Save the tooth, end the pain.

The clearest signs are pain that lingers after hot or cold, pain that wakes you up at night, a tooth that hurts to bite on, swelling near a tooth, or a small bump on the gum that comes and goes. These all point to nerve tissue inside the tooth that is inflamed or infected, and once that tissue is irreversibly damaged, it does not heal on its own.

Sometimes we find a tooth that needs a root canal on a routine X-ray, with no symptoms at all — usually a tooth that had a deep filling years ago and quietly developed a small infection at the root tip. We will explain what we see, show you the X-ray, and let you decide.

We numb the tooth thoroughly — getting good anesthesia is the single most important part of the visit, and we take the time to make sure you are comfortable before we start. We isolate the tooth with a small rubber dam to keep saliva and bacteria out of the cleaned canals.

We open a small access through the top of the tooth, locate the canals (one to four depending on the tooth), and use fine instruments to clean and shape them. We rinse with disinfecting solutions, dry the canals, and fill them with a sealing material that prevents bacteria from re-entering. We close the access with a temporary or permanent filling, depending on the plan.

Most front and small back teeth can be done in a single visit of roughly 60 to 90 minutes. Larger molars sometimes take two visits. You leave numb but generally without significant pain; mild soreness for a couple of days is normal and usually well-managed with over-the-counter pain relievers.

A tooth that has had a root canal is more brittle than a vital tooth — it has lost some of its internal moisture and structure to the procedure. On back teeth that take heavy chewing force, a crown placed within a few weeks of the root canal protects the tooth from cracking. Skipping the crown is the single most common reason a root-canalled molar fails years later.

On front teeth with most of the natural tooth intact, a large filling is sometimes enough. We will tell you which category your tooth falls into.

Some root canals are straightforward and we do them in our office. Others — teeth with unusual canal anatomy, calcified canals, retreatments of previous root canals, or cases that need an operating microscope — are better handled by an endodontist, the specialist trained specifically for this work. We have referral relationships with endodontists we trust, and we do not pretend a case is routine when it is not.

When we refer you out, you come back to us afterward for the crown or final restoration. The work stays coordinated.

If a tooth cannot be saved — too much structure lost, a vertical fracture into the root, severe bone loss around the tooth — extraction is the right answer. A root canal on a tooth with a hopeless prognosis is a waste of money. We will tell you when that is the case.

When a tooth has to come out, we discuss replacement options at the same visit: an implant, a bridge, or a partial denture, depending on the situation. Replacing the tooth (eventually) is important — the teeth around a gap shift, the opposing tooth drifts, and the bone in the area shrinks over the years if nothing replaces what was lost.

Mild to moderate soreness for one to three days after a root canal is normal. The tooth and the surrounding ligament are inflamed from the procedure itself, and they need time to settle. Over-the-counter ibuprofen taken on schedule for the first 48 hours usually keeps you comfortable.

Severe or worsening pain after the first couple of days is not normal — call us. It usually means a small adjustment is needed: trimming the bite slightly so the tooth is not getting hit during chewing, or in rare cases, additional treatment.

A well-done root canal followed by a properly fitted crown has a success rate above 90 percent over many years. Failures, when they happen, are usually a missed canal, a vertical fracture, or new decay reaching back into the cleaned canal. The same prevention that protects your other teeth — brushing, flossing, six-month cleanings, a night guard if you grind — protects your root-canalled tooth too.