The dentist can perform the root canal treatment or refer patients to a specialist trained in diagnosing and treating internal tooth disorders (an endodontist). The root canal treatment typically requires two or more dental appointments, although more may be necessary for more complex cases (e.g., abscesses and severe infection).

Prior to starting treatment, the patient may want to discuss the pros and cons and alternatives to root canal treatment. Also, patients should learn the specifics of their treatment plan for their particular condition. The number of visits it will require and the length of each visit for root canal treatment often vary. The time for each visit also varies, generally from 30 to 90 minutes. Knowing what to expect can help patients avoid anxiety prior to and during these visits. Such anxiety can cause stress that may be worse than the root canal treatment, itself.

The dentist or endodontist will usually discuss the type of sedative or anesthesia that can be used (e.g., local, general). Some weak anesthetics, such as nitrous oxide, can help relieve anxiety. For those undergoing general anesthesia, a physical examination may be recommended prior to treatment to determine if the patient has any conditions that may interfere with the anesthesia.

A dentist may need to remove a patient’s artificial crown or other dental appliances (e.g., a fixed bridge on abutment teeth) before root canal treatment can be performed. This typically requires a separate appointment to prepare the tooth for the actual root canal procedure.

An abscess on the roots or gums may delay the root canal procedure for a week or more while the pus is drained. The pus in an abscess releases a toxin that can make anesthesia less effective during the root canal procedure. The dentist may prescribe antibiotics and wait until the infection clears up before starting the root canal treatment.

Some people may require a dose of antibiotics taken prophylactically (before the procedure) to reduce the risk of bacteria in the teeth causing complications elsewhere in the body. In such cases, the medications are usually taken one hour before each appointment. People may need this precaution if they have:

• Certain heart disorders
• Rheumatoid arthritis
• Compromised immune systems
• Undergone certain procedures (e.g., heart valve repair, joint replacement)

Patients are urged to inform the dentist or endodontist of any medications, vitamins or herbal supplements they are taking prior to the procedure. These substances can interact with the anesthetic, possibly making it less effective at numbing pain. Some medications (e.g., certain osteoporosis or cancer medication) may also require the dentist or endodontist to use different techniques to help prevent complications. Patients should also inform the dental staff about any pre-existing medical conditions (e.g., diabetes, HIV), which may affect the stages of healing.

Some experts recommend selecting a time for dental procedures when the patient will be the most relaxed (early morning or weekends) and to avoid making plans and appointments for immediately after the root canal treatment. Patients may need to make arrangements for someone to drive them home following the procedure, especially if general anesthesia is used.

Finally, patients are urged to strictly follow the preparatory instructions of the dentist or endodontist prior to the procedure. This may include a checklist to follow the night before or morning of the appointment. Depending on the kind of anesthetic being used, there may be restrictions on food and water prior to the procedure. If there are no food or diet restrictions, patients may want to discuss the appropriateness of eating a meal prior to the procedure since it may be too painful or uncomfortable to chew for several hours following the appointment.