The Best Way to Manage Root Canal Pain

More than two-thirds of dental patients ranked root canals as the procedure they feared the most, according to a survey done by the American Association of Endodontists (AAE). But the fear of root canal pain may be unfounded, and patients who actually undergo root canal procedures are six times more likely to describe it as painless than those who have never had one.

“Most of the time, treatment can be accomplished with little or no discomfort,” says James C. Kulild, DDS, President of the American Association of Endodontists. “And most of the discomfort experienced by patients comes from the injection of a local anesthetic.”

Reason for Root Canals

Tooth pulp is a soft tissue containing blood vessels, nerves and connective tissue that lines the inside of the tooth from the crown to the root tips. Deep cavities, cracks in the surface, multiple dental procedures or traumatic injury can lead to infection or damage of the pulp resulting in pain or abscess.

Once the pulp becomes infected or damaged, a root canal is needed to save the tooth. During the procedure, the pulp is carefully removed, and the canal is cleaned and sealed. Often a crown is placed afterwards to protect the tooth.

The Pain Facts

“The vast majority of endodontic pain, almost 97 percent, is caused by infection,” says Dr. Kulild, who is also director of postgraduate Endodontics at the University of Missouri-Kansas City School of Dentistry. “Almost invariably, pain before a root canal is due to infection.” A tooth that has been damaged from the trauma of an acute injury, such as a blow to the mouth, may also be painful prior to treatment.

Despite the bad rap of root canals, nowadays, the actual treatment is no more uncomfortable than having a simple filling. But the misconception that all root canals are painful is hard to dispel. Developing a relationship with patients and offering reassurance before treatment can help reduce anxiety.

“I try to avoid using any negative terms that can conjure fear in patients,” Kulild explains. “I make a contract with the patient. I tell them I’m going to numb them, and if they feel anything during the procedure, I will stop and give them more ‘joy juice.’” This technique helps alleviate patient fear, and a relaxed patient allows the doctor to fully concentrate on the procedure so that optimal results are achieved.

Managing Root Canal Pain

The majority of patients experience soreness for a few days following root canal. The degree of soreness ranges from mild to intense, and some patients have no soreness whatsoever.

Most root canal discomfort can be managed with over-the-counter medications. “I tell patients to take whatever they usually take for headaches,” says Kulild. “Most non-steroidal anti-inflammatories, like Ibuprofen, work extremely well.” He also suggests taking the first dose of the medication before the anesthetic wears off and continuing it routinely, every six hours, for two to three days. “It’s easier to keep discomfort away than to make it go away once it starts.”

The amount of pain patients experience prior to root canal treatment can influence how they feel after the procedure, too. “If the tissue inside the tooth is still alive when I remove it, there’s very little discomfort post-operatively,” says Kulild. “But if the tissue inside and the bone outside the tooth is infected, it can take time for the body to heal.”

Symptom control is also influenced by a patient’s perception and tolerance of pain. In cases when the root canal pain isn’t adequately controlled with over-the-counter medications, a more potent pain reliever may be prescribed.

Healing usually takes place without complications, but there are symptoms Kulild says could be reason for concern, including:

• Continued discomfort
• Swelling
• Pimple-type growth adjacent to the affected tooth that forms after the root canal or, if it was present before the procedure, that doesn’t go away within three to four weeks.

Who Performs a Root Canal?

Both general dentists and endodontists perform root canals. More complicated cases are often referred to endodontic specialists, but with over 15 million root canals done each year, there are plenty of cases to go around. “As many as 80 percent of root canals are performed by general dentists because there are not enough endodontists,” says Kulild.

The success rate for root canal treatment is 95 percent, and with effective treatment, most teeth can be saved. Before having a root canal, make sure your dentist is skilled and experienced in the procedure and that a thorough evaluation has been done.