What is root canal treatment?
Inside every tooth, beneath the enamel and dentine, is a soft core called the pulp. It contains the tooth's nerve and blood vessels and runs down through narrow channels in the roots, the root canals. When deep decay, a crack, a large old filling or a knock lets bacteria reach the pulp, it can become inflamed or infected. Because the pulp sits inside a hard shell, the swelling has nowhere to go, which is why a nerve problem can hurt so much.
Root canal treatment, known in Egypt as حشو العصب or علاج العصب, removes the damaged pulp, cleans and disinfects the canals, and seals them. The tooth no longer has a living nerve, but it stays in the jaw, keeps your bite and chewing intact, and avoids the gap, bone loss and cost of replacing it.
Signs you may need a root canal
Only an examination and an X-ray can confirm it, but these signs are worth a prompt visit:
- Toothache that wakes you at night or throbs without a trigger
- Sensitivity to hot or cold that lingers for more than a few seconds after the drink is gone
- Pain when biting or pressing on a tooth
- Swelling of the gum or face, or a small pimple-like bump on the gum that may release a bad taste
- A tooth that has darkened after an injury
- A deep cavity or broken tooth, even if it no longer hurts; nerves sometimes go quiet after they die, while infection continues
If you have facial swelling, fever or difficulty swallowing, treat it as urgent. Our guide on what to do in a dental emergency explains the next steps.
How we diagnose and plan
We start by finding out exactly which tooth is the problem, which is not always the one that seems to hurt. We use simple tests of response to cold and tapping, look at the gum, and take a periapical X-ray to see the roots, the canals and the bone around the tip of the root. Sometimes a tooth can still be saved with a filling; sometimes a root canal is the right answer; and occasionally a tooth is too badly cracked or broken to be restored, in which case we will tell you honestly and discuss replacement.
Prof. Nouran Abdel Nabi's background in prosthodontics means the plan does not end when the canals are sealed. Before starting, we consider how the tooth will be rebuilt, whether it will need a crown, and whether it is worth saving at all compared with other options. A root canal is only a success if the tooth can then be restored to chew comfortably for years.
Step by step: what happens during treatment
- Numbing. We apply a numbing gel and then give local anaesthetic, waiting until the tooth is properly numb. Very inflamed teeth can be harder to numb, and we take extra time or add anaesthetic rather than pushing on.
- Isolation. Where possible, a thin rubber sheet (a rubber dam) isolates the tooth, keeping it dry and clean and stopping instruments or solutions reaching your mouth.
- Access and cleaning. A small opening is made in the top of the tooth. Fine instruments remove the pulp and shape the canals while disinfecting solutions wash out bacteria.
- Measuring. The length of each canal is measured, often with an electronic device and X-rays, so the canal is cleaned to the right depth.
- Sealing. The canals are filled with a rubber-like material (gutta-percha) and sealer, and a check X-ray confirms the fill.
- Rebuilding. A filling closes the access, and in most back teeth a crown is planned to protect the tooth.
How many sessions will I need?
Many root canals are completed in one visit of roughly 60 to 90 minutes. Teeth with several curved canals, a large infection, swelling, or previous treatment more often need two or three visits, with a medicated dressing left inside the canals between appointments to calm the infection. More visits are not a sign that something went wrong; it is often the more careful choice for an infected tooth.
Is a root canal painful?
The pain people associate with root canals usually comes from the infection itself, not the treatment. With effective local anaesthetic, most patients describe the procedure as similar to a long filling. It is normal for the tooth to feel tender for a few days afterwards, especially when biting; this typically settles with ordinary pain relief that we will advise on. If you feel anxious, tell us. We explain each step, agree a signal for a pause, and never rush. Read more in is root canal treatment painful?
Why a crown usually follows
A root-treated tooth is often weakened by the decay or fracture that caused the problem and by the access opening. Back teeth, which take most of the chewing force, are prone to cracking if they are left with only a filling. For that reason we usually recommend a crown on molars and premolars, ideally within a few weeks. Front teeth with little missing structure can sometimes be restored with a filling alone. See do I need a crown after a root canal? for the details.
Root canal re-treatment
Most root canals work well for many years, but some fail, for example if a canal was missed, the filling did not reach the full length, or a leaking crown let bacteria back in. Signs include renewed pain, a gum bump or a dark area around the root on an X-ray. Re-treatment means removing the old filling material, cleaning the canals again and resealing them. It is more complex than a first treatment and success rates are somewhat lower, but it often saves a tooth that would otherwise be lost. In some cases a small surgical procedure at the root tip, or extraction and replacement, may be the better route, and we will discuss those honestly.
Who is it suitable for, and who is it not?
Root canal treatment suits most people with an inflamed or infected nerve in a tooth that can still be restored. It is generally safe in pregnancy when needed, ideally in the second trimester, with appropriate precautions; see dental treatment during pregnancy.
It may not be the right choice if:
- The tooth has a vertical crack running down the root
- Too little healthy tooth remains to support a filling or crown
- Advanced gum disease has left the tooth very loose
- The tooth plays no useful role, such as some wisdom teeth
Risks of root canal treatment
Like any procedure, a root canal carries some risks: temporary tenderness or swelling, a flare-up of infection between visits, a fine instrument separating inside a narrow canal, or the tooth cracking later if it is not protected. Occasionally, despite good treatment, infection persists and re-treatment or extraction is needed. Using careful technique, X-ray checks and a timely crown keeps these risks low.
Alternatives
- Extraction is the main alternative. It is quicker and cheaper at first, but leaves a gap that usually needs a dental implant, bridge or denture to prevent neighbouring teeth from drifting.
- Pulp capping or partial pulp treatment may be possible in a young tooth where the nerve is only slightly exposed and still healthy.
- Waiting is rarely wise. An infected nerve does not heal on its own, and antibiotics alone do not cure it.
What affects the cost
The cost depends mainly on the tooth (front teeth typically have one canal, molars three or four), whether it is a first treatment or a re-treatment, the number of visits, and the type of crown needed afterwards. We will give you a clear estimate after examining the tooth and its X-ray.
Aftercare
Avoid chewing on the treated side until the numbness wears off, and until the final filling or crown is fitted, avoid hard or sticky foods on that tooth. Keep brushing and cleaning between teeth normally. Contact us if pain gets worse after a few days, swelling appears, or the temporary filling comes out. Regular checkups let us review the tooth with an X-ray over time.
If you have tooth pain now, message us on WhatsApp and we will help you get seen as soon as possible.
