A root canal treatment removes the tooth’s pulp (soft tissue at the center of the tooth that is composed of connective tissue, nerves and blood and lymph vessels). Also called root canal therapy and endodontic treatment, the procedure may be recommended to save a tooth when the pulp is infected or injured. The procedure may be performed by a dentist or endodontist (dentists who specialize in diagnosing and treating problems inside the tooth).

Infection due to tooth decay is the most common reason for root canal treatments. Tooth injury, such as a chipped, fractured or broken tooth, may also require root canal treatment. Teeth that are sensitive to hot and cold (sensitive teeth) may need root canal treatment if other desensitizing methods fail. In addition, repeated dental procedures (e.g., artificial crowns or fillings) on the same tooth can weaken the tooth and prompt a root canal treatment.

Pulp begins at the tip of the root, where the tooth is anchored into the jaw, and travels through the root canals, which are long, thin passageways that lead up to the pulp chamber at the center of the tooth. The chamber is an area inside the crown and below the enamel and dentin. A tooth has only one pulp chamber but may have up to four root canals leading to the chamber. Therefore, root canal treatment on a single tooth may involve removing pulp from multiple root canals that are infected or damaged.

The pulp’s primary function is to supply nourishment (blood and nutrients) for growing teeth while the nerve within the pulp sends messages to the brain, such as whether a drink or food is hot or cold. The nerve also sends pain messages when there is an injury or infection.

Removing an infected pulp does not harm the tooth but does eliminate pain caused by infection or injury by removing the central nerve tissue of the tooth.

In children’s permanent teeth, which are continuing to grow, a procedure called a pulpotomy may be attempted In this procedure, only part of the dead or infected pulp is removed, so the blood vessels can continue to nourish the tooth.

For many people, root canal treatment is preceded by severe pain (toothache). The source of that pain is typically an abscess (a pocket of pus) that can form at the tip of the root when the pulp is infected.

A root canal may be necessary even if there is no pain, when x-rays or a dental examination reveal root cavities or darkened teeth (an indication of dead of dying pulp).

Root canal therapy can be used to treat both primary teeth (baby teeth) in children or permanent (adult) teeth. However, depending on the kind of injury involved with a child’s baby teeth, extraction may also be an option. When extracting baby teeth, it is important to discuss the need for space maintainers. These orthodontic appliances maintain the space of the baby tooth, so that the replacement adult tooth will be able to erupt into the mouth.Dentists try to avoid extracting teeth because doing so can create other mouth problems.

Some people who undergo root canal treatment may require repeated treatments if the initial procedure fails to completely rid the tooth and canal of bacteria and reinfection occurs. Others may require an additional procedure called an apicoectomy if infection spreads to the tip of the tooth’s root (apex). This procedure is also called endodontic microsurgery because it uses a microscope to guide the endodontist in cutting out the infected root tip.

Root canal treatment has long had a reputation as being very painful, and many patients may have chosen to forego the procedure – opting to have the problem tooth pulled instead. However, according to the American Association of Endodontists (AAE), dental techniques and anesthesia have improved in recent years and the painful root canal is largely a myth today. Patients often report the pain to be no more severe than that of a filling, according to the AAE. In many cases, the anticipation of a root canal treatment is worse than the treatment itself.