Treatment that clears infection from inside a tooth and seals it, ending the pain and keeping the tooth in place rather than replacing it.
Inside every tooth is a narrow chamber of soft tissue — nerve, blood vessels, the machinery that built the tooth in the first place. Once the tooth is fully grown that tissue has little left to do, which is the quiet fact underneath this whole procedure: a tooth does not need its pulp to survive. It needs the root, and the root is what we are saving.
Trouble starts when bacteria reach that chamber, through deep decay, a crack, or a filling that has been failing for years. The pulp becomes inflamed inside a space with nowhere to swell, which is why the pain has that particular relentless quality, and eventually it dies and infection escapes through the root tip into the bone. A root canal removes what is in there, disinfects the canals, and seals them so nothing can get back in.
The important thing to understand is that this is not an operation on a healthy nerve. By the time you need one, the nerve is already failing. We are clearing out the problem, not creating one.
Back teeth are then usually crowned. A molar that has been opened up and cleaned out has lost structure, and a crown stops it splitting under the several hundred pounds of force your jaw puts through it every day.
| Front tooth — one canal, straight, quickest | $700–$1,200 |
|---|---|
| Premolar — usually one or two canals | $800–$1,500 |
| Molar — three or four canals, often curved | $1,000–$2,000 |
| The crown afterwards, which back teeth need | $1,000–$2,000 |
| What most dental plans contribute | 50–80% after deductible |
Figures are typical 2026 ranges across United States practices, drawn from published fee surveys. They are here so you have a ballpark instead of a blank, not as a quote from this office. Your own number depends on your mouth and your benefits, and you get it in writing after an exam.
What moves the number:
Most of the dread around this procedure comes from not knowing what is going on, so here it is in order.
The tooth is numbed and a thin sheet of rubber is placed around it. That sheet is there to keep the tooth dry and keep saliva out of the canals, and it has the side effect of meaning nothing touches the rest of your mouth for the whole appointment. A small opening is made through the top of the tooth. The canals are cleaned with fine flexible files, irrigated, dried and filled with a rubbery material called gutta-percha, and the opening is sealed.
Forty-five minutes to ninety, depending on the tooth. You listen to something, we work, and the pressure that has been keeping you awake stops being there.
Root canals have a reputation built in an era before modern anaesthetic, and it has outlived the thing it was describing by about fifty years. Our practice is known for a gentle approach and for Dr. Necciai's painless anaesthesia technique, and this is exactly the procedure it was developed for.
In practice: the tooth is numbed until you feel nothing sharp, and if you do feel something we stop and add more — at any point, however far along we are. Say so. There is no prize for enduring it.
For the first few days afterwards the tooth feels bruised when you bite on it — the ligament holding it in the socket has had a week of infection and a morning of being worked on, and it takes a little while to quieten down. Ibuprofen covers it. Set against the toothache that brought you in, almost everyone describes the treatment itself as the relief rather than the ordeal.
Some people ask us to just take the tooth out. It is a fair question, it is sometimes the right answer, and it deserves a straight response rather than a lecture.
Extraction is cheaper this week — $150 to $450 against $700 to $2,000. What it is not is cheaper by the end of the decade. A gap does not stay a gap: the teeth either side lean into it and the tooth above drifts down to meet it, which turns one problem into three. Filling the gap properly means an implant at $3,000 to $6,000, or a bridge that requires cutting down two healthy neighbours to carry it.
So the honest comparison is not root canal against extraction. It is root canal and crown against extraction and eventual replacement, and on those terms keeping your own tooth usually wins comfortably.
Not every tooth can be rescued. A fracture running down under the gum, or so little sound structure left that there is nothing to build a crown onto, means the tooth has already gone whatever we do — and in that case we will say so directly and move straight on to how the gap gets filled. The reverse is what we want to avoid: an extraction booked because it was the quicker option on a tooth with another fifteen years in it.
Often one. Front teeth and premolars are regularly started and finished inside an hour. A molar with four canals, a tooth that has been infected for weeks, or a case where somebody else's root filling has to come out first will usually want a second appointment, with a medicated dressing sealed inside the tooth in the meantime. Where a crown is needed, that is booked separately once the tooth has settled.
No, and this is worth being clear about. Antibiotics can knock back an infection that has spread into the surrounding tissue and they can buy you a few days of relief, but they cannot reach inside the tooth — there is no blood supply left in there to carry them. The source of the infection stays exactly where it is and the pain returns, usually worse. Antibiotics are sometimes a useful first step. They are never the treatment.
It does not settle down on its own. The pain often fades for a while once the nerve finishes dying, which people understandably read as improvement, but the infection carries on into the bone around the root. From there it becomes an abscess, then a tooth that cannot be saved, and occasionally a facial swelling that needs urgent care. The window where this is a straightforward appointment does close.
It can, particularly on front teeth, though it is much less common than it used to be. If it happens there are good answers — internal whitening, or a veneer or crown — and we would deal with it rather than leave you with a grey tooth in your smile.
If you are looking for the best long-term, healthy option for replacing missing teeth, look no further than implant-supported restorations.
The gold standard for replacing missing teeth. Implants look, feel, and function like natural teeth — and implant-supported overdentures offer the best long-term, healthy option for replacing multiple missing teeth.
More about dental implants →Custom-made caps that restore strength and appearance to teeth that are cracked, worn, or weakened after a root canal or large filling.
More about dental crowns →A fixed, natural-looking way to fill the gap left by one or more missing teeth, anchored securely to neighboring teeth or implants.
More about dental bridges →Comfortable full and partial dentures, including implant-supported options that stay secure so you can eat and speak with confidence.
More about dentures →Call 301-829-2220 or request your appointment online today.
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