Guide to Root Canal Treatment: Costs, Procedure Steps & Will It Hurt?

Have you been told you need endodontic root canal treatment to save a decaying tooth? It's not something any of us look forward to; the root canal procedure can be quite long and – if you're not being treated on the NHS – rather costly.

However, getting a root filling to restore the tooth is preferable to getting it extracted. Think of it as a little short-term discomfort for long-term gain.

In this article, we will answer some of the most commonly asked questions including:

• What is a root canal?
• What does the procedure involve?
• How long does it take?
• Does a root canal hurt?
• How long will it take to recover?
• How much does root canal treatment cost in the UK, on the NHS and privately?

We can't promise to make the procedure any more enjoyable, but at least you'll know what to expect.

What is root canal treatment?

The root canal system is located in the roots of each of your teeth. A tooth root infection, if left untreated, can cause irreparable damage to the tooth and even spread to other parts of the body.

The root canal procedure, an endodontic treatment sometimes referred to as a ‘root filling' or just a ‘root canal', involves drilling right inside the tooth to remove decay and infection deep down in the roots.

This work may be performed by a general dentist or by an endodontist, who specialises in treating the inside of a tooth.

Once the root is treated, the root and tooth are filled to help preserve the remaining tooth. Teeth that have undergone root treatment are more fragile than healthy teeth. Your dentist may therefore recommend fitting a dental crown to help prevent further damage.

The tooth structure

Before we get into the details of what root canal work involves, it's helpful to understand a bit about the structure of a tooth.

The crown is the part which sticks up above the gum line. The section level with the gum line is called the neck, and the part below the gum is the root. The tooth root can be twice as long as the crown.

A root may split into two canals, meaning that teeth usually have up to four root canals each. In some rare cases, six or seven roots have been found in one molar!

The hard white coating on the outside of the tooth crown is called enamel. This is the part you need to protect by brushing and flossing daily. A build-up of bacteria on the teeth resulting from poor oral hygiene can lead to dental caries (tooth decay).

If tooth decay erodes even a small amount of enamel, it leaves the rest of the tooth susceptible to infection. Once bacteria starts eating away at the soft dental pulp inside the tooth it can quickly spread down the tooth root(s) through the root canal system. From here it can reach the surrounding bone and gum tissue.

Untreated root canal infections are likely to lead to an oral abscess.

When is a root canal needed?

An infected root canal usually develops quite slowly, from untreated tooth decay which has led to pulpitis. When a tooth has undergone multiple restorative procedures, or when a crown or filling is loose or faulty, there is a higher chance of root infection. In some cases the infection can develop more quickly, for example if you experience trauma or get a cracked or broken tooth.

If you have regular dental checkups, your dentist should be able to identify and treat any tooth decay before it penetrates the root system. However, if you haven't been to the dentist for a while you may find the infection has already spread and you need root canal therapy to save the tooth.

Root canal infection symptoms

Initial signs that you might need root canal work include:

• Your tooth is painful or sensitive to hot and cold food and drink
• It hurts to bite down
• One of your teeth is loose

If you ignore these root canal symptoms, you may find they disappear over time. This isn't because the infection has healed itself; it just means it has destroyed the nerves contained in the dental pulp so you can no longer feel it.

Eventually you'll notice these symptoms returning, possibly along with the following signs that the tooth has died and the infection has spread much further:

• Swollen gums around the infected tooth
• Swelling in your face
• Pus oozing from your tooth or gum
• Discolouration of the tooth

Going to the dentist as soon as you experience any kind of tooth pain should help prevent the infection from spreading to this more serious stage. The tooth root won't heal itself, and the longer you leave it the less chance there is of root canal treatment being successful.

You also shouldn't rely on antibiotics to clear a root canal infection without any other dental treatment. Although you may be given antibiotics as part of your dental work, medicine alone won't be enough to return your tooth to a healthy state.

If your root canal pain comes on suddenly and over-the-counter painkillers have no effect, you should book an emergency dentist appointment. They may not perform an emergency root canal on the spot, but can at least give you stronger pain relief until you are able to have the treatment you need.

Do I need a root canal or extraction?

The main priority of your dentist should be to preserve your natural teeth for as long as possible. When a tooth is removed it can affect how you eat and put extra strain on the surrounding teeth. Over time the jaw bone at the extraction site can recede, causing changes to your facial appearance.

But if the bacterial infection has spread through a lot of the tooth and the remaining structure is not enough to support a filling or crown, extraction may be the only option.

An extraction may cost less than root treatment, but then you'll need to think about replacing the missing tooth, which will cost you more overall.

Your dentist or root canal specialist will usually begin by taking x-rays of the affected area to determine the extent of the infected root canal. From these images they will be able to see how many canals the affected tooth has, where they are positioned, and how many of them require treatment. They can then plan your procedure and let you know what to expect.

Note that if you have an infected wisdom tooth, there are certain situations where your dentist may opt to extract it rather than perform a root filling. If the tooth hasn't fully erupted, for example, or is in a position that's difficult to clean, your dentist may recommend extraction.

How long does a root canal take?

It's possible to complete a simple root canal in 30 to 60 minutes. More complex procedures, or those involving multiple teeth, will take longer. Multiple visits may be needed to complete your treatment.

Root canal treatment time depends on a number of factors:

• Which tooth is being treated
• The number of roots and canals, and their shape
• The amount of infected tissue
• Which tools your dentist uses

Discuss this with your dentist ahead of time so you know what to expect. Modern advances in dentistry mean it is getting easier to complete the process quickly and with minimal discomfort.

How long does root canal treatment last?

Endodontics is a common dental practice with a relatively high success rate. Around 85% of treatments last for at least 8-10 years if the patient maintains good oral hygiene. Many go on to last a lifetime. Giving up smoking (if you currently smoke) will help prolong the effectiveness of any dental work while improving the overall state of your teeth.

If you experience tooth pain years after a root canal, it may be possible to perform a root canal re-treatment and preserve the tooth for even longer.

One side-effect of root treatment is the tooth may darken over time. However, with modern endodontic techniques this is becoming less common. If you do experience discolouration after root therapy, especially with a front tooth, you may consider getting it chemically whitened so it's not as obvious.

Root canal procedure

There are five main root canal treatment steps needed to restore a deeply infected tooth.

Front tooth root canals tend to be more straightforward because they are easier to access and the canals are generally straighter and wider. This means that a root canal on a front tooth is usually quicker to complete than on a tooth at the back of the mouth. However, your dentist can't know for certain how complex the treatment will be until they actually access your tooth roots.

The exact root canal treatment procedure will vary slightly from one clinic to another, but here is a basic outline of the steps involved:

Preparation

After taking x-rays to plan your treatment, your dentist or endodontist will administer a local anaesthetic. This numbs the area being treated so you shouldn't feel any pain.

It's good practice for dentists to fit a waterproof dental dam (cofferdam) while doing root canal work. This rubber sheet fits around a single tooth to isolate it from the rest of your mouth.

This serves three purposes:

1. It protects the inside of the tooth from bacteria in your saliva
2. You can swallow normally during treatment
3. If the dentist drops a tool or some debris falls into your mouth, there is no risk of you swallowing it and choking

It's possible to perform this work without a dental dam, but according to one study a rubber dam “provides a significantly higher success rate of root canal-treated teeth”.

Opening the tooth

Using a drill, the dentist will make a hole in the top of your tooth (or at the back of a front tooth) through which he can access the pulp chamber and root system. Tiny little files or a mechanical rotary tool help clear away the damaged and dead pulp and nerve tissue from inside the tooth and roots.

Root canals are very thin and are often curved, so it can take some time for the dentist to locate all of the canals and ensure all traces of infected material are removed. They use special microscopes and bright lighting to help them see right inside the tooth.

If you have a root canal abscess at the end of your tooth root, it will be drained at this point.

Cleaning

Next, the inside of the tooth is cleaned thoroughly using water and an antibacterial solution. Your dentist uses a syringe to squirt the cleaning solution into your tooth, then it is sucked back out. This is repeated several times throughout the process to ensure the area is completely sterile.

Root shaping

The narrow and irregular shape of root canals makes them difficult to fill properly. Therefore, one of the most important root canal treatment steps is to enlarge and shape each canal in the tooth. There are several reasons why this is necessary:

• It ensures full removal of necrotic pulpal tissue and bacteria form the canal space
• It creates optimum space for the root cleaning process and root filling
• The resulting smooth tooth structure is preferable for long-term preservation

If your dentist uses traditional hand files, this part of the procedure can be very lengthy and require multiple visits. Modern mechanical rotary tools make it faster and more effective.

Root filling

If your treatment is too complex to complete in one visit, your dentist will fill the roots with some medication to kill any remaining bacteria. He will then apply a temporary filling to protect the tooth in between visits. This filling is removed when you return to complete your treatment.

Once all the canals have been cleaned and widened, it's time to permanently fill them. This is often done with a thermoplastic material which, when heated, softens to fit the exact shape of the chamber. Dentists insert a number of thin cones into the canal and then compress them under heat to ensure complete filling.

It's important that the root canal filling totally fills the space inside the tooth. Otherwise, the filling could fall out and it's more likely to become re-infected.

Once the roots are filled, the remaining space in the tooth is filled and restored just like a regular tooth filling. This provides an extra seal to protect the roots from any more bacteria.

Crowning (optional)

Because a tooth is more fragile following endodontic treatment, your dentist may recommend you have a root canal and crown. A crown (also called a ‘cap') is a protective covering made from porcelain or metal. It covers the entire tooth and should prevent a cracked tooth after root canal work.

To fit a crown, your dentist first has to shave some of the enamel off the outside of your tooth. They use strong dental glue to keep it in place. Once fixed in place it should feel and function just like a natural tooth. Of course, the cost of a root canal and crown is greater than just the root treatment, but your dentist will let you know what's best given the state of your tooth.

Your dentist may wait a few weeks before crowning your tooth, just to be certain that the process was successful and there are no signs of infection after the root canal filling.

The video below gives a quick summary of the whole procedure:

The latest in our series of One Minute Lectures, Dr Shalini Kanagasingam, Senior Clinical Lecturer at UCLan School of Dentistry​ shows how root canals are treated

How much does a root canal cost in the UK?

Root canal prices range from £100 to £700 in the UK with a private dentist. As a general rule, the more complex the procedure, the longer it will take and the more it will cost. You can also get an NHS root canal for a lower price if you are registered with an NHS dentist.

What does an NHS root canal cost?

If you get a root canal on the NHS, the Band 2 charge applies. For 2020/21 this stands at £65.20 in England and £47.00 in Wales, with variable prices in Scotland and Northern Ireland. This flat fee applies regardless of how many visits you need or how many teeth are treated (provided it all relates to the same course of treatment). So, the cost of NHS root canal treatment is relatively inexpensive.

The cost of a root canal and crown on the NHS is the band 3 charge of £282.80 (England) or £203.00 (Wales).

However, not everyone is able to find an NHS dentist accepting new patients. In this case you will need to see a private dentist and the root canal price will be significantly higher.

Root canal costs with a private dentist

Root canal prices with a private dentist in the UK range from £100 – £350 for front teeth and £300 – £700 for back teeth.

The exact cost of a root filling with a private dentist will depend on:

• Your dentist's location and private rates
• The extent and complexity of the damage
• Tooth size (specifically, the number of roots and canals)
• Tooth position (those at the back tend to cost more)

Dentists and root canal specialists probably won't be able to give you a fixed root canal price until they have examined your mouth and possibly taken x-rays to assess the condition of your teeth. You may still be able to get an idea of root canal costs by phoning around different clinics though, and it's worth doing this as prices can vary quite substantially from one to another.

What's the difference between NHS and private root canal work?

Both NHS and private dentists will work to remove any infected tissue from your tooth and repair it to a functional state. The end result should, in theory, be the same.

However, some may argue that a private dentist can dedicate more time to you and carry out the procedure with more care and attention, since they are not under the same pressures as NHS dentists.

Insurance for dental treatment

Many dental insurance plans cover endodontic work to some extent. If you have one, find out what percentage of root canal costs it will cover and how to arrange your treatment.

If you have poor oral health and are likely to need a lot of dental work in the coming years, insurance can be a good way to make it more affordable. Our article on dental insurance in the UK has more information on how to choose a policy to suit your needs.

Is a root canal painful?

Many patients worry about root canal treatment pain and may put off getting the treatment they require because of fear it will hurt. Fortunately, the anaesthetic technology used by dentists these days means the procedure can be performed with minimal discomfort. It should feel no different to having a regular filling, except it will take a while longer and your jaw may feel stiff afterwards because you've held it open for so long.

For patients experiencing significant root canal pain prior to treatment, endodontic therapy in fact provides considerable relief.

Your dentist will administer anaesthetic before starting any work and may “top it up” during longer treatments. Before treatment, you can tell your dentist you will raise your hand if you start to feel uncomfortable at any point.

Particularly nervous patients have the option of IV sedative while the work is done. This doesn't knock you out completely as a general anaesthetic would, but it deeply relaxes you so you don't feel anxious and barely remember the experience.

Managing pain after root canal surgery

Root canal recovery shouldn't be painful, but your restored tooth may be swollen or sensitive for a few days. During this time you can take ibuprofen or paracetamol to ease any discomfort.

You may find it more comfortable to only eat soft foods until your mouth is back to normal, especially if you feel pain when biting on the treated tooth.

Root canal complications and problems

Despite the relatively high success rate of endodontic treatment, some patients do experience problems. Root canal complications can occur anywhere from a few days to a few years after the initial treatment.

A failed root canal can be the result of:

• The dentist missing a canal during initial treatment
• A canal being incompletely treated (i.e. the tip of the canal left untreated)
• Tissue left inside the tooth
• A fracture to the root
• Leakage of bacteria

If any of these complications arise, your dentist or endodontist will assess your tooth to see whether root canal re-treatment can be performed. The process for this is much the same as the original treatment, although more complicated to perform.

In most cases, the alternative to root canal re-treatment is extraction. Patients who don't wish to undergo further root canal therapy may instead choose to have the problem tooth replaced with a dental bridge or implant.

If a root canal fails because of re-infection at the tip of the root, it may be possible to perform endodontic surgery. This involves making a small incision in the gum to access the root tip directly. This allows the original structure from previous treatment to remain in place.

If you are concerned you may have root canal failure, contact your dentist as soon as possible. They are trained to recognise the symptoms of a failed root canal. The earlier it is treated, the less opportunity there is for the bacteria to cause more damage.

Conclusion

Root canal treatment is an effective way to repair a damaged tooth and prolong its life for many years, or even a lifetime. Many people worry that the treatment will be painful, but this really isn't the case. It may be uncomfortable sitting with your mouth open for so long, but it shouldn't hurt at all.

Although it's normal to experience some sensitivity for a day or two after a root filling, you can take painkillers to help with the recovery. If you start to feel pain several days or months after treatment, contact your dentist straight away.

The cost of a root canal in the UK can average £250 to £500 per tooth with a private dentist. The NHS root canal cost has a much lower fixed price, which varies depending on your location in the UK.

Remember, regular dental checkups are the best way to pick up on any dental problems before they reach your tooth root. Taking good care of your teeth will help minimise the chances of you needing a root canal filling in the future.

FAQs

Are root canals safe?

As long as you visit a trained root canal dentist or an endodontist, this procedure is very safe and has a high success rate. Failure can occur, but usually not for many years.

Given that the alternative to root canal treatment is usually extraction, it's preferable to save the tooth and avoid the need for dentures or an implant.

Do I need a root canal or filling?

If the pulp inside your tooth root has become infected, it will need to be removed. If the decay has not spread this far, a straightforward filling should suffice.

How do I find an endodontist near me?

Your dentist may refer you to a root canal specialist if they feel that the treatment is too complex to perform themselves. In this case, they will be able to recommend an endodontist near you.

Does a root canal hurt?

It may be uncomfortable sitting in the dentist's chair for so long, but they'll administer an anaesthetic so you don't feel any pain during the procedure. Your tooth may be sensitive afterwards. To help, follow the tips above for aftercare.

Will I experience pain or swelling after a root canal?

There may be some swelling, sensitivity or pain for a day or two after treatment. You can take over-the-counter painkillers to help with this, and stick to softer foods.

What are the signs of infection after a root canal?

If you start to experience severe pain or swelling a few days after treatment, this can be a sign of infection. You may also notice that the tooth becoming discoloured. Speak to your dentist if you have any concerns ahead of your scheduled checkup.