Eight questions people ask about root canal treatment

Does it hurt, and how long does it take?

Root canal treatment has an undeserved reputation. The pain people associate with it is the toothache that brings them in, not the treatment itself. Once the tooth is properly numb, which can take a little longer in an inflamed tooth and is something we check before starting, the procedure should feel like a long filling. Afterwards the tooth is often tender for a few days, and ordinary painkillers usually manage that. If you are anxious, say so at the consultation; IV sedation is available here for those who need it.

A single-rooted front tooth can often be completed in one visit of around an hour to ninety minutes. A molar with three or four canals is more work and may take one longer appointment or two shorter ones, depending on how infected the tooth is and how the canals are shaped. Your consultation, which includes imaging and costs £150, is where I can give you a realistic estimate for your particular tooth rather than a general one.

Why not simply take the tooth out, and will I need a crown afterwards?

Extraction is quicker and cheaper on the day, and there are teeth for which it is the right answer. But a tooth that has been root treated and properly restored is still your own tooth, with its own root and ligament, and nothing we can replace it with is quite as good. An implant is an excellent substitute, but it costs more, takes months, and involves surgery. In most cases, if a tooth can be saved predictably, saving it is the better value over a lifetime.

Back teeth usually do need a crown after root canal treatment. The tooth has lost its nerve, often a good deal of its structure, and the hollow that remains is more likely to split under chewing forces. A crown wraps and protects it. Front teeth with little damage can sometimes be restored with a filling alone. Here the crown can often be milled on the same day as the root treatment, so the tooth is sealed and protected before you leave.

How likely is it to work, and what does it cost?

Well-performed root canal treatment on a tooth that can be properly sealed and restored has a high success rate, and most such teeth can be expected to last for many years. Outcomes are poorer where infection is long-standing, where the canals are unusually curved or blocked, or where the tooth is not crowned promptly afterwards. I will tell you plainly, after looking at the imaging, which of those apply to you, and whether the odds justify the treatment.

Our guide fees are £150 for the consultation including imaging, £250 for an investigation where the diagnosis is unclear, and from £1,200 for treatment, rising to £1,250 for complex cases and £1,300 for surgical endodontics. A crown afterwards starts from £1,250, and a post and core, where the tooth needs extra support for it, from £350. These are guide fees. We confirm the figure for your particular tooth in writing first, and over-eighteens who would prefer to pay in instalments can apply for finance, subject to status.

Can a root canal be redone, and why do you use a microscope?

Yes. A tooth that was root treated years ago and has become sore again, or shows a shadow on an X-ray, can often be re-treated. The old filling material is removed, the canals are cleaned and reshaped, missed canals are found and the tooth is refilled. Re-treatment is more intricate than first-time treatment, because the old work has to be undone before the new work begins, and it sits in our complex fee band.

Where the problem lies at the root tip and cannot be reached from inside, a small surgical procedure through the gum can remove the infected tip and seal the end. Both re-treatment and surgery are routine in a practice limited to endodontics, and both begin with a CBCT scan, so that the shape of the roots and the extent of any infection are understood in three dimensions before a decision is made.

The canals of a tooth are narrower than a hair in places, and the entrances to them are easy to miss with the naked eye. Working under a Zeiss or CJ-Optik operating microscope gives me magnification and bright, direct light into the tooth, so that every canal is found, cracks are seen and as little tooth as possible is removed. With CBCT three-dimensional imaging alongside it, and a printed guide where a canal has calcified, the microscope is why modern endodontics is more predictable than it used to be.