Root Canal Treatment

Root canal treatment


When people ask us, ‘what is a root canal’ we usually tell them “it’s how we’re going to save your tooth”



Root canal treatment is sometimes the best and only way of saving a damaged tooth.  And here at Smileworks we love teeth and don’t like extracting them if we can help it.  The proper name for these types of treatments is endodontics – and you may hear them described this way or as root fillings or root treatment.  



A root canal is the name dentists give to the procedure of removing infected material from the pulp-filled cavity or root of a tooth if it is damaged by trauma or becomes infected by decay. Cleaning out the cavity with a bleach-like substance and replacing the infected material with inert material saves the tooth and can be done easily by a specialist endodontist or general dentist here in Liverpool.    



A successful root canal will:



Sometimes teeth get damaged by trauma or infected by decay.  This can be as a result of poor oral hygiene. Bacteria gets through cracks in the enamel and deep down into the tooth root.  This is the part of the tooth that is ‘alive’ and is susceptible to infection just like any part of your body.  It’s also the part that can cause you pain.  

Root canal pain

Does a root canal hurt?

Root canal treatments are performed under local anaesthetic. Areas of the mouth and the roots of teeth can be fed by a variety of nerves and a good dentist (or endodontic specialist) with experience and knowledge of facial anatomy will understand this and effectively numb the area so you won’t feel a thing.   So consequently root canal treatment is rarely painful.



Often, the tooth has been dressed as an emergency measure on a previous occasion and the root canal procedure aims to simply clean out the space left by the nerve and fill this back up to avoid bacteria contaminating it in future.   So put simply the nerve may already have been removed along with any infected pulp and the job of the dentist is to simply pack the hole with a rubber-like inert material to stop further infection and save the tooth.  



So when patients ask the question, ‘how badly does a root canal hurt?’, or ‘is the procedure painful? They will get a quizzical look from a dentist who will reply – it doesn’t hurt. It’s performed under local anaesthetic, which makes the tooth numb for two hours or more and the procedure completely comfortable.    



What if I experience throbbing pain after a root canal?

Once the root canal procedure is over and the local anaesthetic has worn off there may be complications that can cause pain. Sometimes after root canal treatment the tooth may flare up and cause pain. This is sometimes called a “phoenix abscess” and can present a few days after the procedure.    



It is more common in women and nobody knows why this is. If this happens, you should consult with your dentist who may need to access the tooth again in order to drain a build-up of pus or may need to prescribe you antibiotics if you have a swelling and/or a temperature. Other symptoms may include hotness to the touch or a bad smell or a bad taste in your mouth.    



How long does the pain last after a root canal?

There should be no pain after a successful root canal. Pain is certainly the exception not the norm. You may feel bruised and a bit swollen in the area that was treated but this can be controlled with over-the-counter medication (the same medication you might take for a headache). If you are experiencing mild pain, speak to your pharmacist for advice on pain relief.


The stronger drugs that you think might help (such as codeine) are often not advised and your pharmacist may recommend paracetamol or NSAID’s. Your dentist is not qualified to give you advice (and neither will we do that here) on how to control pain once you are out of the surgery so speak to your pharmacist.    



What if I have pain after three days?

  Contact your dentist if there is moderate to severe pain and make another appointment. You can make an emergency dental appointment very easily here at Smileworks to have someone look at the situation.    



What if I am in severe pain following a root canal?   You must contact your dentist f you are in pan following a root canal procedure as you may be experiencing a rare complication such as a phoenix abscess or infection that may require treatment with antibiotics. Do not try to mask the pain with strong painkillers, instead speak to your treating dentist and they will decide what to do and help you.    



The causes of severe pain after a root canal might be that root canal treatments sometimes fail or are not successful. A failing root canal can cause pain, and this may require further treatment which may be re-doing the root canal, or extraction of the tooth.     Failing root canals may be for a number of reasons. The tooth root may be infected and the root canal has not cleared the entire infection, or there may be additional chambers to the nerve space which have been inaccessible to the root canal filling, or the root filling may be too short or too long. Sometimes, instruments used in treatment of root canals can perforate (make a hole) in the side of the tooth or the tooth can fracture. All this may cause failure and may cause swelling, pain and the need to call your dentist for an opinion.  



Root canal pain relief

In the unlikely event your dentist has prescribed you with painkillers, take them as directed. Otherwise either take what you would normally take for a headache or speak to your local pharmacist for advice on painkillers as they are the experts.    



How long does it take for a root canal to heal?

Successful root canals will start to heal straight away. You will usually notice this by the absence of symptoms such as pain, or that the bubble on the gum associated with the infected tooth disappears. On X-rays, it often takes a long time for an area of infection to heal, and this can take up to one year for the signs of infection (an area around the root of the tooth) to resolve and fill back in with bone.  



There are reports and studies where it has taken 18 years to gain complete resolution on X-rays. It depends on the healing of the patient and the size of the infection. Generally though, this process is painless once the initial treatment is completed.  Most people who need root canals come to see us because they’re in pain.  The infection inside the tooth can cause swelling and pain and build up pressure. This can manifest as either ‘hot pulp’ which feels like painful toothache, extreme sensitivity or an abscess. Sometimes patients will come in with dreadful pain and swelling in that side of their face.



This is different to the pain caused by cavities and failing fillings. We can replace old fillings for you and remove the painful tooth root sometimes without the need for a root canal.   If you are experiencing pain then you can make an emergency appointment by visiting our emergency dentist page here. We can get you out of pain pretty quickly and have you on the road to recovery in record time. So don’t be shy about making an emergency appointment if you have swelling or pain. Here’s a video explaining the procedure:    


Sometimes acute pulpitis can be very difficult to get numb where the tooth is innervated by one or more nerves. Your dentist will be creative about where they put the anaesthetic to make absolutely sure you will not feel pain. There are potentially 6 nerves that innovate the first molar and we have a multitude of creative and effectual ways of getting them all numb. So the procedure is rarely painful. A hot tooth can be hard to get numb no matter how talented your dentist is. And that is why time is something you need to get this procedure right.  

Causes of infection


So how does the root of the tooth become infected when it’s below the gum line?  Here’s the structure of a tooth and the process of root canal treatment:    


Pulpitis and root canal therapy


Tooth decay, broken or failing crowns or even fillings that have failed or fallen out can cause you to need endodontic treatment.  Bacteria gets in the little cracks and fissures causes painful infections. Recently placed fillings can cause the nerve of the tooth to flare up.  You are more likely to need root canal treatment or get an abscess if you:  


Here at Smileworks we are conservative dentists.  This means that we don’t like drilling or filing your teeth if we can help it.  The reason for this is that as soon as we touch your tooth with the dentists drill, the chances of it failing and requiring subsequent treatment or even removal are dramatically increased.



This is why Braces and adult orthodontics are a better idea than traditional veneers if have the choice and composite bonding is better than porcelain veneers where appropriate as the damage to the individual tooth or teeth is likely to be less. 

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What is a root canal? 

The root canal procedure involves completely numbing the area and then making a tiny hole in the tooth.  A special file is used to carefully removing the infected material from inside the tooth.  This is the nerve or ‘pulp’ that is causing you the pain. 



Because of the numbing you will not feel a thing.  Many people complain that their root canals hurt and this makes here at Smileworks feel very sad.  The only reason a root canal should hurt is if it’s rushed.  And what we have plenty of here at Smileworks is time.  Some molars are innovated by up to six different nerves and our dentists get seriously creative about making sure you won’t feel a thing.    



Once you’re numb we can get all the infected material cleaned out the space and then irrigate it or flush it out with a cleaning solution.  This is typically a chemical called chlorhexidine (contained in some mouthwash) or a weak hypochlorite solution.  And what do we know about hypochlorite?  It kills all known germs, dead.  So this will give your tissue a good chance of recovering.    



The space is then filled in with a special material and the hole is filled in and your tooth is restored to it’s healthy, pain-free and functional old self.  The reason the space is filled in is because any space is liable to fill back up with bacteria.  So we use a rubber-like material to fill the space so nothing can get in and cause you any more problems.  

Root canal cost

Here's the 2020 Root Canal Prices at Smileworks for Root canals and re-root treatments


Here are the costs for your root canal treatment in 2020. Remember the reason you are paying is because here at Smileworks we will make sure we take the time to get you numb and do the work using the most advanced materials and machinery available. Dr Rowland-Warmann likens root fillings to cleaning out the cupboard under the stairs through the keyhole, in the dark. Root canal treatments require attention, skill and are often complex treatments so they need to be planned and managed accordingly. So microscopes, special lights, CBCT scanners and apex locators are all a good idea. And then there’s time. Often the difference-maker between pain and failure and happiness and success.


  • Front tooth upper or lower | £550
  • Front tooth upper or lower (re-treat) | £650
  • Premolar upper or lower | £550
  • Premolar upper or lower (re-treat) | £650
  • Molar upper or lower | £600
  • Molar upper or lower (re-treat) | £700
  • Re-root Anterior (front) Tooth | £450
  • Re-root Incisor Tooth | £450
  • Re-root Premolar Tooth | £500
  • Re-root Molar Root Canal | £500

If you require more than one tooth then just multiply these prices by the amount of root fillings you need or want. Remember that doing nothing is always an option, as is extraction and other less expensive things. So come in to see us and get the full picture.
These are guide prices – if the root canal is particularly complex (such as extremely curved roots, fractured instruments or other complex pathology), fees may vary or you may require a referral to specialist endodontist where the fees will be substantially more. To be clear MJ is a dentist with a special interest in endodontics and not a specialist endodontist.
Fees are quoted at your consultation – here at Smileworks we don’t like surprises so you will know precisely how much you’ll be paying before any work is undertaken.


We want you to be able to comfortably afford your treatment and appreciate some work can be expensive.  Pay with 0% finance and get an instant result from the comfort of your own home.

We offer patient finance through Tabeo. Click the link to calculate your monthly payments and get a quote.


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Private vs NHS Root Canals

The NHS is a wonderful and noble service and we absolutely love and respect it here at Smileworks.  Take a look at your root canal options here.  It’s much, much cheaper than us.



Many of our Smileworks dentists here have worked in the NHS and have done root canals but they (and any conscientious dentist will tell you) they’d rather work in an environment where they can spend twice the time, use a microscope, have tools like apex-locators on hand and be able to diagnose using a CT scanner if necessary.  Most of which, you’ll not find at your local NHS practice.  So the decision is yours.  



We take root canal safety very seriously at Smileworks and if you’ve ever had a root canal without a piece of safety apparatus called a ‘rubber dam’ then you need to change dentist.  Here’s a picture of a Smileworks patient wearing a rubber dam.  It basically stops anything nasty getting swallowed or inhaled during the procedure.  The disco shades are an optional extra along with the Tom Jones root canal playlist…    


Root canal safety Rubber dam      

Root canal risks & complications

Once you get home the tissue can get re infected.  The most common cause for this is a leaky dental crown.  This is where a crown is required on top of the canal because the tooth is too damaged. Bacteria can get in and cause a flare-up. 



Come and see us and we can get this fixed.  To read all about leakage and crowns in general see or main page here: Dental Crowns Liverpool.  


There can be residual pain after a root canal.  This can be a type of ‘bruising feeling’ from the local anaesthetic injection sites or it can be tenderness from the treatment.  Use painkillers you’d normally use for a headache and if it hasn’t resolved in a few days or if they don’t even take the edge off, come in to see us again.  


Root canals are complex.  There is no such think as a routine root canal and there is a great deal of rubbish on the internet about how your root canal is going to be a happy experience with rainbows and sunshine and 100% success rate. 



This is not realistic ands here at Smileworks we tell you how it is not what you want to hear.  The success rate of any dentist is around 80-85% and in more complex cases this may be reduced further depending on the tooth and the associated.  Sometimes root canals fail even with the best treatment for reasons we are not entirely clear about.  But if you come to us for treatment we will fix anything that needs fixing quickly and effectively.


As with any dental treatment there can be swelling but it should subside. IF it is getting worse or more painful then come back in and we will take a look.  If you are experiencing pain worrying in nature, or it is affecting your ability to breathe or swallow, you should proceed straight to A&E.  

Root canal alternatives


If the tooth is unrestorable or if the caries (tooth decay) is too deep or extends down to the bone then an extraction is likely indicated.  Sometimes decay extends so far down that we simply can’t put a crown on because the crown will be beneath the gum margin and it just won’t be a success.  This is when you’ll need an extraction. For extractions you can see our wonderful oral surgeon, Dr Anca Antoniu who will be able to take your tooth out for you painlessly.  


We are not endodontic specialists here at Smileworks but we do know a thing or two about root canals. If the anatomy is really complex, or a previous root canal has had complications that are super-difficult to manage, then we’d rather refer you to one of our trusted partners who will be able to give you the standard of care commensurate with an extremely difficult, specialist case.  



We love referring patients on because we don’t ever put our patients at risk. There is no ‘hero-dontics’ at Smileworks and our cases are reviewed by a multidisciplinary team – something that sets us apart from many practices in Liverpool.  

Do nothing

Sometimes people want to just leave it because they want to have a think.  Not having treatment is always an option.  This may risk the tooth flaring up and you being in pain again.  All we can do is advise you regarding your treatment options.

Root canals for children

Kids sometimes have root canals.  One of the most common causes or children needing root canals is trauma to the front teeth. We don’t want to be extracting the central incisors of children, so if your child is happy and motivated and they understand the treatment then that’s fine and we will typically get excellent results.  The intended outcomes and benefits need to be carefully explained to both parents and the children to make sure everyone is on the same page.  

Root Canal Myths


I can control the pain with strong painkillers:

Strong painkillers will help in the short term but they will not fix the underlying issue and there is a strong likelihood that you may become addicted to some painkillers that will, in the end, cause you far more pain and suffering than even the worst visit to the dentist.    



It’s ok, I’m going to ask to be sedated:

If you are an extremely anxious patient and concerned about your treatment, you may elect to be sedated for your root canal procedure.  We can arrange this for you; we can discuss the fees involved in this at your consultation.  Usually the scariest part of your root canal is listening to Tom Jones for the duration of your appointment (if it’s Dr Rowland-Warmann treating you.  Read some of our reviews and see what people usually feel after their treatments with us. You’re in safe hands and we will make sure you are calm and comfortable throughout your appointment.    



I don’t want my nerve taking out or damaging:

By the time you need a root canal, the nerve is past saving and needs to be removed along with the bacteria and inflamed material.  So ‘saving the nerve’ is impossible.   For more myths see the FAQ section below.    

Root Canal FAQ

Here are the most commonly asked questions about this treatment by our patients.

  • How do I know if I need a root canal?
  • You’ll be in pain and have swelling and your tooth might feel hot or ache or just be downright excruciatingly painful. Your dentist may have recommended you need a root canal also.
  • Are root canals safe?
  • When all the correct procedure are followed and everything is in place, root canal treatment is relatively safe. The only real risk is practices not using an instrument called a ‘rubber dam’. If your dentist has never used this when you’ve had a root canal then you should change dentist, because they are not taking safety seriously and do not care about you. If a file gets accidentally dropped down your throat and you start coughing, can be aspirated (breathed in) and get lodged within your lung, requiring surgery for its removal in extreme cases. So rubber dams are a big deal around here and mandatory in the completion of root canals.
  • Can it fail?
  • Root canal treatments can fail for a number of reasons: - Bacteria remaining in the system - Fractured instruments - Inadequate previous root filling - Perforations of the previous root canal system - Resorption due to trauma – or for no apparent reason - Leaking coronal restorations or leaking crowns leading to reinfection
  • Root canals and crowns
  • If an abscess is big enough and causes facial swelling then it can make you systemically unwell (so cause a fever). If a tooth is throbbing it can cause a headache. Lower teeth can make you seem like you’ve got toothache in your upper teeth and the nerves radiate in all directions causing confusing and often worrying ‘referred pain’.
  • What if I have pain after root canal?
  • Initially there may be some mild discomfort after the procedure. This might feel like a bruise (from the anesthetic) and the area will feel tender. This is fairly common and can be managed with the same painkillers you’d take for a headache and will subside after a day or two. Severe pain and associated swelling a couple of days after the procedure may occur. This can be a flare-up from bugs that lived inside the tooth that have been jiggled about by the treatment. This is called a phoenix abscess. It’s best to make an appointment to see us. The third post-treatment pain type is very severe pain and rapid swelling. Hypersensivity to some of the chemicals used to clean the inside of the tooth can cause this and you must visit A&E or go straight back to your dentist (or Smileworks). Dr Rowland-Warmann has extensively studied the pathology and incidence of such occurrences and you can read about them here. But be aware they are extremely uncommon.
  • How long does a root canal take?
  • At Smileworks a root canal appointment 90 minutes and if it’s more complex, You may need further appointments, which are included in your cost quoted at the start.
  • Are antibiotics a substitute for a root canal?
  • Antibiotics are not a substitute for root canal treatment. They do not make an abscess go away they suppress it and put it to sleep. Then it will reappear at a later date. Antibiotics will reduce the acute phase of an abscess but will not remove the bacteria from the inside of a tooth.
  • Root canal NHS vs Private
  • This is always a tricky subject and one that’s been covered already. Root canals can be clinically challenging to treat and complex in nature. So the thing that is of paramount significance is time. Practitioners in private practice are not necessarily better than those in the NHS. However, many NHS practitioners feel that due to the constraints placed on them by the NHS (including time constraints and the need to hit targets) that they would sometimes not able to allocate the kind of time to complete a root canal in the same way a private practitioner might be able to. The other factor is budgets and equipment. In private practice we have a CBCT scanner for the diagnosis of complex and difficult cases. Private practices may have more ready access to gadgets that make the endodontic procedure more streamlined. We have made significant investments to get you in fast and treated effectively. Pain management In endodontics is a huge deal - and that takes time. And truly conscientious dentists will agree with this sentiment.
  • What happens to my nerve?
  • The nerve is removed. Your nerve lives in the tooth which is like a little hard tube. If the nerve or pulp dies or becomes infected it will increase in size and swell. This is what produces the pain and throbbing. The nerve doesn’t always have to be dead to be infected. It’s usually an acute bacterial infection that causes the pain. The inside of the tooth is cleaned with specialized instruments and made bigger and cleaned out with a cleaning solution and filed with a rubber-like compound that is biocompatible and is called gutta percha. The principle is that a hollow tube can store bacteria but a filled one cant. This has the effect of eradicating bacteria.