Root canal treatment 

Introduction 

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Root canal treatment is a dental procedure to treat infection at the centre of a tooth (the root canal system). Root canal treatment is also called endodontics. The infection is caused by bacteria that live in the mouth and invade the tooth when:

  • tooth decay occurs
  • fillings leak
  • teeth are damaged by trauma, such as a fall 

See the Health A-Z topic on Tooth decay for more information about how decay starts.

Tooth structure

A tooth is made up of two parts:

  • The crown is the part of the tooth that is visible in the mouth.
  • The root extends into the bone of the jaw, anchoring the tooth in position.

These are composed of the following structures:

  • Enamel is the hard outer coating of a tooth.
  • Dentine is a softer material that supports the enamel and forms most of the tooth. 
  • Cementum is a hard material that coats the root surface.
  • Dental pulp is the soft tissue at the centre of the tooth.

The root canal system

The root canal system contains the dental pulp and extends from the crown of the tooth to the end of the root. A single tooth can have more than one root canal.

The pulp is made up of soft tissue that includes nerves and blood vessels. If bacteria infect the pulp, it will begin to die. After this, the bacteria can increase in number. The bacteria and the substances they release will eventually pass out of the end of the root canal through the small hole where the blood vessels and nerves enter.

This process continues as there is nothing to stop more bacteria passing down the root canal, which causes the tissues around the end of the tooth to become red and swollen. This can cause your tooth to become painful and, in extreme circumstances, your face may become swollen (dental abscess).

Outlook

To treat the infection in the root canal, the bacteria need to be removed. This can be achieved by:

  • removing the tooth (extraction) 
  • attempting to save the tooth by removing the bacteria from the root canal system (root canal treatment)

In root canal treatment, the bacteria are removed from inside the root canal system, the root canal is filled and the tooth is sealed with a filling or crown. In most cases, the inflamed tissue at the end of the tooth will heal naturally.

Root canal treatment should not be painful because local anaesthetic is usually used. The procedure is usually very successful and should be no more unpleasant than having a filling. In about 9 out of 10 cases, a tooth can survive for up to 10 years after root canal treatment.

  • show glossary terms

Abscess
An abscess is a lump containing pus, which is made by the body during infection.

Bacteria
Bacteria are tiny, single-celled organisms that live in the body. Some can cause illness and disease and others are good for you.

Inflammation
Inflammation is the body's response to infection, irritation or injury, which causes redness, swelling, pain and sometimes a feeling of heat in the affected area.

Last reviewed: 13/08/2010

Next review due: 13/08/2012

Comments

11 Comments

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Comments are personal views. Any information they give has not been checked and may not be accurate.

User645177 said on 14 February 2012

I did a lot of searching on the internet for a sympathetic and understanding dentist on the NHS. (Dental Phobic)
here in South Bristol. I found one that I thought might be ok, so I sent a message from the website. (Very brave when you are behind a monitor!)
Next day I had a phone call from them with an appointment available three days later. I accepted; and then was in a panic from there on right up to my visit!
I was convinced I had to have at least five extractions.
The dentist I saw was absolutely wonderful and put me completely at ease. I was very embarrassed because my teeth were so neglected through fear.
Imagine my surprise when after examining me they said 'Not too bad'! No extractions needed, just root canal treatment and fillings.
From reading other messages here; I just wanted to say that the initial payment was £17, and I have to pay £30 on my next appointment. Please do lots of searches on NHS Dentists in your area - My dentist has the motto 'We feel you are entitled to be treated the same as private patients'

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Rhiannon20 said on 03 January 2012

I received a filling on my back left bottom molar and had to go back a few days later as it was still very painful.
My dentist was on holiday so I had an emergency appointment with another dentist in the practice. She removed the filling and told me I had an infection which had been missed by my own dentist. This made me very angry. I was in there for about 2 hours while she cleaned the tooth and took an x-ray etc. She then told me I would have to have a root canal. She was unable to do it though as she wasn't my dentist so I had to suffer through Christmas in pain until I could get another appointment with my own dentist.
I went and he had a poke about it and put a temporary filling on, still not fixing the problem. So I also had to go through New Year with pain and being unable to eat properly.
I am now going back again tomorrow to finally get it sorted (I hope)
I was originally charged around £40 for the filling when he didn't notice my infection and now a further £80 for the root canal treatment. I can't afford to go to a private dentist as I have just graduated from uni and living back at home. I just feel incredibly let down. I have had previous problems with this tooth in the past and I can't help but feel this could all have been avoided. I have been told different things from each dentist, and feel like I'm just being ripped off. I've been given appointment after appointment and had nothing successful done as yet. I was told my wisdom tooth had been coming through at the back but nothing more has been said about it. I was originally told that was why I was feeling pain and it was 'nothing to worry about.'
I have a big fear of the dentist as it is, but the pain and trauma I have been through so far has only worsened this. I just hope tomorrow that it will be sorted. I am seriously tempted to just get it ripped out as I am fed up of being messed about. I'd change dentist if they werent so scarce, just wish they would do their job properly!

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Bath resident said on 03 January 2012

Steedie, You can have root canal treatment on the NHS in Bath. I have had it done there very recently. My sister was also offered it although she opted to go privately.. Apparently the inferior equipment and time constraints mean that the chances of success are less than private treatment but it costs £400 - £500 less. My dentist seemed to think it was worth trying and a much better solution than losing a tooth. It may not work, time will tell.

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Steedie said on 21 October 2011

I've just been told by the helpline that root canal work is definitely not available any more on the NHS in the Bath area. Our NHS dentist already told us this, we didn't believe it, so called the Primary Heathcare Trust helpline - who told us definitively that root canal treatment is no longer available in this area as the cost is too high for the dentists to be able to offer on the NHS. The only alternative is to either have the tooth extracted or go privately. The cost quoted is in the region of £800 - £1000 This seems to be a very sad state of affairs, especially as the NHS dental websites still clearly state that root canal treatment is available!

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drewbert30 said on 19 September 2011

I have always looked after my teeth and have only had 2 fillings done in 30 years. I moved house about a year ago and have had to change dentists. I was eating one day and bit down on a bone in some food and broke 2 of my teeth at the back. I went to my dentist and he said that my teeth had broken due to decay! I asked him why he had not spotted this decay when I visited before. He said that there were no signs of decay at that time! he said that both teeth would need to be extracted as root canal was not possible. I was of course very distressed at the thought of losing 2 of my molars in the bottom of my mouth as I would only be ale to chew on one side. I asked him if there was anyway at all to save the teeth and he said no becuase I have wonky roots. He also said he could not do the extraction as it was too complicated and would need to be done in hospital. I then waited for 1 month for the referal and nothing came through. in that time I developed an infection in my tooth and had to have antibiotics. I went back to the dentist and he had forgotten to send the referal through. I complained about this but nothing was done. After a further 6 weeks of not hearing anything the pain in my teeth started to come back. So I decided to go to a private dentist and see what they could do to help me.
I arrived at 8:30 in the morning and explained everything to the dentist, She looked at my teeth and said to me that there was no decay in my teeth at all, the broken teeth were ruptured but were perfectly saveable. I would need a root canal treatment. As she was private it would cost me £500 for both teeth to be done but that would include the crowns. I said yes please! she then did the root canals right then and there. I have to wait 3 to 6 months to then have the crowns fitted. the procedure took 1 hour
Why do NHS dentists lie? I nearly lost 2 pefectly saveable teeth. I will always go private from now on! But I guess thats the idea, be so rubbish people go private!

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barry probin said on 05 August 2011

I have experienced a mixture of previous experiences. My dentist examined a painful premolar and said she would prescribe antibiotics. She went on to say if these did not work the tooth would have to be extracted or she could refer me to a private dentist who would carry out treatment which would amount to up to about £900. She would not do root canal treatment. The antibiotics helped a little but the pain returned so I contacted the practice manager to ask why root canal treatment was not offered since it was listed in the NHS price band on display in the surgery. She reassured me that the practice does carry out NHS root canal treatment and that I could see a different dentist. This was good news. The pain returned and I asked for an emergency appointment but (because of sickness and holidays) none was available so I was obliged to contact the local emergency dental service. I went the same day and the dentist carried out root canal treatment and placed a temporary filling which will need to replaced with a permanent one in due course by my own dentist. The cost of the root canal treatment to this stage cost £17. Maybe a moral is move to the north of England.

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Katald said on 14 July 2011

My dentist suggested a rescue attempt of one of my molars after it had broken. It had already been root treated 5 years ago. Despite an infection on the base of the root apparent my dentist re-filled the tooth and at the same time made a filling to a neighbouring pre-molar. Since then my dental pain has been unbearable and I have been on painrelief for the past 5 weeks. I went back to my dentist suggesting to have the molar removed which she did (without taking another x-ray), but the toothache persisted as before. I changed dentist and went to another private clinic in London. They took an x-ray and I was told that the filling of the pre-molar was very deep and probably had done some damage to the nerve. Thus the persistant pain. This Tuesday I had some root canal treatment done for £350. It was a very painful procedure as the dentist was unable to anethetise my nerv successfully and had to use a local into the canal bit by bit. All in all the treatment has cost me up to now £620! (can't find a NHS dentist who takes me on) I am still in pain, the site of the root canal treatment is very tender and sore to touch. Not sure what to do next. I this "normal" or should I contact my dentist again?

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Maid0fVale said on 06 July 2011

I have been trying for over a year to get a root canal on the NHS just like yourself I cannot afford private and I keep being referred to Private or told to have the tooth extracted - I did have a root canal privately yet the NHS dentists inform me it hasn't been done that well as there is no guarantee and I now I need further work which is not cov ered on the NHS - there might be the opportunity for just graduated dentist to effect the root canal work for me but this concerns me as he being a graduate will need practise and hence I might find like the private work it wasnt done properly - let me know if you find an NHS dentist who has been qualified for at least a year who does root canals
thanks

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londonsquirrel said on 30 June 2011

I have just registered as an NHS patient at my local dentist (which is one of a nine-practice group in West London). During my initial examination I was told that I need root canal treatment for one tooth and have been referred to another practice in the group - which only offers private treatment. I am unable to afford the fees quoted and am in pain. Please - can anyone help by telling me exactly where/how can I get root canal work carried out on the NHS? Many thanks.

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Blue1 said on 09 June 2011

I've just had root canal treatment in one of my front teeth with my NHS dentist and was charged £17 for the initial consultation and £47 for the treatment...I think you need to ask your dentist why you were charged so much on the NHS! The highest band on the NHS is £204 right now, so it sounds like you've been charged way too much...

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General Wolfe said on 21 April 2011

I had to have two root canals done either side of my lower jaw and I was charged £250 per tooth.
Although they are in band 2 I was told that they are not included and therefore I had to pay. Irepeated what is said above but no the NHS cannot afford them.
If they are not included please can you remove them from Band 2 so there is no misunderstanding.
I would like an answer
General Wolfe

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