Root canal treatment: the honest guide
Few dental procedures have a worse reputation than root canal treatment — and few reputations are less deserved. This guide explains what it actually involves, when it may be needed, and why most patients describe the experience as far more straightforward than expected.
Important
This guide is for general information only. Whether root canal treatment is needed — and whether it is the right option — can only be determined by a dentist following examination and X-rays. If you are in pain, please book an assessment rather than using this guide to self-diagnose.
What is root canal treatment?
Every tooth contains a soft tissue called the pulp — a bundle of nerves, blood vessels, and connective tissue inside the root canals (the narrow channels that run through the root of each tooth). When the pulp becomes infected or irreversibly inflamed, it cannot heal on its own.
Root canal treatment (also called endodontic treatment) removes the affected pulp, cleans and shapes the root canals, and seals them to prevent re-infection. The tooth is then restored — usually with a crown to protect it.
The alternative to root canal treatment is extraction — removing the tooth entirely. Root canal treatment, where clinically viable, allows you to keep the tooth.
When might root canal treatment be needed?
Root canal treatment may be recommended when the pulp inside a tooth becomes infected or irreversibly inflamed. Common causes include:
• Untreated decay reaching the pulp • A tooth that has been cracked or fractured deeply • Repeated dental procedures on the same tooth • A tooth that has been traumatised (e.g. knocked in an accident)
Symptoms that may indicate pulp involvement (these don't confirm root canal treatment is needed — only clinical assessment can — but they are worth getting checked):
• Pain that lingers after the hot/cold trigger is removed (rather than passing quickly) • Spontaneous pain — particularly at night — with no obvious trigger • Swelling or a persistent pimple on the gum near the tooth • Severe, throbbing pain • Darkening of the tooth
Does it hurt? The honest answer
Root canal treatment has a fearsome reputation — and it's almost entirely historical. The technique and anaesthetics available today are significantly better than they were decades ago, and the procedure is routinely carried out under local anaesthetic with the tooth fully numb.
Most patients report that the experience is comparable to having a filling — occasionally uncomfortable, rarely painful. Post-procedure discomfort is usually mild and manageable with over-the-counter painkillers for a day or two.
The pain that drives patients to seek treatment is caused by the infection, not the treatment itself. Root canal treatment removes the source of that pain.
What does the process involve?
01
Assessment and X-ray
The tooth is examined and an X-ray taken to map the root canals and assess the extent of infection or inflammation. This determines whether root canal treatment is appropriate.
02
The procedure
Under local anaesthetic, a small opening is made in the top of the tooth. Very fine instruments are used to remove the pulp tissue, clean and shape each canal, and irrigate to remove bacteria. This typically takes 60–90 minutes, sometimes over two appointments for more complex teeth.
03
Sealing
Once clean, the canals are filled with a rubber-like material called gutta-percha and sealed with cement to prevent re-infection.
04
Restoration
Root-treated teeth are more brittle and prone to fracture. A crown is usually recommended — particularly for back teeth — to protect the tooth long-term.
What if I choose extraction instead?
Extraction is a valid option — and in some cases it's the right one (if the tooth is too damaged to restore, or if root canal treatment is not clinically viable). But it creates a gap, and replacing a missing tooth has its own implications and costs.
Where root canal treatment is viable and the tooth can be restored, most dentists will recommend it over extraction — preserving your own tooth is almost always preferable. Your dentist will give you an honest view of which option makes sense for your specific situation.
What does root canal treatment cost?
| Tooth type | Approx. cost | |
|---|---|---|
| Front tooth (single root canal) | £500 – £750 | |
| Premolar (1–2 canals) | £650 – £900 | |
| Molar (3–4 canals) | £850 – £1,200 | |
| Plus crown (recommended after) | £900 – £1,200 |
Indicative ranges only. Final costs confirmed following examination and X-ray.
Questions to ask at your appointment
Is the tooth salvageable?
Is the tooth salvageable — or would extraction be the better option?
How many canals?
How many canals does this tooth have, and how complex is the treatment likely to be?
One or two appointments?
Will this be done in one appointment or two?
What are the success rates?
What are the success rates for this type of case?
Will a crown be needed?
Will a crown be needed afterwards, and what would that add to the cost?
What happens if I delay?
What happens if I delay treatment?