An emergency root canal is usually the first stage of root canal therapy, done to relieve severe toothache caused by an inflamed or infected nerve. On the day, your dentist numbs the tooth, removes the damaged pulp, cleans the canals and seals in a medicated dressing. The treatment is then completed over one or more further visits.
If you’re not sure whether your pain needs urgent care, our dental emergency guide can help you decide. This article explains what to expect, step by step.
Signs you may need urgent root canal treatment
Inside each tooth is the pulp, a soft tissue containing nerves and blood vessels. Deep decay, a crack or an injury can let bacteria reach it. Signs the pulp may be badly inflamed or infected include:
- severe or throbbing toothache
- pain that lingers for more than a few seconds after hot or cold
- pain that starts on its own or wakes you at night
- pain when biting, or a tooth that feels raised
- swelling of the gum or face, or a pimple-like lump on the gum
- a tooth that has darkened after an injury
Not every toothache needs a root canal. Your dentist will test the tooth and take an X-ray to find the cause.
When to go to hospital instead
Call 000 or go to your nearest hospital emergency department if you have:
- difficulty breathing or swallowing
- swelling that is spreading to the eye, neck or floor of the mouth
- a high temperature with facial swelling, or you feel very unwell
- bleeding that won’t stop after 15–20 minutes of firm pressure
- a possible broken jaw, or a jaw that won’t open or close properly
- a knock to the head with loss of consciousness, vomiting or confusion
Our clinic is open Monday to Friday. Outside those hours, call healthdirect on 1800 022 222 for 24/7 nurse advice.
What happens during an emergency root canal
- Assessment. Your dentist asks about your symptoms and medical history, tests the tooth and takes an X-ray. They’ll explain whether the tooth can be saved, the alternatives (including extraction), the likely costs and the risks before starting.
- Local anaesthetic. The tooth and surrounding area are numbed. A very inflamed tooth can be harder to numb, so your dentist may give extra anaesthetic and check before continuing. Let them know if you feel anything sharp.
- Isolation. A thin rubber sheet called a dental dam is placed around the tooth to keep it clean and dry and to stop you swallowing any cleaning solutions.
- Removing the pulp. A small opening is made in the biting surface or back of the tooth. The inflamed or infected pulp is removed from the tooth and its canals, a step called a pulpectomy. Sometimes only the pulp in the chamber is removed on the first day. The canals are rinsed with disinfecting solutions, and if there is an abscess, it may drain through the tooth.
- Dressing. A medicated dressing is placed inside the tooth to settle inflammation and reduce bacteria, and the opening is sealed with a temporary filling.
This first stage focuses on relieving pain and removing the source of the problem. Many people who visit us in North Sydney find their throbbing pain eases considerably within a day or two, although the tooth is often tender to bite on for a few days.
If you feel anxious about dental treatment, ask us about happy gas (nitrous oxide), which can help you feel more relaxed while you stay awake.
Completing the treatment
The dressing is a temporary step. Root canal therapy is usually completed over one or two further visits, often a week or more apart. At these appointments, your dentist will:
- remove the temporary filling and dressing
- clean, shape and measure the canals along their full length
- fill the canals with gutta-percha, a rubber-like material, and a sealer
- seal the access opening with a filling
Don’t leave a temporary filling in place longer than advised. It can wear or leak, letting bacteria back in and lowering the chance of success. You can read more about root canal therapy and how each stage works.
Why a crown is often recommended
A root-filled back tooth has usually lost a lot of structure to decay, old fillings and the access opening, which makes it more likely to crack under chewing forces. A crown covers and protects the tooth. Your dentist will advise whether your tooth needs one and when.
Aftercare between visits
- Avoid eating and hot drinks until the numbness wears off, so you don’t bite your cheek or tongue.
- For tenderness, take over-the-counter pain relief such as paracetamol or ibuprofen, taken as directed on the pack, if it’s safe for you.
- Chew on the other side and avoid hard or sticky food until the tooth is fully restored.
- Brush and floss as normal, gently around the temporary filling.
- Call us if the temporary filling falls out, pain gets worse after two or three days, swelling increases or you develop a fever.
Antibiotics aren’t usually needed for toothache alone. Your dentist will prescribe them only if appropriate, for example if an infection is spreading.
How much does an emergency root canal cost?
The cost depends on which tooth is involved (back teeth usually have more canals), how complex the canals are, how many visits are needed, X-rays and whether a crown is recommended afterwards. Your dentist will give you a quote before treatment. For more detail, see our article on root canal cost in Sydney.
If you have extras cover, you may be able to claim part of the cost, depending on your policy. We’re a preferred provider for Bupa Members First, Medibank Members’ Choice and nib First Choice. See our price guide or ask about payment plans. To book, contact our emergency dentist in North Sydney. We aim to see urgent problems as soon as possible, often on the same day.
Frequently asked questions
Does an emergency root canal hurt?
The tooth is numbed with local anaesthetic before treatment starts, and most people feel pressure rather than pain. It’s common for the tooth to feel tender for a few days afterwards. Tell your dentist straight away if you feel anything sharp during treatment.
How long does the first appointment take?
It varies with the tooth and how many canals it has, but it’s often around an hour. Your dentist can give you a better idea after examining the tooth and taking an X-ray.
Can I have the tooth taken out instead?
Extraction is an option in many cases. Your dentist will explain the pros and cons of keeping or removing the tooth, including what may be needed to replace a missing tooth later.
Will I need antibiotics?
Not usually. Removing the infected pulp treats the source of the problem. Antibiotics may be prescribed if an infection is spreading or you’re unwell, and should only be taken if prescribed for you.
Need help now?
North Sydney Dentistry is at Level 1, Suite 102/71 Walker St, North Sydney, a two-minute walk from North Sydney station. We’re open Monday to Friday, 9am to 6pm, and keep time aside for urgent problems where we can. Call (02) 8090 1108 or book online.
This article is general information only and is not a substitute for advice from your own dentist or doctor. Any surgical or invasive procedure carries risks. Before proceeding, you should seek a second opinion from an appropriately qualified health practitioner.