What is root canal treatment (and why it has that name)
Root canal treatment — formally called endodontic therapy — is the procedure by which infected or necrotic dental pulp is removed from inside the tooth. The pulp is the soft tissue occupying the central chamber of the tooth and the root canals: it contains nerves, blood vessels and cells. From this comes the Italian term “devitalizzazione” (devitalisation): what was living inside the tooth is removed.
The goal is not aesthetic or evasive: it is to save the tooth. When the pulp is reached by deep decay, trauma or bacterial infection, it does not regenerate. If left untreated, the infection spreads to the surrounding bone — and at that point extraction often becomes unavoidable. Root canal treatment, performed in time, is the alternative that allows the tooth to remain in place for years or decades.
Does it hurt? The honest answer
Root canal treatment has a historical reputation for being a painful procedure — a reputation largely built on experiences from decades ago, when techniques were different and local anaesthesia was less effective.
Today the situation has changed substantially. Here is the key distinction:
- Before treatment: the pain exists — caused by the pulp infection, which can be very intense, often worse at night and when lying down. This pain is not caused by root canal treatment: it comes from the tooth that needs treating.
- During treatment: with correctly administered local anaesthesia, the procedure does not hurt. You may feel pressure, instrument vibrations, the weight of the rubber dam isolating the tooth — but not pain. If you feel anything during treatment, just signal: more anaesthetic is added and treatment continues.
- After treatment: mild sensitivity and discomfort when chewing in the 2–3 days following is normal. The tissues around the root are responding to treatment. An over-the-counter analgesic (ibuprofen or paracetamol) manages discomfort well in most cases.
When root canal treatment is needed
Not every toothache requires root canal treatment. It is indicated when the pulp is irreversibly compromised. The signals that usually lead to this diagnosis:
- Spontaneous and persistent pain, often worse at night or with heat, that does not pass with analgesics
- Deep decay that has reached or approached the pulp chamber
- Dental abscess — infection with swelling, fever, pus
- Trauma that caused nerve death (the tooth may darken over time)
- Tooth that has had multiple restorations and whose pulp has progressively become inflamed
How root canal treatment unfolds step by step
Knowing what will happen helps reduce anxiety:
- Local anaesthesia — one or more injections of anaesthetic around the tooth. A few minutes are waited for full effect before any procedure begins.
- Rubber dam isolation — a latex (or silicone for allergic patients) sheet that isolates the tooth from the oral environment, keeping it dry and sterile throughout treatment.
- Access to the pulp chamber — an opening is created in the top of the tooth to reach the pulp.
- Canal shaping — with endodontic files (often automated, rotating), the canals are shaped while removing the pulp and infected material. The microscope allows every canal to be visualised with precision.
- Disinfection — thorough irrigation with sodium hypochlorite and other solutions to eliminate residual bacteria from canal walls.
- Obturation — the cleaned canals are sealed with gutta-percha (a biocompatible material) and endodontic cement, preventing reinfection.
- Coronal restoration — in the same or a subsequent session, the missing part of the tooth is rebuilt with composite or a ceramic crown.
After root canal treatment: what to expect
The first 24–48 hours after treatment are the most delicate. It is normal to feel:
- Sensitivity or mild pain when chewing on the treated tooth
- Some tension in the root area, as the periodontal tissues recover
- A feeling that the tooth is “high” if the bite isn’t yet perfect — this adjusts quickly
What helps: ibuprofen 400–600 mg every 6–8 hours for the first days (if not contraindicated), avoiding intense chewing on the treated side, soft foods for the first few days.
How long does a devitalised tooth last?
A tooth correctly treated with root canal therapy, with a good ceramic crown and correct home hygiene, can last decades — often a lifetime. It is not a second-rate tooth: it is a tooth that has lost its nerve, not its function.
The factors that influence the cost of root canal treatment
The cost varies based on specific clinical factors — there is no fixed universal price. The main ones:
- Number of root canals: an incisor generally has 1 canal; a premolar 1–2; a molar up to 3–4.
- Anatomical complexity: curved, calcified or supernumerary canals require longer instrumentation.
- Use of the surgical microscope: the microscope significantly increases treatment quality and long-term success probability, but has a higher operating cost than traditional naked-eye treatment.
- Final restoration: the post-treatment coronal reconstruction (composite or ceramic crown) has a separate cost.
Is your tooth giving you pain?
An urgent assessment visit will determine whether root canal treatment is needed — and we’ll explain all the options.
Article written by Dr. Luigi di Bari, Dental Studio in Manfredonia (FG). Last updated: May 2026.
