In most cases, root canal treatment is not painful while it is being done. The tooth is numbed with local anaesthesia, so most people feel pressure and vibration rather than pain, much like having a large filling. The tooth may feel tender for a few days afterwards, and the treatment usually relieves the toothache that brought you in.
Why root canal treatment has a reputation for pain
Root canal treatment (also called endodontic treatment) removes the inflamed or infected soft tissue inside a tooth, called the pulp, then cleans, disinfects and seals the space. The pulp contains nerves and blood vessels, which is why a damaged pulp can hurt so much.
Much of the fear comes from the pain people feel before treatment. A deep cavity, a crack or an old injury can let bacteria reach the pulp, causing throbbing pain, sensitivity to hot drinks or pain that wakes you at night. The treatment is what removes the source of that pain.
If you are not sure whether your tooth needs this treatment at all, our article on how the choice between root canal treatment and extraction is made explains the reasoning.
What you feel during the treatment
Before starting, the dentist numbs the area with local anaesthesia: an injection that blocks the nerves around the tooth for a few hours. A numbing gel is often applied to the gum first, so the needle is barely felt. You stay fully awake. As the NHS explains, with a local anaesthetic you are awake but should not feel pain during root canal treatment.
Once the tooth is numb, most people describe these sensations:
- pressure when the dentist works on the tooth
- light vibration from the instruments
- the sound of the instruments and of the suction tube
- a tired or stiff jaw from keeping the mouth open
Sharp pain is not normal. If you feel anything more than pressure, raise your hand: the dentist can pause and give more anaesthetic.
When numbing takes longer
A very inflamed tooth, sometimes called a “hot tooth”, can be harder to numb, especially a lower back tooth. This is well known and manageable. The dentist may wait a little longer, add anaesthetic in a different place or use a technique that delivers it closer to the tooth. Telling the dentist honestly what you feel is the most useful thing you can do.
The procedure step by step
- Examination and X-ray: the dentist checks the tooth, your symptoms and an X-ray showing the shape of the roots and any infection at their tips.
- Anaesthesia: the tooth is numbed, and the dentist checks that it is working before going further.
- Isolation: a thin rubber sheet called a rubber dam is placed around the tooth to keep it dry and clean and to stop small instruments or liquids from reaching your throat.
- Cleaning the canals: a small opening is made in the top of the tooth, the pulp is removed, and the narrow canals are cleaned and shaped with very fine instruments and rinsed with disinfecting solutions.
- Filling the canals: the canals are sealed with a rubber-like material called gutta-percha and a sealing cement.
- Closing the tooth: a temporary or permanent filling closes the opening. Back teeth often need a crown later to protect them from breaking.
An appointment usually lasts about one to one and a half hours. Many teeth are treated in one or two visits; teeth with several curved canals, an active infection or an earlier treatment that needs redoing may need more. For a fuller description of each stage, read what actually happens in the chair during root canal treatment.
Pain after a root canal: what is normal
When the anaesthesia wears off, usually after a few hours, the tooth and gum may feel sore.
- tenderness when biting, often for a few days
- a dull ache that improves day by day
- mild soreness of the gum or jaw where the injection was given
For most people, over-the-counter painkillers such as ibuprofen or paracetamol are enough, if they are suitable for you. Follow the dose on the packet, and ask your dentist or pharmacist if you have a medical condition or take other medicines. Avoid chewing on the treated side until the tooth has its final filling or crown, and do not eat while your mouth is still numb, so you do not bite your cheek or tongue.
When to contact the dentist
Contact the clinic if you notice any of the following:
- pain that gets worse after the first few days instead of better
- swelling of the gum, face or jaw
- a fever or feeling generally unwell
- the temporary filling falls out or breaks
- your bite feels high or uneven when you close your teeth
- a rash, itching or other signs of a reaction to a medicine
If you are in severe pain before your appointment, our guide on what to do right now about a severe toothache gives practical first steps.
Is it worth it? Results, alternatives and cost
In most cases, a tooth that has had root canal treatment and is well restored can last for many years.
The main alternative is extraction, meaning removal of the tooth. This can be the right choice when a tooth cannot be saved, but the gap then usually needs to be filled with an implant, a bridge or a denture to keep chewing comfortable and stop neighbouring teeth from moving. Antibiotics alone do not cure an infected pulp; they may be used alongside treatment when an infection is spreading.
The cost depends on which tooth is involved and how many canals it has, how complex those canals are, whether it is a first treatment or a re-treatment, the number of visits, and whether the tooth will need a crown afterwards. Only an examination can give you a clear picture, so we invite you to come in for a consultation.
Root canal treatment at Ajam Dental Clinic in Tripoli
At Ajam Dental Clinic, root canal treatment, including re-treatment of previously treated teeth, is carried out by a visiting specialist endodontist, a dentist who focuses on the inside of the tooth and its roots. You can read more about our root canal treatment.
Patients come to our clinic on Fouad Chehab Boulevard from across Tripoli — Al-Qobbeh, Bab al-Tabbaneh, Jabal Mohsen and Dam wa Farez — as well as from Beddawi, Minieh and the rest of North Lebanon. If a tooth is hurting or you have questions about treatment, contact us by WhatsApp or phone to book a consultation.
Frequently asked questions
Does the anaesthetic injection hurt?
Most people feel a brief pinch or sting for a few seconds. A numbing gel is often put on the gum first, and the anaesthetic is usually given slowly, which makes it more comfortable. After a minute or two the area starts to feel thick and numb, and from then on the treatment itself should not be painful. Upper teeth can often be numbed with a small injection next to the tooth, while lower back teeth may need an injection further back in the jaw. If needles make you nervous, say so before starting: knowing what is coming, and having a signal to pause, helps many people feel more in control.
Can I go back to work or school the same day?
Usually, yes. Most people return to their normal activities straight after the appointment. The main limitation is the numbness, which can last a few hours, so it is wise to wait before eating and to avoid hot drinks until feeling returns, because you could burn or bite yourself without noticing. After a long appointment your jaw may also feel tired. If you can, plan something light for the rest of the day, and take a suitable painkiller before the anaesthesia wears off if your dentist has advised it. Local anaesthesia does not make you drowsy, so it does not normally stop you from driving.
Is it normal for the tooth to feel different weeks later?
A treated tooth can feel slightly different for a while, for example a little tender when you tap it or bite on something hard. This usually fades over a few weeks as the tissues around the root heal. What is not normal is pain that keeps getting stronger, swelling, or a small pimple-like bump on the gum near the tooth, which can point to an infection that has not settled. In those cases, contact your dentist so the tooth can be checked, sometimes with a new X-ray. Occasionally a tooth needs re-treatment, which means a second root canal treatment to clean and seal the canals again.
Can I take a painkiller before my appointment?
In general, if you are in pain before the visit, you can take your usual painkiller as directed on the packet. Tell the dentist what you took and at what time, because it helps them plan your care. Do not take more than the recommended dose, and never put aspirin or any other tablet directly on the gum, as it can burn the tissue. If you take blood thinners or have a medical condition such as heart disease, diabetes or kidney problems, mention it when you book. Do not stop a prescribed medicine on your own without speaking to your doctor first.
My tooth has stopped hurting. Do I still need the treatment?
Possibly, yes. Pain sometimes stops because the nerve inside the tooth has died, while bacteria remain inside the canals. The infection can then spread quietly to the bone around the root and later cause swelling or an abscess, which is a pocket of pus. Only an examination and an X-ray can show what is really happening. If a tooth has been very painful and then suddenly goes quiet, it is worth having it checked rather than waiting to see. Treating a tooth before an infection spreads is usually simpler and more comfortable for you.
I am very anxious about dental treatment. What can help?
Dental anxiety is common, and there is nothing to be embarrassed about. Mention it when you book and again once you are in the chair, so the pace can be adjusted to you. It helps to agree on a signal, such as raising a hand, to pause at any time. Some people like to hear each step explained before it happens, while others prefer not to know the details. Eating a light meal beforehand, arriving a little early and breathing slowly through your nose can also make the appointment feel easier. Asking all your questions at the consultation means fewer surprises on the day.
Have a question about your teeth?
Send a WhatsApp message to Dr. Abdel Rahman Ajam or Dr. Soumaya Ajam, or call the clinic to book a consultation.
This article provides general information for patients. It does not replace an examination by a dentist, who can advise you on your own situation.