All About Root Canals

Getting a root canal today is much easier and more comfortable than in the past due to advances in technology. Warning signs that you might need a root canal include experiencing increasing pain in the tooth and pain when biting down.

Could you start by explaining what a root canal is and why someone would need one?

Dr. Darren McKeever: The first thing about root canals, a lot of people think that because they have pain, we’re going to do a procedure and take the roots out of a tooth, and that’s not quite right. What a root canal is, is when the vitality of a tooth, and what we mean by that is the nerve, artery and vein within the tooth, are either irreparably damaged and dying or they’ve completely died off and they are starting to form an abscess. The root canal process is where we go in, we make an access hole through the tooth, usually in the biting area of the tooth, and we clean out the canal system that is within the root that the nerve, artery and vein used to inhabit.

The reasons why people might need a root canal are usually because they’ve had such a deep cavity that the nerve and artery have died or they might have intense pain because the filling has just been too deep because the decay led the filling to be too deep. Sometimes, we actually do root canals prophylactically because we want to put attachments into natural teeth and, in that manner, we don’t have to extract the tooth and do an implant. Those are really just some of the reasons that someone might need a root canal, but those are also the most common.

Could you explain further the process involved in the actual root canal procedure maybe from beginning to end?

Dr. Darren McKeever: It’s a little more complex than what I’ve touched on, but there is really, in my opinion, there are three phases to a root canal.

The first part, after you’ve diagnosed the need for one obviously, is you have to access the canal system and, like I said, we put a little hole in the top of the tooth. We try and minimize how large the hole is, and that is our access hole to get to the nerve root canal system.

The second step is we have to negotiate that canal to the tip of the root and clean it out thoroughly. We have to remove the dead or dying or diseased tissue. We have to shape that canal, and that allows us to perform the third part of the root canal process, which is literally filling the entire canal system with a material. It is a natural material. It’s a byproduct of the rubber-making process. It’s called gutta-percha. The first golf balls were actually made out of gutta-percha.

We pack that canal system with the gutta-percha, and what that does is it obliterates that area for bacteria to hide from your body’s immune system, and then the tooth has to be restored after that. If you don’t restore the root canal tooth, usually, when people say, “Oh, I had a root canal and it failed,” it’s because the tooth wasn’t restored properly afterwards, so I don’t consider that one of the three parts of a root canal, but it is required for a root canal tooth.

People think root canals are extremely painful, but they’re not, so what type of anesthesia is used during the root canal and how much pain is to be expected?

Dr. Darren McKeever: In my 30 years, root canals have gone from being uncomfortable very often to, nowadays, most people tell us afterwards, very little discomfort. They’re done with just local anesthetic, a Novocaine, if you will, even though we don’t use actual Novocaine anymore.

People have this connotation because, years ago, root canals were much more complex, much more higher failure rates, were a lot more inconvenient for people and there was discomfort. But, nowadays, technology has come along and a lot of continuing education has come along that’s made dentists a lot better at doing root canals and getting better results, so most people now by far say, “I don’t know why a root canal was so scary,” because they really have minimal discomfort after, if any.

After the root canal is complete, is there anything the patient should watch out for while healing?

Dr. Darren McKeever: The body heals through the process of inflammation, and without inflammation, you can’t get healing, but, unfortunately, in confined spaces in the body, inflammation creates potential swelling which can be misconstrued as infection, so we tell people to keep an eye open for if they have significant swelling. A little bit of discomfort during the inflammatory healing process is not unusual, but by and large, in my experience, most people can manage that very easily with Advil.

What we really need to worry about is people who may have intense pain or increased swelling. Those are hallmarks of something else that might be going on with the tooth. Sometimes we think you need a root canal and it turns out the tooth may actually be fractured, in which case the root canal is not the answer. It is very hard to distinguish that on an X-ray, a fracture, usually until they’re catastrophic, but that is rare. Really, the most things we ask people to watch out for are did you have a lot of discomfort, and did you have swelling?

What are the warning signs and symptoms that someone might need a root canal, and would this be considered a dental emergency that should be checked out right away?

Dr. Darren McKeever: From my experience, usually, when it comes to a tooth that is on its way towards a root canal, you’ll only get one, maybe two warnings before all of a sudden it is a late-night phone call or a weekend phone call or you’re on vacation, that kind of phone call. We just got that last night.

The warning signs are usually discomfort; you’re biting down on the tooth and it just doesn’t feel right. That could sometimes just be a very simple matter that is adjusted, but sometimes it could be an indication that there is an abscess already forming at the tip of a root, so, most people, what we encourage them to do, is if you have discomfort, a tooth is just not acting properly, get it checked.

X-rays are not always the best way to diagnose whether or not you need a root canal, but they’re so incredibly helpful, and you can’t do one of those over the phone, so you really should get the tooth checked. Figure out if you’re on your way towards a root canal because that pain that you’re having isn’t just some transient issue. Get it looked at. Find out what the issue is and then treat the tooth properly.

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If you are interested in speaking with Dr. Darren McKeever, visit or call 973-839-8180 to schedule an appointment.

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