A root canal is a restorative treatment that is used to cure a tooth infection and revive the health of the tooth. During root canal therapy, we scrape out the infected dental pulp, clean the tooth’s canals, and then fill the inside of the tooth with gutta-percha, a permanent filling.
Weakened rear molars may also require a dental crown to protect them from further damage. Read on in this blog from Smileplicity Dentistry to learn about the 5 signs that indicate you need a root canal.
What Happens During a Root Canal? A Quick Overview
Before getting into the warning signs, it helps to understand the procedure itself, since a lot of the fear around root canals comes from misconceptions rather than the actual experience.
- Numbing. The area is fully numbed with local anesthesia, so the procedure itself is not painful.
- Access and cleaning. A small opening is made in the tooth to access the infected pulp, which is then carefully removed along with the canals being cleaned and shaped.
- Disinfection. The canals are disinfected to eliminate remaining bacteria and reduce the risk of reinfection.
- Filling. The empty space is filled with gutta-percha, a biocompatible material, and the access opening is sealed.
- Crown placement. For most back teeth, a crown is placed afterward to protect the now more brittle tooth from future fracture.
Most patients report that a root canal feels very similar to getting a routine filling, largely thanks to modern anesthesia and technique.
1. Pain
When you have a tooth infection, it’s because of inflammation and bacteria penetrating the inside soft layer of your tooth, known as the dental pulp. This layer of your tooth contains connective tissue, blood vessels, and nerves.
Your nerves are responsible for sensation and can be hypersensitive in response to inflammation and bacteria. This is why a tooth infection can be incredibly painful. The pain may come and go or be constant.
However, pain is not always a present symptom when the tooth is infected. If the infection is left untreated, the nerves can die, resulting in no sensation but the infection is still active and needs to be treated.
2. Tooth Sensitivity
As previously mentioned, your tooth is hypersensitive because of bacteria affecting the tooth’s nerves and blood vessels. This is especially the case when consuming hot or cold foods and drinks.
If you experience intense tooth sensitivity after eating foods at extreme temperatures and the sensitivity lingers for a long time after you’ve eaten the foods, this is a big sign that you need a root canal. It suggests that the dentin layer of your tooth has been exposed.
A helpful way to think about this: normal sensitivity fades within a few seconds of removing the hot or cold trigger. Sensitivity that lingers for 30 seconds or longer, or that shows up seemingly out of nowhere while eating something at room temperature, is more concerning and worth having evaluated.
3. Swelling
Swelling can be a sign of infection or some other oral health problem. In a tooth infection, swelling can occur in the gums near the infected tooth as well as in the face and jaw. This is a result of inflammation and acid waste. Usually, when there’s swelling, there is also an abscess, which is a pus-filled pimple on the gums. Abscesses are a surefire sign of an infection.
An abscess in particular should never be ignored. Left untreated, the infection behind it can spread beyond the tooth into surrounding tissue, and in rare but serious cases, into the bloodstream. Facial swelling paired with fever, difficulty swallowing, or difficulty breathing is a medical emergency that warrants immediate care, not just a routine dental appointment.
4. Tooth Discoloration
Usually, a tooth infection can cause discoloration of the tooth, especially the darkening of the tooth that causes a gray or black appearance. If your tooth has changed color, that’s a sign that the pulp inside of the tooth is dying because it no longer has a supply of blood and other nutrients.
Tooth infections cut off the blood supply to the pulp and the longer it is left untreated, the greater risk of pulp death. At this point, the infection has penetrated deep through the dental pulp and needs urgent treatment to save the tooth.
5. Damaged or Loose Tooth
An infection can be caused by other disturbances other than tooth decay. If you suffer from dental trauma or an oral injury, this can also cause inflammation of the dental pulp or expose the tooth’s root and cause bacteria to infect the pulp, or an injury that doesn’t chip or crack the tooth can still cause damage to the dental pulp.
A crack that runs up to the gum line and an exposed nerve is a big sign of an infection. Over time, your tooth may also feel loose. Loose teeth can be caused by the nerves in the teeth dying which softens the bone around the tooth’s root.
Root Canal vs. Extraction: Why Saving the Tooth Usually Wins
When a tooth is infected, patients sometimes wonder whether it’s simpler to just have it pulled instead. Here’s how the two options generally compare.
| Factor | Root Canal | Extraction |
|---|---|---|
| Keeps natural tooth | Yes | No |
| Impact on neighboring teeth | None | Can allow shifting, may require future replacement |
| Bone preservation | Bone around the tooth is maintained | Bone in the area can begin to resorb without a replacement |
| Recovery time | A few days of mild soreness | Similar short-term recovery, but replacement adds time later |
| Long-term cost | Often more cost-effective than extraction plus replacement | May seem cheaper upfront, but often costs more once a bridge or implant is added |
In most cases, saving the natural tooth through a root canal is the preferred option, both for function and for avoiding the downstream effects of tooth loss. If extraction does end up being necessary, our article on how dental implants support jaw bone health explains why replacing a missing tooth promptly matters for your jawbone.
What Happens If You Ignore These Symptoms?
Delaying treatment when these signs are present rarely makes the problem go away. Instead, the infection typically continues to spread, which can lead to a larger abscess, increased bone loss around the tooth, and in more severe cases, the loss of the tooth altogether. What could have been resolved with a root canal early on sometimes turns into an extraction plus a replacement procedure later, which tends to be more time-consuming and expensive than addressing it promptly. If you’re weighing what replacement might look like down the line, our guide on everything you need to know about dental implants covers that process.
Recovery After a Root Canal
Most patients return to normal activities the same day or the next, with a few simple care steps in the days following treatment.
- Mild soreness for a few days is normal and usually manageable with over-the-counter pain relief.
- Avoid chewing on the treated tooth until any permanent crown is placed, especially with a temporary filling in place.
- Continue brushing and flossing normally, being gentle around the treated area.
- Contact the office if you experience severe pain, swelling, or an allergic reaction to prescribed medication.
If you’re pregnant and a root canal has come up as a recommended treatment, our dental guidelines for pregnant patients covers why the procedure and anesthesia used are considered safe at any point during pregnancy.
Frequently Asked Questions About Root Canals
Does a root canal hurt?
The procedure itself is performed under local anesthesia, so it shouldn’t hurt. Many patients find it comparable to getting a filling. Some soreness afterward is normal and typically fades within a few days.
How do I know if I need a root canal or just a filling?
A filling addresses decay that hasn’t reached the inner pulp, while a root canal is needed once the infection has reached that inner layer. Your dentist can determine which applies to your specific case with an exam and X-ray.
Can a tooth infection go away without treatment?
No. Without treatment, a tooth infection will not resolve on its own and typically continues to worsen, increasing the risk of a spreading infection or tooth loss.
How long does a root canal take?
Most root canals are completed in one to two visits, generally lasting 60 to 90 minutes each, depending on the tooth and complexity of the case.
Is a crown always needed after a root canal?
Not always, but it’s common for back teeth like molars, since they bear more chewing force and are more prone to fracture once the tooth has been hollowed out and filled.
Have Any of These Symptoms? Contact Our Raleigh Office Right Away
Having signs of a tooth infection is a serious dental emergency. You should contact us at Smileplicity Dentistry right away to schedule an emergency appointment in Raleigh with Dr. Daiana Atari. If caught early enough, we can save your tooth from extraction, prevent the spread of the infection, and prevent serious complications like sepsis.
