Most people arrive knowing they need root canal treatment but with very little idea of what the appointment actually involves. Here is what happens, in the order the stages come, from the first assessment to walking back out of the door.
Root canal treatment is carried out under local anaesthetic, with the tooth isolated so that nothing from the procedure reaches the rest of your mouth. You are numb throughout. Most appointments take between 60 and 90 minutes, and more than nine cases in ten are finished in a single visit.
Treatment begins with an assessment, not a drill. I take a history, test the tooth, and in most cases look at that tooth on a CBCT scan - a three-dimensional X-ray that shows the root anatomy and any infection around the root tip in a way a flat X-ray cannot. That scan tells me how many canals there are, what shape they are, and whether there is a significant area of infection to deal with. The scan also tells me before we begin whether this is a one-visit or a two-visit case, so you are not told partway through that things have changed.
Plenty of local anaesthetic is essential for root canal treatment, and treatment is not started until the tooth is completely numb. Some teeth, particularly those that are already badly inflamed, take longer to numb than others. That is a question of patience and sufficient anaesthetic rather than a problem - every tooth gets there eventually. If you have found numbing difficult in the past, it is usually because the anaesthetic was not given enough time to work.
Once the tooth is numb, a thin sheet called a rubber dam is placed so that only the tooth being treated is exposed. This does two things. The dam keeps the tooth clean and dry while I work, which matters because the purpose of the treatment is to remove infection rather than introduce more. And the dam protects you - the cleaning solutions and any debris stay inside the tooth and away from the rest of your mouth. Most patients find the dam makes the appointment easier rather than harder: you can swallow normally, and there is nothing to hold or rinse.
The tooth is opened and the canals located under a dental operating microscope. Root canals are narrow, curved and often not where you would expect - extra canals, branches and calcified sections are common, and magnification is what allows them to be found. Each canal is then cleaned and shaped along its full length and thoroughly disinfected. The disinfection is the part that does the real work; the shaping exists so that the disinfection can reach everywhere needed.
Once the canals are clean, they are sealed along their length so bacteria cannot re-establish, and the opening in the tooth is closed.
The whole sequence under the dental operating microscope: access, cleaning and filling of the canals.
Most treatment is completed in a single visit - comfortably more than ninety per cent of the cases I treat. The exception is a tooth with a large area of infection already present, which I will have seen on the CBCT beforehand. Those cases are treated over two appointments, with a medicament left inside the tooth in between to work on the infection. The second appointment is usually within two weeks.
If your treatment needs two visits, your tooth is fully protected in between. A well-adapted interim filling seals and supports the tooth, so you can eat and function normally in the meantime.
Most appointments take between 60 and 90 minutes from start to finish. That is longer than a filling, and deliberately so - it is the time needed to find, clean and seal every canal properly in one sitting, rather than rushing the tooth and coming back later.
You will leave with clear aftercare advice, including what to take over the next few days, and antibiotics where they are genuinely needed. You will also have my phone number, so if anything concerns you afterwards you can reach me directly rather than waiting. The practice will normally check in with you the following day.
Most people find the tooth is tender for a few days and settles steadily. There is more detail in the guide on what to expect after a root canal, and on caring for a root-treated tooth once the tooth has been permanently restored.
Most of the worry around root canal treatment comes from anticipation rather than experience. Proper anaesthetic and the patience to let that anaesthetic work, a tooth that is isolated and protected, magnification to see what is actually there, and enough time to do the job once - that is what the appointment consists of.
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