Signs You May Need a Root Canal

In our years of experience taking care of patients, we know that teeth problems can cause more than just pain.  Often, the idea that a tooth might need a root canal is the cause of severe anxiety.  The good news is that not every twinge of pain in a tooth indicates the need for a root canal.  The bad news is that a tooth can need a root canal without causing pain.  So how do you know if you might need one?

Why Do Teeth Need Root Canals?

Diagram of tooth with red spot on the left side to show pain
When the pulp tissue inside the tooth becomes infected or dies, the body is not able to get its own healing responses or antibiotic medications to it.

Teeth are hollow.  The inner chamber of a tooth contains nerves and blood vessels in a soft tissue called the pulp.  Dental pulp tissue is unique in that it has a very limited ability to heal itself.  The hard structures of a tooth (enamel and dentin) completely surround the pulp tissue except in one tiny opening at the tip of each root.

When the pulp tissue inside the tooth becomes infected or dies, the body is not able to get its own healing responses or antibiotic medications to it.  For this reason, it does not heal.  We must remove it.

A root canal treatment is the removal of the soft tissue from the inside of a tooth.  We don’t leave the chamber empty; we seal and fill it with a biocompatible filling material.  There are two main situations that indicate the need for a root canal:

  1. Irreversible Inflammation of the Pulp

The word “irreversible” is very important.  This means that the state of the pulp has progressed past its limited ability to heal.  Irreversible inflammation occurs as a response to infection by bacteria or irritation by an injury.  Bacteria can reach the pulp tissue through large cavities or cracks in the tooth.  Injuries causing trauma to the tooth can also irreversibly harm the tooth.  Irreversible inflammation causes pain in the tooth.  Because the pulp tissue swells with inflammation, yet remains encased in hard tissue, the pain can be severe.

Irreversible inflammation is a step along the pathway to death of the tissue.  An irreversibly inflamed pulp is a dying pulp.

  1. Death of the Pulp

The pulp can also respond to both infection and injuries by dying.  It may be a slow process, where the tooth goes through various stages, including the painful stage of irreversible inflammation.  It can also simply die with no noticeable symptoms.

Signs to Watch For

The following list contains signs or symptoms you might experience if you have a tooth with a dead or dying nerve.  If you or a loved one are experiencing any of these things, make sure to seek dental care as soon as possible.

man holding a purple cloth to his inflamed right cheek
Because of the pulp’s enclosed anatomy, it cannot swell, so the pressure increases.

Severe Toothache Pain

A severe toothache can encompass a lot of different sensations.  Because of the pulp’s enclosed anatomy, it cannot swell, so the pressure increases.  This increased pressure leads to the severity of pain many experience with a toothache.  The pain can be sharp and stabbing or dull and throbbing.  It may be constant or arise spontaneously.

Pain with Hot or Cold Temperatures that Lingers after Swallowing

Sensitivity to hot and/or cold in itself is not an indication that you need a root canal.  However, if the hot and/or cold temperature causes pain on the tooth, and the pain lingers for thirty seconds or longer, you may have a dying nerve.  As the pulp tissue undergoes irreversible inflammation, it becomes hypersensitive.  This means that normal sensations become exaggeratedly painful and incite pain that does not go away when the temperature in the mouth returns to normal.

Isolated Pain on Chewing

By isolated, we mean that you can pinpoint a single tooth that hurts when you chew or bite on it.  You may also be able to elicit pain by tapping on the tooth with your fingernail.  This symptom indicates that there is inflammation and/or infection around the root of the tooth.

Swelling in the Gums near the End of a Tooth’s Root

Any and all swellings in the mouth should be taken seriously.  A swelling at the end of a tooth’s root usually means an infection is spreading from within the tooth to around its root.  It is important to note that these swellings can be small, like a pimple, and completely painless.  If something looks unusual, make an appointment to have it evaluated.  Swellings are actually more urgent than pain because they could mean a dangerous infection is spreading.  Don’t wait until it hurts!

Discoloration or Darkening of a Tooth

teeth with one tooth with growing gray coloration on the top
When a nerve dies, the pulp tissue and the hard tooth structure surrounding it change in substance and in color.

When a nerve dies, the pulp tissue and the hard tooth structure surrounding it change in substance and in color.  This can lead to a change in the outer appearance of the tooth, usually a darkening in color.  The color can turn dark purplish-grey or a dark yellow.  When you see a discoloration like this, it is important to see your dentist for testing of the nerve tissue.  If the nerve is dead, it must be removed before it becomes infected.

More Questions about Root Canals?

Call today to schedule a consultation with our wonderful dentists.  They can answer any question about root canals and assess your particular situation to determine whether you need one.