A root canal has a worse reputation than it deserves. It is the treatment that stops toothache, not one that causes it, and for most people it feels much like having a filling done. This page explains what actually happens, so you can decide with real information rather than with what someone told you years ago.
If you are in pain right now, call 201-425-8600. We keep time aside each working day for urgent cases. We are at 115 Christopher Columbus Drive, Suite 200, two minutes from the Grove Street PATH.
Why a tooth needs one
Inside every tooth, under the hard outer layers, is a soft core of nerve and blood vessels. When decay gets deep enough, or a crack lets bacteria in, or a tooth takes a heavy knock, that core becomes infected.
The infected tissue cannot heal on its own and antibiotics cannot reach it, because there is no blood supply left to carry them in. That is the key fact, and it is why a course of antibiotics from an urgent care clinic makes the pain fade and then come back. The infection has to be physically removed.
Left alone it spreads out of the bottom of the root into the jawbone and forms an abscess. At that point you are looking at swelling, possible emergency treatment, and usually losing the tooth.
The signs
- Pain that lingers for more than a few seconds after something hot or cold
- Pain that wakes you at night, or that throbs when you lie down
- Tenderness when you bite on one particular tooth
- A tooth that has gone darker than its neighbours
- A small pimple-like spot on the gum that comes and goes
- Swelling in the gum or face — see us the same day
Not every one of these means a root canal, and some teeth need one with no pain at all, found on an x-ray. That is why we take a picture before telling you anything.
What actually happens
Usually one appointment of about sixty to ninety minutes, occasionally two for a molar or an awkward case.
- Numbing. Local anaesthetic, the same as for a filling. We wait until it has properly taken hold and we check with you before starting. An infected tooth can be harder to numb, so tell us if you still feel anything rather than gritting your teeth — there are ways round it.
- Isolating the tooth. A small sheet of rubber goes over it to keep it dry and clean. It also means nothing goes down your throat, which most people find more comfortable, not less.
- Opening and cleaning. A small opening in the top of the tooth, then the infected core is removed and the narrow canals inside the roots are cleaned and shaped and disinfected.
- Filling and sealing. The cleaned canals are filled with a rubber-like material so bacteria cannot get back in, and the opening is sealed.
- Protecting it. Almost always a crown afterwards. See below, because this is the part that surprises people.
Does it hurt
The treatment itself should not. You are numb, and the sensation most people report is pressure and vibration rather than pain. A great many patients tell us afterwards that it was easier than they had braced for.
The reputation comes from a time before modern anaesthetics, and from the fact that people arrive already in severe pain from the infection. What they remember is the toothache that brought them in.
Afterwards the tooth is often tender to bite on for a few days, sometimes up to a week, because the ligament around the root has been disturbed. Ordinary painkillers handle it. Sharp pain, swelling, or pain that is getting worse rather than better after the first few days is not expected — call us.
The crown afterwards, and the cost nobody mentions
A tooth that has had a root canal is more brittle than a living one. It has lost its blood supply, it has had material removed from the inside, and the back teeth in particular take heavy load every time you chew. Without protection, a fair number of them eventually split, and a split root usually cannot be saved.
So a back tooth almost always needs a crown after root canal treatment. Front teeth sometimes manage with a filling.
Budget for both from the start. The commonest unpleasant surprise in dentistry is someone who priced the root canal, had it done, and then learned that the crown is a separate treatment at a separate cost. We quote you for the whole thing at the outset, and we will tell you plainly if the crown can wait a little while.
Root canal or take the tooth out
This is a fair question and we will give you a straight comparison rather than steering you.
Keeping the tooth costs more up front, and once it is done you still have your own tooth, with your own root holding the bone in place. A well-treated tooth commonly lasts many years and often decades.
Taking it out is cheaper and quicker today. But the gap does not stay a gap: the teeth either side lean into it, the opposing tooth drifts down, and the bone where the root was begins to shrink. Replacing it later with a dental implant or a bridge costs considerably more than the root canal and crown would have.
Extraction is sometimes genuinely the better answer — a tooth that is broken far below the gum, or so decayed there is nothing left to build on. When that is the case we will say so rather than talking you into treatment that will not last.
How long it lasts
Root canal treatment has a strong long-term record, especially when the tooth is crowned promptly and looked after. The two things that shorten it are delaying the crown, and decay creeping in at the edge of the restoration years later.
A treated tooth cannot feel decay, because the nerve is gone. That is worth knowing: it does not warn you, so it needs check-ups like any other tooth. Occasionally a treated tooth flares up again later, which can usually be dealt with by re-treating it.
If you are nervous
Tell us when you book, not when you are in the chair. It changes how we plan the appointment — more time, a slower start, stopping when you raise a hand, and explaining each step first if that helps, or deliberately not describing it if you would rather not know.
Dr. Singal earned her Doctorate in Dental Surgery at the New York University College of Dentistry and carries out root canal treatment herself, so you are not referred out mid-problem. More about the practice.
We see patients from across downtown Jersey City, including Grove Street, Exchange Place and Paulus Hook. For swelling or a broken tooth right now, see emergency dental care.
Does a root canal hurt?
The treatment itself should not, because the tooth is fully numbed first. Most people describe pressure and vibration rather than pain, and many say it was easier than expected. The reputation comes from the severe toothache that brings people in, which the treatment is what relieves.
How long does a root canal take?
Usually one appointment of sixty to ninety minutes. A molar, which has more canals, or an unusually awkward tooth may need two visits.
Will I need a crown afterwards?
A back tooth almost always does, because a treated tooth is more brittle and molars take heavy load when you chew. Front teeth can sometimes be restored with a filling instead. Ask for the cost of both up front, as the crown is a separate treatment.
Can antibiotics fix it instead?
No. Once the core of the tooth is infected there is no blood supply to carry antibiotics into it, which is why the pain fades on a course of tablets and then returns. Antibiotics can calm surrounding swelling, but the infection inside the tooth has to be physically removed.
Should I just have the tooth pulled instead?
Extraction is cheaper today but rarely cheaper overall. The neighbouring teeth lean into the gap, the opposing tooth drifts, and the bone shrinks. Replacing the tooth later with an implant or bridge costs considerably more than the root canal and crown. Sometimes extraction is genuinely the right answer, and we will tell you when it is.
How long will the tooth last afterwards?
Commonly many years and often decades, provided the crown is fitted promptly and the tooth is kept clean. Because the nerve is gone the tooth cannot warn you about new decay at the edges, so it still needs regular check-ups.
What if it still hurts a few days later?
Tenderness when biting for a few days, sometimes up to a week, is expected and settles with ordinary painkillers. Sharp pain, swelling, or discomfort that is getting worse rather than better is not expected. Call us.
Can I go back to work afterwards?
Yes, most people do. You are numb for a few hours, so take care with hot drinks and avoid chewing on that side until the feeling returns.