How do you know if you need a root canal?

How do you know if you need a root canal

A root canal is one of the most feared dental procedures, and it is on the rise because of poor dietary habits and bad oral hygiene. The teeth that require root canal presents various signs and symptoms. In this article, I will discuss how you know if you need a root canal by looking at your signs and symptoms.

Why do you get root canal treatment?

You get a root canal treatment when the tooth’s root canals become infected or dead. A root canal treatment involves cleaning, disinfecting, and filling the root canals to save and restore the tooth’s function. 

How do you know if you need a root canal?

There are several reasons why you need a root canal. Also, the symptoms of a root canal range from severe pain in the tooth to no signs at all. 

You will experience different symptoms when the infection is confined to the root canals and when it spreads out in the bone. Moreover, low-grade chronic infection around the tooth shows mild signs than acute infection. 

Let’s get into the details of root canal signs and symptoms:

A cavity or broken down tooth 

A tooth cavity is the most common reason for root canal treatment in the teeth. 

A cavity can be seen in the following forms:

  • A cavity on the chewing surface is seen as black discoloration in the pits and crevices of the tooth. However, decay between the teeth is hidden from the naked eye and can be identified by a toothache or lingering sensitivity in the tooth. Dentists use special instruments and X-rays to diagnose these cavities. 
  •  In advanced stages of tooth decay, one or more tooth walls fall apart, making a hole in the tooth. The tooth usually breaks down spontaneously while chewing hard food.

Tooth discoloration

Tooth discoloration is a sign that the pulp is dead. It often occurs after an injury to the tooth. The tooth turns brown or black due to the release of pigments into dentin from the disintegration of hemoglobin from the damaged pulp vessels. 

a Cracked tooth 

A crack or fracture is a discontinuation of enamel in the tooth. It violates the integrity of the enamel that protects the inner layers from environmental hazards. A crack passing the pulp allows bacteria to enter the tooth through the gap and destroy the teeth. These teeth also require evaluation for root canal treatment. 

These micro-cracks are so small that they require special light for diagnosis.

If you have a cracked or fractured tooth, you will feel pain on biting or spontaneous pain on eating and drinking hot or cold foods.

Habits that can crack or fracture teeth are cracking a nut with teeth, pencil chewing, night grinding, etc.

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root canal Pain

The following pain experiences indicate that your tooth needs a root canal. The root canal pain is often associated with a cavity in a tooth. However, cavities between teeth may initially appear as severe pain in the tooth until the tooth breaks into a cavity. 

Episodes of severe pain in the tooth

This is the most common symptom of the root canal that brings the patient to the dentist. 

You will experience continuous, severe throbbing episodes of pain in the tooth that goes on for hours and is relieved by over-the-counter pain medications. The pain occurs spontaneously or is triggered by eating or drinking hot and sweet food. The pain gets worse at night when you lie down. 

Pain in the filled tooth 

Black discoloration at the margins of existing fillings shows secondary decay on the tooth. If it’s accompanied by pain with or without swelling, it may be a sign of a root canal in the tooth. These teeth also need further evaluation for refilling, pulp capping, or root canal treatment.  

Pain on one side of the jaw

Another type of pain indicating root canal pain is pain felt on one side of the jaw, but you can’t point the tooth. This occurs when the tooth infection is confined to the root canals because the pulp lack receptors (proprioceptors) that respond to the position and movement of the organ. The pulp can only react through pain.

a Painless cavity with a previous history of severe pain (pulp necrosis)

A painless cavity with prior history of severe pain in the tooth is a sign of pulp necrosis or dead pulp. However, you may feel mild pain on chewing. 

Pulp tissues lie in an enclosed space surrounded by hard dentin from all sides. Under a bacterial attack, fluid flows from the blood vessels to bring the white blood cells to the inflamed site. The white cells attack the bacteria to combat the infection. 

Due to the enclosed space, the accumulated fluid eventually compresses the blood vessels leading to pulp necrosis or death of the pulp. In other organs, the tissues swell and become warm when inflamed.

Why is it essential to treat pulp necrosis?

You may wonder why it’s essential to treat pulp necrosis as the pulp is dead and is not causing any pain. It is necessary to understand that localized, low-grade chronic infection can produce disease elsewhere in the body. It has been seen that dead pulp and pus pockets are often the source of acute and chronic rheumatoid arthritis.

According to Rosenow, enclosed bacterial reservoirs that can drain into circulation, such as dead pulp, are the most dangerous Foci of infection. 

The bacteria harboring in the root canal can infect other areas of the body traveling through the blood. In a study, patients diagnosed with rheumatoid arthritis had one or more necrotic teeth in the mouth and the bacteria found in the root canal were identified in the inflamed joints of these patients.  

Lingering sensitivity 

You may also experience lingering sensitivity in the tooth after a hot drink. Cold drinks usually don’t elicit pain as hard contracts or shrink the vessels.

Mild pain on chewing in the decayed tooth

The release of bacterial products (not the bacteria) from the infected root canal into the tooth surrounding tissues initiates a low-grade chronic inflammation, which appears as episodes of mild pain on chewing. The pain becomes localized when the space outside the tooth gets involved, as this site is rich in mechanoceptors. 

Swelling around the tooth 

The swelling of the jaw or gums around the tooth often represents an extended infection from infected root canals. This swelling is known as a periapical (peri means around and apical means tooth end or apex) abscess. 

This abscess is formed when infection from the root canals travels to the tissues around the tooth. 

In response to the bacterial invasion from the dead pulp, the white cells (the body’s innate arm) in the periapical area fight them, and in reaction, some of them die, leading to pus formation. This acute inflammatory response also causes bone resorption (dissolution), allowing pus to move. Finally, the pus ends up causing jaw swelling or discharge through the gums (where the tooth’s root terminates) as gum boil or pimple. 

Moreover, this acute inflammation provokes spontaneous pain in the tooth on biting and touching, with swelling around the tooth or sinus tract.  

A Gum boil or pimple 

If the acute inflammation is left untreated, the pus drains from the sinus. The pus release relieves the pressure and decreases the pain intensity. Acute inflammation changes into chronic inflammation. 

Long-standing gum boil implies that the inflammation has been in the dead tooth’s surroundings for quite some time. This ongoing inflammation also elicits internal or external root resorption in the teeth. The root canal treatment heals the gum boil and stops the resorption.

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a Pink tooth or pink spot on the tooth  (internal resorption)

A pink spot on the tooth indicates internal resorption (dissolution) in the tooth. Internal resorption is the destruction of the dentine from the inside. The tooth appears pink due to underlying pulp showing through the resorbed area.

The progression of internal root resorption stops with pulpotomy or root canal treatment depending upon the pulp status. 

Pink growth from a cavity (pulp polyp)

Sometimes you may see a pink growth protruding from a large cavity. It is frequently experienced in large cavities by young patients in their teens and twenties. The increased blood supply and reparative capacity of the pulp allow it to cover its exposed surface with scar tissue (granulation tissue). These teeth also require a root canal to save them from further destruction. 

Displacement injury to the tooth 

Displacement and avulsion (the whole tooth comes out with intact roots and attached fibers) injuries damage the vitality of the tooth. Adult teeth with complete root formation have a small apical opening for blood vessels and nerves entering and exiting the tooth. 

These teeth are incapable of repairing the damaged vessels in response to tooth displacement. Therefore, these teeth must be treated with root canal treatment within 7-10 after injury before the necrosed pulp becomes infected. These teeth are also more prone to internal resorption.

If you have a displacement or avulsion injury on the tooth, you need to get it checked for root canal treatment. 


In this article, I have discussed how you know if you need a root canal by looking at your signs and symptoms.

Root canal signs and symptoms have variable presentations. The most common reason for getting a root canal is a deep cavity in the teeth. The cavity infection may spread to the surrounding tissues and lead to jaw swelling. You need professional advice if you experience severe pain in the tooth, jaw swelling, gum boil, pink teeth, pink growth in a large cavity, or tooth discoloration. 

Tooth Displacement due to trauma to the tooth impinges its vitality and needs a root canal treatment.

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