What it is: Deep cavities, extensive or repeated dental procedures, or trauma to the tooth can leave a tooth’s soft insides, or pulp, inflamed and eventually infected. During a root canal, a provider drills into the root of your tooth to remove infected, necrotic (dead ) pulp in the center of your tooth. The inside of the canal is cleaned, disinfected, filled, and sealed.
When it’s needed: The pulp contains a tooth’s nerves, and once that tissue has begun to decay, there’s no option but to take it out, Simmons says. Otherwise, the infection can spread to other parts of the body. Although it’s rare now, before the advent of antibiotics untreated infected tooth pulp could sometimes be fatal.
When to question it: It’s important that your dentist perform adequate testing to determine that your tooth’s pulp is necrotic and not salvageable, because some people who need root canals don’t experience pain as a symptom. Testing may include X-ray imaging, and your dentist should do a sensitivity test, such as placing something cold against the suspect tooth and assessing your reaction. If you can’t feel the cold at all, the tooth is probably dead and needs a root canal, Lawson says. Significant or extreme pain is also a concerning sign. A few seconds of pain, however, may mean that the tooth’s pulp is inflamed but not irreversibly so. (If the tooth is crowned, a temperature-based test might be less effective.) The dentist should also place the cold object against one of your other teeth for comparison.
What the alternatives are: For a tooth that definitely needs a root canal, the only alternative is to extract the tooth (and potentially place an implant). But for a tooth that has reversible inflammation (known as reversible pulpitis), a filling plus a pulp cap—a much less expensive procedure in which pulp exposed by drilling is covered with protective material—can suffice, Lawson says. But keep in mind that this option isn’t always successful. If consumers go with that choice, he says, “they have to assume the risk that they might continue to hurt because it didn’t work, and they might be paying for two treatments.”
Cost of root canal treatment: $620 to $1,472, depending on whether it’s a molar, premolar, or front tooth. A crown, if needed, will add to the cost.
