Ask anyone what dental treatment they dread most and root canal comes up almost every time. The name alone makes people nervous. But here's the thing: most of that fear is built on what root canals used to be like decades ago — not what they are now.
A modern root canal, done well, is closer to a filling in terms of discomfort. Patients who've had one are almost universally surprised by how ordinary it felt.
Why Would You Need One?
Inside every tooth, beneath the hard enamel and dentine, there's a soft tissue called the pulp — a bundle of nerves, blood vessels, and connective tissue. When that pulp gets infected, usually from deep decay, a crack, or repeated dental procedures on the same tooth, it can't heal itself. The infection spreads into the root canals and sometimes into the bone around the root tip, forming what's called a periapical abscess.
At that point, you have two options: remove the tooth, or remove the infected pulp and seal the canal. A root canal saves the tooth. And saving a natural tooth is nearly always the better outcome — both for your bite and your jawbone long-term.
The Signs You Might Need One
- Persistent toothache, especially when biting or applying pressure
- Prolonged sensitivity to heat or cold that doesn't settle after a few seconds
- A visible pimple or swelling on the gum near the tooth
- Tooth that has darkened or gone grey compared to surrounding teeth
- Sometimes: no pain at all — the nerve has already died, but infection is still present and visible on X-ray
What the Procedure Actually Involves
First: the area is numbed with a local anaesthetic. Modern anaesthetics — articaine and lidocaine are the most common — are highly effective. You should feel absolutely nothing during the procedure. If at any point you do, the dentist stops and adds more anaesthetic. This is non-negotiable.
A rubber dam is placed over the tooth to isolate it from saliva and keep the area sterile. Then a small opening is made through the top of the tooth to access the pulp chamber. The infected tissue is removed using instruments called rotary nickel-titanium files, which are flexible, precise, and far more efficient than the manual files used in older techniques. The canals are flushed with a disinfecting solution, shaped, and dried.
Finally, the canals are filled with a biocompatible material called gutta-percha and sealed. In most cases, the tooth then needs a crown placed over it to protect it from fracture — because a tooth that's had its pulp removed becomes more brittle over time.
How Long Does It Take?
With modern rotary instruments, most root canals are completed in a single visit of 60 to 90 minutes. Multi-visit root canals — where the dentist cleans partially and sends you home for weeks — are becoming less common. Some complex cases with severe infection or difficult anatomy still need two visits, but that's the exception rather than the rule at a well-equipped clinic.
Does It Hurt?
During the procedure: no, not if the anaesthetic is working properly. Afterwards: yes, for a few days. The tissue around the root tip is inflamed, and that inflammation takes a few days to settle. Ibuprofen manages it well for most people. By day three or four, it should be significantly better. If pain is worsening at that point rather than easing, call the clinic — it usually means the infection needs reassessment.
What Happens If You Avoid It?
The tooth doesn't get better on its own. The infection spreads. What starts as pulp infection can move into surrounding bone, and in serious cases into the jaw or neck — a dental abscess that has tracked into the neck is a genuine medical emergency. It's rare, but the pathway is predictable. Getting the root canal done early is faster, cheaper, and far less complicated than dealing with what happens if you leave it.
Success Rate
Root canal treatment has a success rate of over 95% when performed properly on teeth with a good prognosis. That means the vast majority of treated teeth last for decades — sometimes a lifetime — with normal function.
Our endodontics specialist, Dr. Komal Imran (BDS, FCPS Operative Dentistry & Endodontics), handles complex root canal cases at our clinic near Bahria Town Phase 7 Rawalpindi. If you're experiencing toothache or sensitivity that hasn't settled, book a consultation before it becomes an emergency.