Is Root Canal Treatment Painful? Myths vs Reality

Why Root Canals Have a Painful Reputation

The reputation of root canal treatment as an extremely painful procedure stems from several sources, most of which no longer reflect current practice.

• Historical dentistry — decades ago, dental anaesthesia and techniques were far less refined. Patients who underwent treatment in earlier eras may have genuinely experienced significant discomfort, and those stories have been passed down over generations.
• Media portrayals — films, television, and even casual conversation have reinforced the idea of root canals as something to dread. These portrayals are rarely accurate, but they shape public perception.
• Misunderstanding infection pain — many patients arrive for root canal treatment already in considerable pain from an infected or inflamed tooth. It is easy to associate that existing pain with the procedure itself, when in fact the treatment is intended to address the source of the discomfort.

Understanding where the fear originates is an important first step in recognising that the experience today is fundamentally different from what many people expect.

What Happens During a Root Canal?

Root canal treatment involves cleaning out the infected or damaged pulp tissue from inside a tooth, then sealing it to prevent further infection. Understanding the process can help reduce anxiety about what to expect.

The key stages typically include:

• Local anaesthetic — the area around the affected tooth is numbed thoroughly before any work begins. Your dentist will ensure you are comfortable before proceeding.
• Accessing the tooth — a small opening is made in the crown of the tooth to reach the inner pulp chamber.
• Cleaning and shaping — the infected or inflamed pulp tissue is carefully removed, and the root canals are cleaned and shaped.
• Sealing the tooth — the cleaned canals are filled with a biocompatible material and sealed. In many cases, a dental crown is placed afterwards to protect the treated tooth.

Because the tooth is numbed with local anaesthetic, sharp pain during the procedure is typically prevented. Most patients report that the experience is far more comfortable than they anticipated.

Does Root Canal Treatment Hurt During the Procedure?

This is the question most patients want answered before agreeing to treatment. The honest answer is that most people are pleasantly surprised by how manageable it is.

With effective local anaesthesia, the tooth and surrounding area are numbed before treatment begins. During the procedure, patients commonly report:

• Numbness — the treated area should feel numb throughout, meaning sharp pain is not typically felt
• Pressure sensations — some patients feel a sense of pressure or vibration during cleaning, which is normal and generally not painful
• Mild jaw tiredness — keeping the mouth open for an extended period can cause some stiffness, but this is temporary

It is important to acknowledge that individual experiences can vary. Some teeth, particularly those with active infections, may be more difficult to numb completely. In these cases, your dentist may adjust the anaesthesia or take additional steps to ensure comfort. If at any point during treatment you feel discomfort, letting your dentist know allows them to respond promptly.

What About Pain After a Root Canal?

Once the anaesthetic wears off, it is normal to experience some degree of post-treatment discomfort. This is part of the body's natural healing response and should not be cause for alarm.

Common post-treatment experiences include:

• Mild soreness around the treated tooth for a few days
• Tenderness when biting — the tooth may feel slightly sensitive to pressure as the surrounding tissues settle
• Gradual improvement — most patients find that discomfort eases significantly within a few days to a week

Over-the-counter pain relief such as paracetamol or ibuprofen is usually sufficient to manage any post-treatment soreness. Each patient heals at a slightly different pace, so exact timelines can vary. If discomfort increases or does not improve after several days, contacting your dental practice is always advisable.

Is Root Canal More Painful Than an Extraction?

Many patients ask whether it would be easier to simply have the tooth removed rather than undergo root canal treatment. In terms of comfort, neither procedure should be significantly painful during treatment thanks to local anaesthesia.

However, there are important differences to consider:

• Saving the natural tooth — root canal treatment preserves your own tooth, which is generally better for long-term oral health and function. An extraction removes the tooth entirely, which may require a replacement such as an implant or bridge.
• Recovery comparison — recovery after root canal treatment tends to be relatively straightforward. Extraction recovery can sometimes involve more swelling and a longer healing period, particularly for more complex removals.
• Long-term considerations — keeping a natural tooth avoids the need for future restorative work to fill the gap, which has both practical and financial implications.

Your dentist will always discuss the options available and help you understand which approach is most appropriate for your specific situation.

Signs Something Isn't Healing Normally

While most patients recover well after root canal treatment, it is helpful to know which symptoms may suggest that further review is needed. Contact your dental practice if you experience:

• Increasing pain that worsens rather than improves over the days following treatment
• Noticeable swelling in the gum, cheek, or jaw area near the treated tooth
• A return of symptoms — if the original toothache returns or a new type of discomfort develops
• Feeling unwell — fever or general malaise alongside dental symptoms

These symptoms do not necessarily mean the treatment has been unsuccessful, but they do warrant professional assessment. Early review allows your dentist to evaluate the area and take appropriate action if needed.

Why Root Canal Treatment Relieves Toothache

One of the most important things to understand about root canal treatment is that it is fundamentally a pain-relieving procedure. The pain patients experience before treatment is typically caused by infection or inflammation within the tooth's pulp — the soft tissue containing nerves and blood vessels.

By removing the infected pulp, root canal treatment achieves several things:

• Stops the source of pain — the inflamed or infected nerve tissue causing the toothache is removed
• Relieves internal pressure — infection can create pressure inside the tooth that causes throbbing or persistent aching
• Prevents further complications — untreated infections can spread to surrounding tissues, potentially leading to abscesses or more extensive problems

Many patients describe feeling significant relief in the days following treatment, once the initial post-operative tenderness settles. The tooth that was causing so much discomfort is often far more comfortable once the infection has been addressed.

How to Reduce Anxiety About Root Canal Treatment

Feeling anxious about any dental treatment is completely understandable. There are practical steps you can take to feel more at ease:

• Ask questions beforehand — understanding exactly what will happen during the procedure can significantly reduce uncertainty and fear. Your dentist should be happy to explain each stage.
• Understand the process — knowing that the tooth will be numbed, that the treatment typically takes one or two appointments, and that sharp pain is usually prevented can all help manage expectations.
• Communicate openly — let your dentist know if you are feeling nervous. Most dental teams are experienced in supporting anxious patients and can adjust their approach accordingly, such as taking more frequent breaks.
• Focus on the outcome — remembering that the purpose of the treatment is to relieve pain and save your tooth can help reframe the experience positively.

There is no need to feel embarrassed about dental anxiety — it is very common, and your dental team will understand and support you throughout.

Discussing Root Canal Treatment in London

At our London practice, we approach every root canal consultation with honesty and transparency. We believe patients deserve a realistic understanding of what to expect — including comfort levels — rather than vague reassurances.

Our approach includes:

• Assessment-led planning — we examine the tooth thoroughly and explain whether root canal treatment is the most appropriate option
• Honest comfort expectations — we explain what you are likely to feel during and after the procedure, without making promises we cannot keep
• Support throughout treatment — we check in with you during the appointment and encourage you to communicate if anything feels uncomfortable

If you are experiencing tooth pain and would like to understand your options, you are welcome to book a consultation. A thorough assessment can help clarify what is causing the discomfort and how it can be managed.