January 20, 2021
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The joy of root canal therapy

By: George Malkemus
November 1, 2019

Tooth pain can be the excruciating.  Luckily, root canal therapy can relieve intense tooth pain and save one’s tooth, the joy of a root canal. 

Teeth are meant to last a lifetime.  So, if a tooth becomes critically injured or diseased, it is best to save it with root canal therapy.  Though root canal therapy has been a standard dental procedure for decades, recent advancements in dental technology has made treatment much more comfortable and predictable.  With conscious sedation, a fearful patient can have a relaxed, anxiety-free appointment with no memory of the visit. To help understand when and why root canal therapy is needed, I have answered some of the most frequently asked questions about the procedure.

What is a root canal? 

Root canal therapy is a filling that is placed into the canal of the root after the canal has been thoroughly cleaned.   Filling material is also placed into the cleaned pulp chamber of the tooth.  The pulp is a soft tissue in the center of a tooth that contains the nerves, arteries, veins, and lymph vessels.  When the pulp is diseased or injured and unable to repair itself, the pulp dies, and has to be removed.  Root canal therapy then becomes necessary.

Why does the pulp need to be removed?

If the damaged or diseased pulp is not removed, the tooth and surrounding tissues become infected.  Pain and swelling may accompany the infection.  Even in the absence of pain, an abscess can form at the tip of the root and eat away the bone in the jaw.  Without root canal therapy, the tooth will eventually have to be removed, because of bone loss.

Are root canals painful?

Most root canal therapies are not painful and actually relieve pain.  Once the nerve of the tooth is removed, there should be no more discomfort in that tooth.  The procedure is similar to a filling being placed through the top of the tooth.  The canals are very small, so generally more time is needed to clean out all the infected tissue and fill the canals.  

Last week, I treated a woman who had endured pain in her lower left molar for two years. The tooth had a crown placed upon it five years ago. The tooth had been sensitive to hot, cold and chewing for two years, and she had learned to live with the discomfort by avoiding the tooth.  After root canal therapy, I called her at home the next day.  All her symptoms of pain had gone away.  She said, “I feel great!  I don’t know why I didn’t do this sooner.”  I receive that same positive response with almost every completed root canal.  

Root canals work 98 percent of the time.  Occasionally root canal therapy is not effective, because of a severe infection or a crack in the root.  In which case, the tooth has to be removed and an implant or bridge must be placed to replace the missing tooth.  Over 80 percent of the time, a tooth will immediately feel great after root canal treatment with no discomfort at all.  Some 15 percent of the times, a tooth will take up to a week to calm down.  Infrequently, after root canal therapy, a tooth will take up to a month or longer to feel completely normal.

How different will my tooth feel after a root canal?

Other than the fact that the tooth won’t hurt; there will be no noticeable difference.  Since the nerve has been removed, there is no sensation to pain, hot, cold, or pressure.  However, the teeth adjacent to the treated tooth still feel normal sensation and there is sensation in the bone surrounding the root of the tooth, so everything feels the same as far as patient can tell.  

However, the treated tooth does lose its vitality once the internal live tissues are removed. It becomes more brittle and less resilient to biting forces, which can lead to a tooth fracture.  Therefore, crown placement is required after most root canals to hold the teeth together and prevent fracturing.

Why are most root canals preformed?

Root canal therapy is necessary for 3 main reasons, tooth fracture, deep tooth decay and tooth trauma.  

Tooth Fracture:  Last month, a young man broke his upper right bicuspid biting into pebble in a hamburger.  The pulp was exposed, and a root canal was completed, much to his relief.   

Deep Tooth Decay:  Recently I treated a 54-year-old man, who had deep decay and severe pain in his lower left molar.  He had been putting off treatment for years because of dental fear.  With conscious sedation to alleviate his anxiety, root canal therapy was completed along with numerous tooth colored fillings.  He was happy, thankful and pain-free for the first time in a long time.  

Tooth Trauma:  A 36-year-old lady traumatized her upper left molar from years of night grinding.  The dying pulp caused the tooth to ache.  After root canal therapy and a mouth guard to wear at night, she has total relief.     

Why do a root canal?  Why not remove the tooth?

It is always best to save a tooth if possible.   It is more involved and costly to replace a tooth with an implant or a bridge.  Teeth support each other, like bricks in an archway.  When a tooth is removed and not replaced, the teeth next to the empty space have to endure more forces of chewing with reduced support.  They often shift, become crooked, and become lost as well.

So, root canals should be cherished as a joyous advancement to save teeth and eliminate pain, not a dental procedure to be feared.



George Malkemus has a Family and Cosmetic Dental Practice in Rohnert Park at 2 Padre Parkway, Suite 200. Call 585-8595, or email info@  Visit Dr. Malkemus’ Web site at