Root canal treatments are procedures designed to save teeth damaged by injury and/or severe tooth decay (cavities). The procedure may also be called root canal therapy or endodontic treatment. “Endo” means inside and “odont” means tooth in Greek. The procedure involves the removal of pulp, the soft tissue inside the tooth.

One or more root canals are found inside every tooth. Each canal contains pulp, often referred to as the nerve center of the tooth. Pulp actually consists of nerves, blood vessels and connective tissue. When that pulp is damaged by deep cavities or a fractured or cracked tooth, it can cause severe pain (toothache) and a root canal treatment may be needed.

There are multiple steps in a root canal treatment, but the basic procedure involves drilling into the top or back of the tooth, removing all or part of the pulp (pulpectomy), replacing it with a rubber-like material (such as gutta percha) and putting an artificial crown (cap) over the tooth to strengthen it. Patients may be given either a local or general anesthetic.

Root canal treatment may be performed on only one root or in more than one root in the same tooth. Depending on their type and location in the mouth, teeth can have up to four root canals per tooth.

The root canal procedure is typically performed in two or more dental appointments (each lasting 30 to 90 minutes, depending on the case). A dentist or an endodontist (a dentist trained in diagnosing and treating internal tooth disorders) can perform the procedure.

Certain alternatives to root canal treatment (e.g., pulp capping and pulpotomy) are typically used only on injured teeth. Pulling the tooth (tooth extraction) is an alternative, but dentists usually try to avoid this option. Extraction creates additional problems associated with missing teeth, including shifting or misaligned teeth, bite problems (malocclusion) and gum recession. In addition, missing teeth can dramatically alter a person’s appearance, which may be distressing.

Some people who undergo root canal treatment may need a second treatment if infection recurs in the tooth or if an infected root canal was overlooked during the initial procedure. According to the Academy of General Dentistry, root canal treatments have a 5 percent failure rate.

The American Association of Endodontists (AAE) estimates that nearly 16 million root canals are performed each year in the United States. According to the American Dental Association, smokers are more likely than non-smokers to need root canal treatment.

Over the years, root canal treatments have gained a reputation for being painful. However, according to the AAE, root canal treatment today is no more painful than having a filling placed or another type of dental restoration.