The short answer to the question “Does Root Canal Therapy Hurt” is absolutely No. The procedure itself should not hurt if performed under anesthesia. The patient may not be able to get numb for the procedure because of bacteria secreting toxins that changes the chemistry in the tissue that prevent the proper action from the anesthetics.
For a longer answer, we can look into what kind of discomfort might be experienced by the patient and the cause of those discomfort. My goal of this article is to educate the public about this common dental emergency procedure and to help people to cope with the fear of going to the dentist.
There are two major sources of discomfort experienced by the patient during the root canal therapy procedure. One kind of discomfort is of nervous origin. It can be the pain/discomfort from not having enough anesthesia. Another kind of discomfort comes from the physical distress from undergoing the procedure, such as from opening the jaw for an extended time, stretching of the cheek and retracting of the tongue.
The nervous pain is due to the problem of patient not being able to get enough anesthesia from the injected anesthetics. There are many possibilities of why patient cannot get numb. It can be due to the anesthetics not penetrating to the location where the nerve is located or there is not enough anesthetics to sufficiently numb the nerve. This usually can be easily corrected by letting the dentist to readjust the site of injection so that the anesthetics can get to the right place or, if there is not enough anesthetics, dentist can give additional anesthetics to the area. However, there are times that the patient might still not be able to get numb even after the dentist does the necessary steps of injecting the anesthetics. The chemistry of the body tissue might have changed due to the presence of bacteria when the patient is having dental infection. Sometimes the infection might affect only one smallest part of the nerve within the tooth and the dentist won’t be able to find out until the tooth has been worked on in the middle of the treatment. Most of the time, the tooth can be anesthetized if the dentist administers additional anesthetics, but in some rare instances if the patient still cannot get numb, the dentist might tell the patient to come back after a week of taking the antibiotics.
During the root canal therapy procedure, the patient might have physical distress from the technical aspect of the procedure. The patient’s jaw might get tired from opening wide for extended time. Or patient might have discomfort from having the cheek stretched. Most of this is due to the technical aspect of the root canal therapy. The patient might need to open for extended time because root canal therapy consists of multiple steps which requires the most concentration from the dentist and it takes time to thorough treat the infection within the infected nerve canal in the tooth. Sometimes if the patient cannot open wide enough, it might add difficulty for the dentist to be able to see and reach the nerve canals in the tooth. And also, sometimes the patient would express their distress in their body movement. So even though we cannot change the technical aspect of the procedure and we cannot change how wide the patient can open their mouth, we can educate patient about the procedure and let them more tolerable to the procedure. A calm patient will definitely contribute to the outcome of the root canal therapy.
In summary, the root canal therapy is not a painful procedure. Under proper anesthesia and proper physical coping, the patient should have a pleasant experience of undergoing the dental procedure. The fear of going to the dentist is due to the lack of understanding of the dental problems and the dental procedures. I hope people to find that the root canal therapy is not “scary” so they can get the necessary dental treatment to save their teeth.
Written by Daniel Tee, DDS, MS
Practicing Emergency Dentist Serving the city of Tempe, Chandler, Phoenix, Gilbert, and Mesa in Arizona.