).

We’ve dedicated an entire page to this subject: Root canal aftercare and precautions. What to do.

5) Pain management during emergency visits.

It seems likely that many of the remarks that you hear about how painful having root canal therapy is should really be attributed to those events that initially signaled that it was needed Signs | Symptoms, and not the procedure itself. And when this type of tooth flare-up occurs, an emergency trip to your dentist’s office is indicated.

Acute flare-ups.

In some instances, the final (and possibly only) sign that a tooth needs root canal treatment is experiencing a painful, severe toothache.

It would be dishonest to suggest that during this type of event (a time when you are stressed, and your tooth and its surrounding tissues are inflamed and possibly involved with an active infection) that the steps your dentist must take to provide pain relief and to set the stage for the healing process can always be accomplished with absolutely no discomfort.

a) Difficulties associated with inflammation.

One big problem associated with acute tooth flare-ups is that local anesthetics are much less effective when used with tissues that are inflamed. In fact, there’s an 8-fold higher failure rate as compared to when teeth are numbed under normal circumstances. (Rosenberg – linked above.)

Solutions.

• In some cases, simply allowing more time for the anesthetic to take effect may be all that’s needed. Your dentist may ask you to arrive 20 or 30 minutes early so they can employ this technique.

  Other times the solution may lie in modifying the way the anesthetic is given or simply using more of it (although there are specific dosing guidelines that must be followed).

• As an alternative, your dentist may employ a technique where the anesthetic is placed directly between the tooth and surrounding bone, or in the jawbone in the region of the root’s tip. These methods are respectively termed intraligamentary and intraosseous injections. And while they can be, they aren’t usually used to numb up teeth for routine procedures.

• It may be that things have been going just fine with your procedure, until that point where your dentist starts to work directly with your tooth’s nerve. If so, they may utilize an intrapulpal injection.

  This type of shot is given directly inside your tooth. And interestingly enough, it’s not the anesthetic that’s used that’s the effective factor. It’s the pressure created by the injection process that deadens (conks out) the tooth’s nerve (so really, even just injecting water could be successful).

  While this sounds like a horrible injection to get, it’s more of a good news, bad news type of situation. Yes, you will feel the injection (a sharp pain) but just for a split second. Then, that’s all. Your dentist should then be able to continue with your procedure painlessly.

• Your dentist may ask you to take an NSAID (nonsteroidal anti-inflammatory drug) prior to your appointment. Ibuprofen/Motrin/Advil (Common over-the-counter pain medications), ketorolac, and diclofenac have a history of being used for this purpose.

  Studies suggest that with cases where teeth with inflamed nerve tissue are being treated, pretreatment dosing with an NSAID helps to create an environment where the local anesthetic used will be more effective. (Hargreaves, Nagendrababu)

• Experiencing an acute tooth flare-up can be a stressful event. And patients that have are usually tense and exhausted and typically respond to pain more so than under normal circumstances.

  As discussed above, the use of sedation techniques (laughing gas, oral or IV medications) can help to relax these types of patients, and as a result, decrease the amount of discomfort they experience.

▲ Section references – Hargreaves, Nagendrababu

b) Difficulties associated with infections.

Tooth flare-ups that involve a significant amount of swelling will complicate pain management.

• It may be that the swelling limits your ability to open your mouth, thus preventing any type of treatment directly involving your tooth.
• As a general rule, dentists don’t inject quantities of anesthetic into areas of swelling (for fear of spreading infection/bacteria to other tissues). With teeth that hurt, this may mean that no direct treatment is possible.

Solutions.

Even if your dentist can’t work directly with your infected tooth now, they can initiate treatment that will help to clear up its infection more quickly so later on they can.

• Placing you on antibiotics will help to bring your infection under control more quickly.
• If the swelling has localized (a boil, pimple, or swollen bump near your tooth), your dentist may be able to make an incision in the affected tissue that allows the trapped pus to drain.

To keep you comfortable until that time when your tooth can be worked on, your dentist will likely have you take some type of oral analgesic (pain pills), either prescription or over-the-counter.

What’s next?

We have a lot more information about root canal treatment …