We’ve all felt that sinking feeling when a routine dental check-up suddenly turns into a list of procedures. The thought of a numbing shot, the high-pitched drill, the awkwardness of lying still and the lingering numbness is enough to make anyone uneasy. Add in the possibility of more extensive – and costly – work such as bridges, crowns, extractions or implants, and the anxiety can grow even stronger.

For roughly 15 million Americans each year, the more extensive work that's recommended is a root canal.

Despite its reputation, a root canal is often smoother, quicker and less painful than most people expect. Here’s what it involves, why it’s done and what you can expect during and after treatment.

What is a root canal?

A root canal is a dental procedure designed to treat and preserve a tooth whose inner pulp – the soft tissue that contains nerves, blood vessels and connective tissue – has become infected or irreversibly damaged.

“This can happen from large cavities, fracturing teeth or trauma" that has allowed bacteria to invade the pulp, explains Dr. Daniel Koman, a dentist in Denver, Colorado. Left untreated, infection can lead to abscesses, bone loss or even facial swelling.

To determine if a root canal is needed, dentists conduct a thorough exam, often with X-rays, to evaluate decay, damage and the tooth’s internal condition. In some cases, the full extent of damage becomes clear only once treatment begins. If the pulp cannot be saved, “a root canal is recommended to repair and save your tooth instead of removing it,” says Dr. Erinne Kennedy, consumer adviser spokesperson for the American Dental Association.

The procedure typically begins with local anesthesia and placement of a rubber dam to isolate the tooth. The dentist then creates a small opening, removes the infected pulp and carefully cleans and shapes the canals with specialized files and irrigating solutions. “Your dentist may also treat the tooth with germ-killing medicine,” Kennedy notes. Once cleaned, the canal is filled with a rubber-like material and sealed to prevent reinfection. Finally, the tooth is restored, often with a crown, for strength and long-term function.

With proper care, Koman says, a treated tooth can last just as long as a natural one.

Do root canals hurt?

Thanks to modern anesthesia and advances in dental care, root canals are usually no more uncomfortable than having a cavity filled. “There is little to no pain because your dentist will use local anesthesia, so the procedure is not felt,” Kennedy says. For most patients, the worst part is the brief “pinch” of the initial numbing shot.

After treatment, mild soreness or sensitivity is common for a few days as the surrounding tissues heal. This discomfort typically peaks within 24 to 48 hours and subsides within three to five days, easily managed with over-the-counter pain relievers.

A small percentage of patients may experience more significant discomfort due to complications such as a missed canal, lingering infection or an uneven temporary filling that affects their bite. “And it is not uncommon for root canals to reinfect,” says Dr. Corbin Popp of Colorado BioDental + Esthetics.

If pain worsens or persists beyond a week, it’s important to follow up with your dentist, as retreatment or an adjustment may be needed.

How long does a root canal take?

The duration of a root canal depends on where the affected tooth is located and the degree of the infection. “A front tooth often has a single canal that is relatively easy to treat," says Popp, while back teeth can have three or more canals – sometimes curved or hidden – that take more time to clean and fill.

Other factors include the level of inflammation and how quickly anesthetics work. Severely inflamed tissue may make numbing more difficult, and in advanced infections, antibiotics may be prescribed beforehand. If a crown is needed, the dentist may fit a temporary one during the appointment, with a follow-up visit scheduled for permanent placement.

Generally, full treatment can be completed in 30 to 60 minutes, “much less time than is usually expected,” says Kennedy. More complex cases can take up to 90 minutes or require a second visit.

Many root canals are avoided altogether with proactive care. "Root canals often can be prevented by taking care of small cavities before they become larger cavities and by taking care of teeth that are structurally cracking prior to a catastrophic break," says Koman. "With proper brushing and flossing and regular visits to your dentist, root canals are very avoidable."

This article originally appeared on USA TODAY: Is a root canal actually all that painful?

Reporting by Daryl Austin, USA TODAY / USA TODAY

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