Root canals have reputation of being painful and bad. But this is just a misconception. Most of the times, no pain occurs during and after root canal treatment. When a patient is told that he would be requiring root canal treatment, the first thing which will come in his mind is root canal treatment pain. This is just a myth that root canal procedure causes pain.  Root canal treatment is a painless procedure and is done to eliminate pain which is present due to infection in tooth. When pulp is infected or non-vital, then root canal treatment is done. Most of the people who have undergone root canal treatment will say that root canal procedure is a painless procedure and no pain occurs during root canal treatment.   

Pain during Root Canal Treatment

Dental anxiety or the fear of the dentist, dental clinic or dental treatment is one of the main reasons of avoidance of dental treatment. People will visit their dentist when it becomes utmost important to take a professional help. They will be horrified to sit on the dental chair and when the dentist or endodontist numbs the area, they will discover that the local anesthetic shot (Novocain) was not that painful. After the area is numb, patient will feel no pain during root canal procedure.

If patient keeps on anticipating that root canal procedure is going to cause pain or discomfort, then he will be making it more difficult for himself. He will concentrate on local anesthetic shot stimulus and will be making the whole experience more unpleasant for himself. Getting a root canal treatment done is more or less similar to any other type of dental procedure like having a dental filling.

When can Pain Occur during Root Canal Procedure

If there is no pus in tooth or tissues are not inflamed, then Novocain generally works very well with standard shot. If the tooth is infected or has an  abscess  (pus) present or in case of inflamed tissues, single standard shot of anesthesia is not enough to numb the tooth. More of local anesthesia is given to the patient to numb the tooth in these cases. In case of infection or inflammation, that is when the tissues become red, swollen, hot and painful, PH becomes low and because of acidic environment, local anesthesia converts lesser of anesthetic molecules into diffusible form. That is why more of anesthesia is given to the patient.

If the nerve in tooth is already non-vital that is dead, then a single shot of anesthesia is sufficient to numb the area and to complete the procedure. If the tooth is vital and the nerve is infected and inflamed, then multiple shots of anesthesia are given to the patient. Vital tooth with infected nerve is called as hot tooth. Intrapulpal anesthesia may also be given in root canal treatment of hot tooth. In this drilling of the tooth is done from the top to the pulp chamber and then, local anesthesia is given directly into the nerve in the tooth.     

If the tooth is very painful and infected before the root canal procedure, then it is better to get the root canal procedure done from an endodontist who is specialist in performing root canal procedures. An endodontist may even give you local anesthetic shot which is stronger and last longer and will be suitable to numb an infected hot tooth.

In case of infected and painful tooth, antibiotics can also be prescribed for 3-5 days to reduce the infection in tooth and surrounding tissues.  

Patient may experience pain because of keeping mouth open for quite a long time which can cause pain in the jaw. Some degree of jaw soreness occurs after all the dental procedures.

What if Pain occurs during Root Canal Treatment

If patient feels pain during the root canal procedure, then he should tell his dentist or endodontist about this. Tooth may not have been anesthetized adequately and local anesthetic shot is then given again.

Root canal treatment is commonly done in 2 sittings. In the first visit, nerve is removed and cleaning and shaping of canals is done. Medicated temporary dressing is given to patient after cleaning and shaping of canals. In second sitting, canals are filled with a filling material. Local anesthesia is given during first sitting. In second sitting, nerve is which is responsible for pain and sensation is removed so anesthesia is not required. If patient wants to get local anesthesia for second appointment to numb the surrounding tissues and to avoid any discomfort, then he can tell his dentist to numb the area.

Gas pressure build up can cause pain after first appointment. Pressure can build up in the tooth after nerve is removed and before filling of dental canal. Temporary filling material is given to the patient after removing the nerve. By decrease in environmental pressure or because of temperature rise, pressure build up can occur inside the tooth and cause pain. Patient can take pain med in such situation. If pain med doesn’t provide relief, then temporary dental filling material can be removed.     

 If local anesthesia is achieved, then root canal treatment causes no pain. Pain can occur during root canal procedure if local anesthesia is not given at correct position.

If local anesthesia is not achieved, then the procedure can also be done under conscious sedation. If patient is very anxious before root canal procedure, then anti-anxiety meds can also be given to the patient.

Root canal treatment pain on scale of 1-10 with 1 being the least pain and 10 being severe pain is 2. If it is a non-vital tooth, then it causes no pain but if it is a vital infected tooth, then there will be no pain after profound anesthesia is given to the patient.

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  • dr ritz

    dr ritz 20 - December - 2011, at 01:52 AM

  • Yousuf, Tenderness of palatal canal can be there because of infection in the canal. If root canal procedure is already performed for tooth, then re-root canal treatment may also be required to remove the infection from the tooth. Before doing the procedure, make sure to also give palatal anesthesia. Without clinical examination, it is difficult to give definite answer. If tooth is infected, then antibiotics and pain meds can be given before procedure.

  • yousuf

    yousuf 20 - December - 2011, at 00:22 AM

  • sir i have a problem,I have a patient whose palatal canal in tender ,so what should I do to make her pain free..I will be waiting for your reply

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