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How to know if your tooth needs root canal: symptoms and treatment

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Tooth pain is often a sign of serious issues with your teeth; however, a toothache does not always mean you need a root canal. Continue reading to understand how to know for sure if your symptoms mean a root canal is necessary for you.

According to a computer-assisted interview held in Maryland, 44.3% of U.S. citizens have experienced at least five toothaches within the last ten years. 45.1% of these respondents estimated the pain intensity of their last toothache as the highest possible. The survey showed that, in general, pain sufferers preferred self-care measures based on nonprescription medicines to decrease pain intensity, rather than professional dentist prescriptions.

The self-diagnosing strategy is a poor one that can lead to the necessity of tooth removal if too much time is lost before professional diagnosis. In this case, self-confidence can become a serious mistake and result in too much pain and one tooth less. But, one less tooth is not the most frightening consequence of a delayed toothache, however, and modern history tells of certain cases where a simple toothache has been fatal.

In 2007, a 12-year-old boy from Maryland died from a brain infection. Before his death, he had two surgeries that costed his family about $250,000. The cause of such a terrible infection was due to bacteria from an abscess, but his life could have been saved with a simple tooth extraction performed in time, for only about $80. That is why a timely root canal treatment can prevent abscesses, keep your smile unhidden, and even save your life. In this article, we will discuss root canal therapy in a more detailed manner, including the cases where it is needed, and how to perform proper aftercare.

What Is a Root Canal?

A root canal has two meanings: the first refers to the inner tooth situated between the tooth roots and the pulp. The second refers to the tooth treatment aimed at the removal of infected material and elimination of a toothache. Root canals have blood vessels for delivering nutrients to teeth and nerves that identify various influencing factors, such as cold, heat, and pressure. Many patients often ask: “When would I need a root canal, and is it necessary to remove a nerve in cases where I only have a toothache?” All these aspects are tightly connected. Removing a nerve is one of the stages of root canal therapy that is required when there is tooth decay and a pulp infection. Below, we will consider this procedure in more detail.

What Causes a Root Canal Infection?

A root canal infection can occur for several reasons, though the basic root of the problem is always the penetration of bacteria into the pulp. Reasons for root canal infections are determined by the way the bacteria invades the tooth pulp. In this paragraph, we list the main causes of such an infection. The reasons for root canal infection include:

  • Dental decay (caries) that allows bacteria to penetrate into the pulp and infect it.
  • A cracked or damaged tooth, which opens the way for bacteria.
  • An avulsed tooth that allows bacteria to penetrate into the pulp.
  • Various tooth displacements caused by extrusion, intrusion, or subluxation.
  • Sterile necrosis caused by tooth concussion (signs include tooth discoloration or highly calcified canals, which can be identified by x-ray).
  • Tooth anatomy abnormality that allows bacteria to infect pulp tissue.
  • Repeated dental treatments on the same tooth.

According to our experience, the main reason for a root canal infection is the caries that damages the tooth and allows bacteria to access and infect the pulp. This is why it is important to timely identify and eliminate caries in order to prevent pulp infections.

When Is a Root Canal Needed?

The need for root canal therapy can be effectively identified by a professional dentist; however, patients can also prepare themselves by taking specific characteristics into account. In this paragraph, we will cover the main symptoms that are evident and can indicate the necessity of a root canal.

Symptoms Identifiable by Patients

Only qualified dentists are able to determine the necessity of a root canal, using professional methods. The following symptoms of root canals, however, can also let patients know what they can expect from future dental treatments.

  • Pain;
  • Swelling;
  • Gum tenderness; and,
  • A general feeling of illness.

Whether the patient is experiencing one or several of these symptoms, there is a likely a problem. Each characteristic has to be analyzed further, and in a detailed manner, in order to determine the necessity of a root canal.


Strong pain does not always mean that the patient needs a root canal treatment. In some cases, the tooth which requires the surgery, may not even hurt. When pain is present, however, this can indicate a necessity for a root canal. By determining whether the pain is intense and sharp or a dull ache, a patient can understand what to expect from their next visit to a dentist.

Pain types that can help identify a root canal infection include:

  • A pulsing toothache;
  • Pain intensity changing when a patient changes their posture;
  • Pain so severe that a patient cannot sleep at night.
  • A spontaneous toothache (continuous or intermittent);
  • Pain triggered by specific stimuli like tapping, pressure, or a thermal insult (eating hot food right after cold food, and vice versa);
  • A toothache cannot be fully eliminated with painkillers; and,
  • The patient can easily identify which tooth hurts, or indicate a painful area.

Therefore, any type of pain can be a sign that a root canal is infected and a corresponding treatment is needed. Pain must be considered together with other symptoms to indicate the problem.

Swelling and Gum Tenderness

Swelling does not always indicate that there is a need for root canal surgery. Though, when it emerges with any type of a tooth pain, it can indicate the necessity of such treatment. Swelling can come in various forms and types. Whether it looks normal with some kind of tenderness, or is an obvious lump that can be easily seen or felt, it often means that root canal surgery is required. In some cases, the swelling can even expand to the patient’s face or neck.

Swelling characteristics that can indicate a root canal infection include:

  • Gum swelling is situated in front of the root tip.
  • A gum boil on the tip of the root.
  • Pronounced swelling can be any size: from hardly visible to an obvious lump that is easy to feel.
  • Swelling can last for either days or months.
  • Foul breath odor is present, as a result of the pus coming from the root canal.
  • The problem tooth feels as taller than neighboring teeth.

The swelling may not be accompanied by a toothache, but can still mean that a root canal is required. Furthermore, swelling itself is not always the sign you need such a procedure; however, the swelling is always a sign indicating that the tooth requires urgent medical treatment. In most cases, dentists prescribe oral antibiotics to deal with infection and eliminate swelling.

General Feeling of Illness

Swollen or tender lymph nodes, a fever, and a general feeling of uneasiness can all be indicators that endodontic surgery is needed, especially when these symptoms are accompanied by other signs. If you feel ill and have any of the above-mentioned symptoms, you must inform your dentist and, do your best to avoid coming up with a  diagnosis on your own. Consulting with a qualified dentist will save you precious time and ensure you will be able to save your tooth.

Symptoms Identifiable Solely by Dentists

After having listened to your symptoms and concerns, a dentist will use professional methods to define whether endodontic therapy is required. In this paragraph, we will cover the common techniques and methods dentists use to indicate the need for a root canal.

The methods dentists use to indicate a canal root is required include:

  • X-rays;
  • Identifying persistent or recurring gum boils;
  • Identifying the darkened problem tooth;
  • Occurred nerve exposure;
  • Tapping on the problem tooth;
  • Thermal and electric testing;
  • Selective anesthesia; and,
  • The cavity test.

Dentists may not always use every single one of the above-mentioned techniques, and a root canal prescription does not necessarily require the presence of gum boils, a problem tooth being darkened, or a sharp pain as a result of tapping. For a professional dentist, several points are enough to indicate that endodontic therapy is required. In most cases, even one of these signs (e.g. x-ray) can inform a dentist of the best treatment for the problem; however, specialists often use several techniques to determine this, for sure.


After having read our article, you have already learned what causes you to get a root canal; however, when a problem tooth provokes no pain and swelling, you may not even notice that you need urgent dental treatment. That is why regular x-ray examinations can timely identify emerging problems with teeth, allowing you to apply efficient methods of treatment. For this reason, dentists use x-rays to identify a radiolucency, which is a term defining a dark spot on the tip of the problem tooth, and indicates that bone changes have already happened due to the infection inside of the tooth.

X-rays, however, are not always a 100% indicator that a root canal is needed. They can show various suspicious elements that, in fact, may not even be pathological. This tool is used, together with other methods, to form a full picture of whether endodontic therapy is needed.

Gum Boils

Dentists also pay attention to the presence of gum boils that are medically called fistulous tracts. In fact, these are pus drains that allows pus to vent off, instead of penetrating the soft tissues around the tooth. So, pus looks for a way out: it can either penetrate the soft tissues and cause swelling, or it can build a drain to go outside. If that drain is blocked, pus may cause swelling. Such tracts are usually tender to the touch, but they do not necessarily indicate that a root canal is needed. In some cases, such a lesion can also be caused by gum disease (periodontal issue).


Tooth discoloration means that some changes have occurred within the nerve space. In many cases, this sign indicates that root canal therapy is required. Discoloration often occurs as a consequence of some kind of tooth trauma, in some cases taking up to 10 years for the discoloration to appear. Furthermore, the discoloration may not be accompanied by a toothache or swelling. A darkened tooth is not always a sign that endodontic therapy is needed, however. This symptom is usually paired with others to determine the necessary course of treatment.

Nerve Exposure

Since it is hard to determine how close a nerve is situated to the tooth surface, exposure of the nerve can occur if a dentist makes contact with pulp tissue during treatment. In this case, a root canal is recommended, because exposure can provoke tissue degeneration in the future.

Testing Methods

X-ray results, fistulous tracts, tooth discoloration, and nerve exposure are the main indicators that a root canal is necessary. Dentists may also use testing methods to determine the need for a corresponding treatment.

Testing methods for determining whether a root canal is necessary include:

  • Tapping on the problem tooth;
  • Thermal and electric testing;
  • Selective anesthesia;
  • The cavity test; and,
  • Additional x-rays at various angles.

A dentist can tap on the problem tooth to determine whether pain appears when adequate pressure is applied. The painful feeling can mean that a root canal is required. With the same idea, a specialist can use thermal and electric testing. Selective anesthesia is used to identify the source of the pain when a patient cannot clearly indicate the tooth that is causing it. Additional x-rays can clearly show whether a radiolucency is present when the first film has not managed to provide any information. In cases where a dentist cannot be sure the current tooth is the problem, or he or she is suspicious that the nerve is dead, then a cavity test may be applied, where a specialist drills a divot into the tooth to check whether the nerve tissue is healthy.

Advantages and Disadvantages of Root Canal Therapy

Taking into account that there is no more effective method to eliminate root canal infections, endodontic surgery has doubtless benefits over tooth extraction or ignoring the problem, in general. This kind of treatment does, however, also have several unavoidable disadvantages. Root canal dangers and discomforts are actually the cost of saving your tooth. Let’s consider both pros and cons of this endodontic surgery, below.


  • When therapy is done, a patient will no longer feel pain and have no need to take painkillers to eliminate toothaches caused by the problem tooth.
  • Due to scraping bacteria as a part of root canal therapy, the spread of any inner infection is prevented.
  • This kind of treatment helps stop the formation of abscess around the tip of the problem tooth.
  • A root canal will have no negative impact on your sensation or biting force. The problem tooth will need only a few days to recover.
  • Such a treatment allows you to save your own tooth and keep your natural chewing abilities.
  • Applying root canal therapy allows you to protect neighbouring teeth from strain.
  • Saving your own tooth helps you avoid spending money on expensive artificial tooth crowns and implants, or being ashamed of any missing teeth.


  • After root canal therapy, a patient can feel uncomfortable or even experience a small pain during the first few days. Pain relievers can help the coping process.
  • The treatment can lead to discoloration of the problem tooth.
  • Right after the therapy, the tooth is weak, which  is why actions such as chewing should be avoided for this tooth, until it is fully restored by a dentist.
  • Unfortunately, the treated tooth will no longer have its original solidity and strength after the infection and resulting treatment.
  • It is impossible to obtain 100% cleanliness of a tooth’s root canal.
  • The infection can appear again, if final restoration is not completed in a timely manner.
  • Using cheap materials of low quality can lead to the additional treatments to be performed again, in the near future.
  • An extra or hidden canal will force you to redo treatment.

Being aware of possible negative consequences, patients should approach their qualified dentist who can professionally strengthen the treated tooth to avoid its cracking in future, and clean the canal as effectively as possible. Choosing a specialist who can perform all operations and necessary treatments in a timely manner, and with reliable materials and a deep level of expertise, is important to ensuring a high quality of medical care.

Who Performs Root Canal Treatments?

Dentists who specialize in root canal therapy are called endodontists; however, both dentists and endodontists can perform this kind of treatment. So, who should you approach for your treatment? Since root canals are the specialization of endodontists, they have a deeper expertise, more practical knowledge, and better experience in this kind of therapy.

According to the U.S.-based Marquette University, endodontists and dentists have almost the same success ratio for performing root canals for incisors, canines, and premolars with a one year to five year perspective. This means that both types of specialists ensure the equally-high effectiveness of their endodontic treatments for short and medium-term outcomes. Endodontists do, however, show better results over other providers in performing root canals for molars at a five (2% difference) and ten-year (5% difference) perspective. Therefore, endodontists perform root canal treatments a bit better, and more reliably, from a long-term perspective.

What Is Root Canal Surgery?

Endodontic surgery refers to the Greek words meaning “inside” (“endo”) and “tooth” (“odont”). In fact, a root canal is only one of the types of endodontic therapy, referring to the treatment of the soft tissue inside of teeth, called the pulp, which plays a significant role in a tooth’s development and growth. When a tooth is fully formed, it can survive without the pulp due to the surrounding tissues. In this paragraph, we will cover all the stages of root canal surgery, including:

  1. Performing dental x-rays;
  2. Anesthesia;
  3. Placing a dental dam;
  4. Creating an opening and removing the decayed pulp;
  5. Medicating the opening;
  6. Sealing the tooth; and,
  7. Restoring the tooth.

Step #1: Performing Dental X-Rays

X-rays allow an endodontist to clearly identify damage to the pulp and determine the shape of your root canal. This technique also helps the specialist identify the location of a dental infection, and damage to the surrounding bone.

Step #2: Anesthesia

At this stage, a professional applies a local anesthetic to eliminate any possible pain a patient may experience. Despite the fact that inner nerve usually is dead in these situations, a dentist may still apply anesthesia to eliminate any possible pain.

Step #3: Placing a Dental Dam

A dental dam is a rubber sheet to ensure a dry area surrounds the problem tooth. This dam prevents saliva accessing the treated area.

Step #4: Creating an Opening and Removing the Decayed Pulp

An endodontist creates an opening in your tooth to access the infected pulp. Since an anesthesia is applied, this process will not cause any pain. Once the hole is made accurately, the specialist removes the bacteria-infected pulp with thorough root canal scrubbing.

Step #5: Medicating the Opening

In cases where your tooth contains the inner infection, a dentist medicates the internal tooth area to remove bacteria. Then, your tooth can be filled with a temporary material until you return on your next visit. In some cases, the hole can be left open until the next visit, to allow pus to drain out.

Step #6: Sealing the Tooth

At this stage, a dentist seals your tooth off. First, he or she replaces the temporary material inside of your tooth with a permanent replacement, and then seals it off.

Step #7: Restoring the Tooth

During the final stage, a dentist fully restores your treated tooth. In many cases, an artificial crown will replace the tip of your tooth.

How Painful Is a Root Canal?

Since qualified dentists and endodontists apply anesthesia to your problem tooth, you will experience no pain during the procedure; however, your tooth may feel sensitive a few days after therapy, especially if it was painful and infected before the visit. Though this discomfort can be eliminated with convenient painkillers, you should approach your endodontist if pain is still present after several days.

Can a Root Canal Be Done in One Visit?

A root canal can be done in either one or multiple visits. According to the Journal of Clinical Pediatric Dentistry, there is no statistical difference between performing a root canal therapy in one or multiple visits. The success of endodontic surgery does not depend on the number of visits for it to be done; however, each case is specific and has its own specialties and complications. The necessary number of visits can be determined only after a personal examination is completed by a dentist or endodontist.

How Much Does a Root Canal Cost in New York?

  • The cost of endodontic surgery in NYC may vary from $500 to $1,000.
  • The price of post tooth strengthening ranges from $250 to $350 without crown restoration costs.
  • A pulp vitality test can cost approximately $50.
  • Pulp capping costs range from $55 to $65.
  • Retreating a canal root costs between $650 to $1,000.
  • Root canal obstruction treatments can cost up to $450.

Root Canal Aftercare

As mentioned above, a patient may feel some discomfort a few days after the procedure, in the form of tooth sensitivity or even pain. In this case, painkillers may be applied to relieve the sensation.

A required stage of a root canal is the final tooth restoration. For this purpose, a dentist may install an artificial crown, instead of the treated tooth. Root canal aftercare does not require any special measures from a patient, other than monitoring any feelings of pain and careful use of the treated tooth, taking into account that is not as strong as before the infection.

How to Perform Root Canal Treatment in NYC

As you may have already learned, a toothache is always the sign that something is wrong with your tooth. It is very important that you don’t ignore such signs, and approach a specialist immediately. Of course, regular visits to the dentist can help prevent root canals, all together, through the timely detection of tooth problems.

Dr. Rosenberg is one of the best dental specialists in NYC, with deep expertise and significant experience performing root canal therapy. You will receive professional treatments and guaranteed positive result when it comes to your dental care. To get started, leave your information through our contact form, and we will contact you to discuss how you can get and maintain an amazing smile to last a lifetime!

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Before and After Results

In the pictures below, you will see the results of How to know if your tooth needs root canal: symptoms and treatment for patients with various dental issues. These are only a sample of the treatments performed at our clinic. Over her decades of working in dentistry, Dr. Rozenberg has helped a lot of people, including celebrities and politicians, to name a few.

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