For many people, “root canal” is shorthand for the worst thing that can happen at the dentist. The research tells a very different story, and it is worth knowing before your appointment.
Most of the pain comes before treatment
A systematic review by Pak and White pooled the results of 72 studies of patients having root canal treatment. The pattern was consistent:
- Before treatment, about 81 percent of patients had pain.
- One day after, that fell to about 40 percent.
- One week after, it was about 11 percent.
Severity dropped even faster. On a 100-point pain scale, the average was 54 before treatment, 24 a day later, and 5 after a week, which is barely noticeable.
In other words, the pain people associate with a root canal is usually the toothache that sends them to us. The treatment is what makes it stop.
Why some people expect it to be worse
A review of patient-centered research found that fear of pain before a root canal is common, and that anxiety itself can make pain feel worse. The same review found that the disease inside the tooth usually causes moderate rather than severe pain, that treatment brings a dramatic drop in pain over the following week, and that patient satisfaction with root canal treatment is very high.
Getting numb, and staying numb
The Pak and White review also found that extra anesthetic is often needed, especially for a tooth that is very inflamed. That is normal, and it is why Dr. El-Refai checks that the tooth is fully numb before beginning and adds more whenever you need it. You should feel pressure and vibration, not pain. If you feel anything sharp, raise your hand and we stop.
If you feel anxious, you have options: you can seek oral sedation from your medical doctor, or we can schedule you for IV sedation with a board-certified anesthesiologist, who comes to our office. IV sedation is an optional addition to your treatment plan.
Afterward
Some tenderness when you bite is normal for a day or two. The American Dental Association’s 2024 guideline on dental pain recommends anti-inflammatory medicines such as ibuprofen, alone or combined with acetaminophen, as the first choice, because they relieve dental pain well with fewer side effects than opioids. Take them only if they are safe for you, and follow the label or your physician’s advice.
Chew on the other side until your tooth has its final restoration, and call us if the pain grows instead of fading, or if you notice swelling. Patients of ours can reach us after hours.
How we keep you comfortable
Treatment is calm and unhurried, and most teeth are finished in one visit. For many teeth, we use the GentleWave procedure, and in a multicenter study of that procedure fewer than 4 percent of patients had even moderate discomfort in the first two days. Read more about root canal treatment or what to expect at your visit.
