Root Canal Explained
Root canal treatment has a reputation it no longer deserves. For most people it feels no different from having a filling, and it's often the treatment that ends the pain rather than causes it. Here's what it involves, and what your other options are.
Root Canal in Edinburgh: What Happens, and Does It Hurt?
Root canal treatment removes infected or inflamed tissue from inside a tooth, cleans and seals the canals, and lets you keep a tooth that would otherwise need to come out. It's done under local anaesthetic, usually over one or two visits, and feels much like a filling. At Comely Bank Dental in Edinburgh, fees range from £450 for a front tooth to £595 for a molar.
What Is Root Canal Treatment, and When Is It Needed?
Inside every tooth is a space containing the pulp: nerves, blood vessels and connective tissue that run down through narrow channels in the roots, called root canals. If the pulp becomes badly inflamed or infected, it can't heal on its own. Root canal treatment removes that tissue, disinfects the canals and seals them, so the tooth can stay in your mouth without pain or infection.
The pulp usually gets into trouble because of:
- Deep decay that has reached, or nearly reached, the nerve
- A crack or fracture that lets bacteria in
- A knock or injury, sometimes years earlier
- Repeated work on the same tooth, such as several large fillings over time
Root canal treatment is the main alternative to taking the tooth out. If you'd like to keep the tooth, it's usually the treatment that makes that possible.
Signs a Tooth Might Need a Root Canal
Not every toothache means root canal treatment. Brief sensitivity that fades within seconds often settles with a filling or simpler care. These signs point more towards a nerve that's beyond recovery:
- Pain to hot or cold that lingers for a minute or more after the drink has gone
- Throbbing pain that starts on its own, or wakes you at night
- Pain when you bite or press on the tooth
- Swelling of the gum or face, or a small spot on the gum that weeps (a sign of a dental abscess)
- A tooth that has darkened after an old injury
Sometimes there are no symptoms at all. A nerve can die quietly, and we find the infection on a routine X-ray as a dark area at the tip of the root.
A note on antibiotics: they don't cure toothache or an infection inside a tooth, because the source of the bacteria is sealed inside where the blood supply can't reach. They're only appropriate if infection is spreading, with facial swelling or fever. The real fix is removing the cause, either by root canal treatment or extraction.
Toothache That Won't Settle?
Call us. We offer emergency appointments, and we'll find out whether the tooth needs root canal treatment or something simpler.
How Do We Decide If Your Tooth Can Be Saved?
Before recommending treatment, we examine the tooth, test how it responds to cold and tapping, and take an X-ray to see the roots and the bone around them. In more complicated cases, such as curved roots, a suspected extra canal or an unexplained problem, our on-site CT scanner gives a 3D view.
We're also asking whether the tooth is worth saving. Root canal treatment isn't the right choice when:
- There's too little tooth left to restore once the decay is removed
- A crack runs down into the root
- Gum disease has left the tooth with very little bone support
In those situations we'll explain why, and talk you through extraction and replacement instead. It's better to know at the start than to spend money on a tooth with a poor outlook.
What Happens at Each Appointment?
Most root canal treatments take one or two visits, each lasting roughly an hour to an hour and a half. Front teeth usually have one canal and are quicker. Molars have three or four, sometimes more, and often take two visits.
At the first visit:
- The tooth is numbed with local anaesthetic.
- A rubber dam, a thin sheet that fits around the tooth, keeps it dry and free from saliva and stops anything falling into your mouth.
- A small opening is made in the top of the tooth to reach the pulp.
- The canals are located and their length measured electronically and with X-rays.
- The canals are cleaned and shaped with fine instruments while being flushed with disinfecting solutions.
If we're finishing in two visits, an antibacterial dressing is placed inside the canals and the tooth is sealed with a temporary filling.
At the final visit, the canals are filled with a rubber-like material called gutta-percha and a sealer, and the top of the tooth is sealed. We take a final X-ray to check the result.
Does Root Canal Treatment Hurt?
The treatment itself shouldn't. Modern local anaesthetics are very effective, and the tooth is numb before we begin. Most people say it feels like a long filling: some pressure and vibration, and a bit of tiredness from keeping your mouth open.
A badly inflamed tooth, especially a lower molar, can occasionally be harder to numb. If that happens we give additional anaesthetic in a slightly different way, and we don't carry on until you're comfortable. Tell us at any point and we'll stop.
Afterwards, the tooth and gum often feel tender for a few days, especially when biting. Over-the-counter painkillers you can safely take usually manage this. Occasionally there's a flare-up with more pain or swelling, which needs a call to the practice.
If you're anxious about dental treatment, you're far from alone. We can take things slowly, build in breaks and, for very nervous patients, offer IV sedation. Our nervous patients page explains more.
How Successful Is Root Canal Treatment?
When a root canal is well carried out and the tooth is properly restored afterwards, most treated teeth heal and stay comfortable. Research reviews of first-time treatment commonly find that around 85% or more of root-filled teeth are still in place and working several years later. Rates of complete healing are a little lower when strict criteria are used, and every tooth starts from a different place, so results vary.
Several things improve the odds:
- Treating the tooth before infection is long-standing
- Thorough cleaning under a rubber dam
- A good seal at the top of the tooth, so bacteria can't leak back in
- Protecting back teeth with an onlay or crown
Treatment can still fail. Bacteria can survive in a hidden canal or tiny side branch, a seal can leak, or a tooth can crack. We'll review the tooth with an X-ray at a later dental examination to make sure it's healing.
Will the Tooth Need a Crown Afterwards?
Back teeth usually do. A molar or premolar that needs root canal treatment has often lost a lot of its structure to decay or old fillings, and the access opening removes a little more. Without its cusps protected, it's at risk of splitting, and a split root often can't be saved.
So for back teeth we normally recommend an onlay (£800) or crown (from £760) a few months after the root filling, once we're happy it's settling. If little tooth is left, a fibre post and build-up may be needed first.
Front teeth take less biting force. A root-filled front tooth that is largely intact can often be restored with a white filling, and a crown is only needed if a lot of tooth has been lost. Our dental crowns page has more detail.
What Are the Alternatives to Root Canal Treatment?
The only real alternative is taking the tooth out. Leaving an infected tooth untreated isn't a safe option, because infection can spread and cause swelling or further bone loss, even if the pain fades.
After an extraction, you can choose to:
- Leave the gap, which may be fine at the back of the mouth, though neighbouring teeth can drift and tilt
- Replace it with a dental implant, the closest thing to a natural tooth, but a bigger and more expensive treatment
- Replace it with a bridge or denture, depending on the teeth either side
Where a tooth can be saved with a good outlook, we generally recommend keeping it. Your own tooth, well restored, is hard to improve on. But it's your decision, and we'll lay out the costs and trade-offs of each route in writing.
How Much Does Root Canal Treatment Cost in Edinburgh?
At our Comely Bank practice, fees depend on the tooth, because more roots mean more canals and more time:
- Front tooth (incisor or canine): £450
- Premolar: £525
- Molar: £595
- Repeat root canal treatment: from £595
A back tooth will usually need an onlay or crown afterwards, which is a separate fee. If you come to us in pain, an emergency visit can include removing the inflamed nerve to relieve symptoms (£110) before treatment is completed.
All fees are guide prices confirmed in a written treatment plan before we start. Members of our dental plan save 10% on most private treatment.
Questions
This guide is general information, not a diagnosis. A dentist needs to examine you to say what is right for your teeth.