"Root canal" has become shorthand for something horrible. In surveys where people are asked what they most dread, root canal treatment often outranks public speaking, turbulence, and tax audits. The irony is that most people who have actually had root canal therapy describe it as no worse than a filling — sometimes easier.
The fear is not irrational: it dates from a period before effective local anaesthetics when the procedure was genuinely painful. Modern root canal therapy is a different experience.
What a root canal actually is
Inside every tooth, below the hard enamel and dentine, is a soft tissue called the pulp. It contains blood vessels and nerves. When a tooth is healthy, the pulp is unremarkable — you are not aware of it. When bacteria reach the pulp through a deep cavity, a crack, or a failed restoration, the pulp becomes infected or dies.
An infected pulp cannot heal on its own. Without treatment, the infection spreads to the bone surrounding the root, causes an abscess, and eventually threatens the tooth entirely. Root canal therapy — technically called endodontic treatment — removes the infected pulp, cleans and shapes the canals inside the root, and seals them to prevent re-infection. The tooth is then restored, usually with a crown.
"The pain people associate with root canals is the infection before the procedure, not the procedure itself. We numb the tooth thoroughly before we start."
— Dr. Adaeze Okafor, BDS, FMCDS
What happens during treatment
The dentist administers local anaesthetic — the same type used for fillings — and waits for the tooth to go fully numb. A rubber sheet called a dam is placed around the tooth to keep it clean and dry. The dentist then opens the crown of the tooth with a small drill and uses progressively larger files to clean the canals inside the root.
The canals are rinsed with an antibacterial solution (usually sodium hypochlorite — the same substance as household bleach, in a dental concentration) and shaped with rotary instruments. Once clean and dry, they are filled with a rubber-like material called gutta-percha and sealed.
A simple root canal on a front tooth takes 45–60 minutes. Molars, which have 3–4 canals, may take 90 minutes or require a second visit. Some difficult cases are referred to an endodontist — a dentist who specialises in root canals.
Does it hurt?
During the procedure: if the anaesthesia is working properly, no. You will feel pressure and vibration. You may feel a brief sting when the anaesthetic is injected. You should not feel sharp pain; if you do, tell the dentist immediately and more anaesthetic can be given.
After the procedure: expect tenderness for 2–4 days. The area around the root tip is inflamed from the infection, and cleaning the canals disturbs it further. Over-the-counter ibuprofen (if suitable for you) or paracetamol controls this well for most people. Severe or escalating pain after 72 hours warrants a call to your dentist.
What happens to the tooth afterward
A root-treated tooth is no longer living — it has no pulp — but it can last decades, sometimes a lifetime, with proper care. Because the tooth becomes more brittle without its internal blood supply, it almost always needs a crown to prevent fracture, particularly on the biting surface.
Without a crown, a root-treated molar has a meaningful risk of cracking catastrophically, which would mean extraction. The crown is not optional; it is the final step of the procedure.
When root canal is not the answer
Root canal therapy is not always possible. If a tooth is too badly broken down, if the bone loss from infection is too severe, or if the canals are calcified and inaccessible, extraction may be the more appropriate choice. Your dentist should present both options and discuss the cost and consequences of each. Replacing an extracted tooth with an implant or bridge has its own implications and costs.