Dreading a root canal?

This story first appeared in Healthy You - April 2025, The Gazette’s quarterly health publication.

Everyone dreads hearing from their dentist that they will need a root canal. We fear pain and multiple, long visits to the endodontist. Thankfully, advancements in the area have made the root canal procedure much less painful and much quicker; it can most often be done in one visit.

Dr. Abhishek Parolia, associate professor and director of research at the Department of Endodontics in the University of Iowa College of Dentistry and Dental Clinics, frequently talks with patients who are hesitant to go through with the procedure.

“We are trying to relieve their pain and save their natural teeth,” he reminds them.

Dr. Derek Peek, board-certified endodontist in Cedar Rapids, agrees. “The long-term goal is to save teeth,” he said. Research has shown that people who are able to preserve their natural teeth live longer lives.

Both endodontists point out that today, a root canal procedure is no more painful than getting a filling. For the majority of patients, over-the-counter pain medicine — like ibuprofen or Tylenol —are the only post-procedure medicines patients need.

The need for a root canal starts deep inside the tooth. Our teeth are not hard all the way through. At the center of each tooth, underneath the hard layers of enamel and dentin, is the soft, living pulp. Pulp cells helped your body create teeth when you were young. Nerves in the pulp let us know when something is too hot, cold or hard for our teeth.

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Problems arise when infection gets into that part of our tooth, causing pulpitis. Pulpitis can cause pain, and it can even cause the nerves within it to die.

“If that nerve dies, the inside of the tooth becomes like a tunnel,” said Peek. “That empty tunnel can be filled with bacteria.”

Usually, the hard surface of our tooth protects the pulp from infection. But deep caries, or cavities, in a tooth can let bacteria into the pulp. A crack or chip in a tooth due to an injury or tooth-grinding can do the same thing. Sometimes people can be aware that there’s something wrong: they get a toothache. Other times, people can be unaware of an infection until a dentist notices it.

Infected pulp — or a tooth with dead nerves where the pulp used to be — are signs that a root canal procedure needs to be done. If it’s not done, the infection could cause you to lose your tooth.

Advancements that help make the procedure more comfortable for patients include new diagnostic tools and tools that are used during the procedure itself.

To plan for the procedure, Parolia uses CBCT, or Cone Beam Computed Tomography, an imaging device that provides 3-D images of a patient’s teeth.

“I use CBCT on all my patients,” Peek said. “The 2-D x-ray pictures don’t really show everything. They only identified 25 percent of the problems.” With faulty diagnosis, patients used to have to go back for more treatment. With CBCT, 100 percent of problems in the tooth can be seen, so patients get a better diagnosis.

Endodontists are also experts in making sure the patient’s mouth is numb for a procedure. “We make sure the procedure is painless,” Parolia said. Depending on a patient’s medical history, allergies, the depth of the infection, and even their anxiety level, the type of anesthesia can be adjusted for any patient.

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The procedure itself is now much quicker and more efficient than in the past. Once the patient’s mouth is numb, the endodontist will drill a small hole into the infected tooth, and use tiny instruments to make sure the pulp and canals in the roots of the tooth can be accessed. According to Parolia, a surgical microscope can sometimes be used to do the procedure with greater precision.

Then, the inside of the tooth needs to be cleaned of bacteria and infected material. Today, endodontists use a device that uses sound waves and a disinfecting fluid to remove infected material rather than scraping it out. This new procedure means that less of the tooth needs to be removed, leading to a stronger tooth post-procedure.

Once the inside of the tooth has been cleaned, the endodontist will fill any empty tunnels and canals with a biocompatible material, sealing them against future infection — and that’s the end of the procedure. Most root canal procedures at Peek’s office can be done in one visit that takes 45 minutes or less.

Most people will need to have their tooth crowned sometime after their root canal procedure. The infection has already weakened the tooth, so a crown will help protect it. Peek reminds his patients that even though their pre-root-canal toothache might be gone after the root canal procedure removed the infection, they still need to have a dental crown put on the tooth.

With advancements in dental technology and knowledge, patients can face a root canal procedure with less fear, knowing that their teeth will be saved. As Peek’s website proudly declares, “Root canals are good!”