What is endodontics?
Endodontics is the field of dentistry that deals with the dental pulp and the root canals. Its main goal is to save the natural tooth and avoid an extraction. At Jerusalem Dental Clinic, patients receive explanations and a written treatment plan in English.
Endodontic care includes first-time and repeat root canal treatment, pulp capping, apexification in young teeth whose roots are still developing, and the treatment of teeth with complex infections. In every case, the approach is conservative and aims to keep as much natural tooth structure as possible.
What does a root canal specialist (endodontist) do?
The inside of a tooth has a complex system of canals, and a good understanding of tooth anatomy is essential for a successful root canal. An endodontist is a dentist who has specialized in treating problems of the pulp and the root canals. According to the AAE, in the United States this specialty training lasts two years or more beyond dental school.
Complex cases
Endodontists handle cases that a general dentist may find difficult: precise diagnosis of pulp problems, complex inflammation and infection, very curved or narrow canals, unusual root anatomy, and retreatment of teeth whose previous root canal did not heal.
Magnification and cleaning tools
According to the AAE, endodontists use dental operating microscopes to see the inside of the canals better and treat them thoroughly, along with ultrasonic cleaning, an electronic apex locator (which measures the length of each canal) and biocompatible filling materials. When a root problem is complex, such as a retreatment, treatment can be carried out by the endodontist who works at the clinic.
What is a root canal, and why do tooth roots need treatment?
A root canal saves a damaged tooth by removing the infected or inflamed soft tissue (the pulp) from inside the root canals, cleaning and disinfecting the canals, and finally filling and sealing them with a dedicated material.
Roots need treatment when the pulp, which contains nerves and blood vessels, is damaged by infection or inflammation. The most common cause is deep tooth decay that has worked its way through the layers of the tooth to the pulp. Other causes include rotten teeth left untreated, trauma such as a broken tooth or a blow, and sometimes repeated dental work on the same tooth. Once the pulp is irreversibly damaged it cannot heal on its own, and the inflammation can spread to the surrounding tissues, causing a local infection or even an abscess.
Contrary to a common belief, a root canal and a crown do not automatically go together. A dental crown is often recommended to strengthen a root-canal-treated tooth and protect it from fracture, but in some cases a filling is enough. The decision depends on the position of the tooth, how much of it was destroyed before treatment and other factors the dentist weighs.
The guiding principle is to keep the natural tooth whenever possible: root canal treatment is considered before extraction, as long as the tooth can be restored.
How do you know you need a root canal?
Recognizing the need for a root canal early helps prevent severe pain and further damage. The most telling sign is a strong, lasting toothache, especially pain that gets worse at night or when chewing or pressing on the tooth. This pain comes from inflammation or infection of the pulp. Sensitivity to hot or cold that does not fade once the stimulus is removed also points to possible pulp damage and calls for a professional assessment.
Other signs that may indicate the need for a root canal:
- an abscess on the tooth or in the gum
- swelling of the gum around the affected tooth
- a tooth turning gray or dark
- bad breath that persists despite good oral hygiene
A tooth that has suffered trauma, such as a fracture or a blow, may need a root canal even without immediate symptoms.
Diagnosis combines a clinical examination, sensitivity tests on the tooth and X-rays. The approach is conservative: a root canal is recommended only when it is needed to save the tooth.
Why a tooth may need a root canal even when it does not hurt
Pain is not always the first sign of a problem: a deep infection can develop without noticeable symptoms when the nerve inside the tooth has already died or is dying. In these cases, the infection can spread without pain until it reaches an advanced stage.
Sometimes the lesion is found only on a routine X-ray. Early detection can prevent significant complications, including loss of the bone that supports the tooth, a gum boil, cyst or fistula, and spread of the infection to nearby tissues. Root canal infection treatment is meant to save the natural tooth, which is why it matters even without pain.
Root canal treatment steps: how is it done?
Root canal treatment usually follows a few main steps, each of them essential to its success. It is done under local anesthesia.
1. Anesthesia and isolation of the tooth
The area is numbed with a local anesthetic. The tooth is then isolated with a rubber dam, a thin sheet that keeps bacteria and saliva out of the treatment area. An opening is made in the tooth to reach the canal system, and the infected pulp is removed with dedicated instruments.
2. Cleaning and shaping
Special endodontic instruments shape the canals and remove infected tissue. During this stage the canals are rinsed with disinfecting solutions; ultrasonic activation of the rinse helps it reach difficult areas of the canal.
3. Filling and sealing
Once cleaning and shaping are complete, the canals are dried and filled with a sealing material (usually gutta-percha) together with a sealer, so that they are tightly closed.
What happens if you do not get a needed root canal?
Delaying a needed root canal can have serious consequences, for the tooth and for your general health. An untreated tooth infection keeps spreading and destroying nearby tissue.
Without treatment, the infection can lead to an abscess and make any later restoration more complex. In severe cases, extraction becomes unavoidable once the infection is beyond saving. Losing a tooth then brings additional costs (an implant, a bridge or a denture) and affects chewing and appearance.
In rare cases, an untreated dental infection can spread and cause sepsis, an extreme response of the body to an infection and a medical emergency. Fever, swelling spreading toward the eye or neck, or difficulty swallowing or breathing require going to a hospital emergency room immediately.
Root canal treatment cost: what affects it?
The cost of root canal treatment depends on several factors, the most important being the complexity of the case. For example, a root canal on a front tooth with a single canal usually costs less than one on a molar with three or four curved canals. The full list of factors is on our page how much does a root canal cost.
Other factors: whether it is a first treatment or a root canal retreatment, whether magnification is needed, whether the case is treated by an endodontist, and the restoration needed afterwards (crown or filling). The clinic does not publish a price list: you receive a detailed written quote after the examination, and itemized receipts you can submit to your insurer (coverage depends on your policy). A root canal that keeps the natural tooth can save the higher cost of replacing it after an extraction.
Examination, treatment plan and price quote
detailed and personalized
During the consultation, Dr Haim Aseriel examines your teeth, explains all the options and gives you a transparent price quote, with no obligation. The clinic is at 12 HaTnufa Street, Jerusalem.
Root canal recovery and side effects
Recovery after a root canal is usually short, but it needs attention and follow-up to ensure long-term success.
According to the AAE, most patients feel mild discomfort for a few days after treatment, and a feeling of pressure in the treated area is common at first. The dentist gives instructions adapted to each patient.
3-5days
Most symptoms improve within this time (AAE)
Right after treatment, the tooth may be tender and react to pressure or temperature. Strong pain after a root canal, pain that gets worse or lasts more than a few days, or swelling call for an examination.
Lasting pain may point to ongoing inflammation or to a temporary filling that needs adjusting. For pain relief after treatment, ask your dentist or pharmacist which medicine and which dose suit you. According to the ADA's 2024 guideline, in adults without contraindications, non-opioid pain relievers such as nonsteroidal anti-inflammatory drugs (NSAIDs) are generally the first choice for acute dental pain.
Careful oral hygiene supports normal healing. Brush the treated area gently and use mouthwashes only if your dentist recommends them. According to the AAE, avoid chewing hard food on the treated tooth until your dentist says it is safe, usually once the permanent restoration is in place. Follow-up visits make it possible to detect problems early.
When is root canal retreatment needed?
Root canal retreatment is a second root canal on a tooth that has already been treated, when the original treatment did not heal completely or a new infection has developed. The clearest sign is lasting or returning pain around the treated tooth, especially when biting or touching it.
X-ray findings are another important clue: a dark area around the root can indicate persistent inflammation or an infection that was not fully treated. Swelling, a fistula (a small "pimple" on the gum) or pus also suggest the earlier treatment has failed. Retreatment may also be needed when the original treatment was incomplete, with untreated canals or partly filled canals. According to the AAE, new decay, a loose or cracked crown or filling, or a fracture of the tooth can expose the canal filling to bacteria again, sometimes years after a successful treatment.
Not every symptom means retreatment is needed: mild pain or discomfort in the days after a root canal is usually part of healing, not a sign of failure. A professional assessment with X-rays is needed before deciding. Read more on root canal retreatment.
Why does a tooth hurt the day after a root canal?
Some pain after a root canal is a known and, to a degree, expected reaction.
Inflammatory response
Pain in the first days mainly comes from an inflammatory reaction of the tissues around the root tip to the cleaning and disinfection of the canals. Although the nerve inside the tooth has been removed, the tissues around the root contain sensitive nerve fibers. This is part of healing but can cause temporary discomfort.
Complexity of the case
In more complex treatments, especially with a significant infection or advanced inflammation, pain during early healing may be stronger. In such cases the dentist tells the patient how to manage it.
Mechanical cause
Sometimes the temporary filling placed at the end of treatment is slightly too high, which overloads the tooth when you bite. According to the AAE, an uneven bite is a reason to call the dentist; a simple adjustment usually relieves the pain.
Root canal and crown: what happens after treatment?
Once the root canal is finished, the next step is the final restoration of the tooth. A root-canal-treated tooth is structurally weaker, so a full restoration is important to keep it and prevent fractures. Depending on how much tooth structure remains, there are two main options: a full crown, or an onlay or inlay when the loss of structure is more moderate.
01
Restore without delay
Putting off the permanent restoration for a long time can let bacteria leak in through the temporary filling, cause the root canal to fail and make retreatment necessary. The tight seal of the permanent restoration is essential to prevent reinfection. Depending on the tooth, a post may be needed to support the crown.
02
Choosing the material
The materials used affect the long-term stability of the tooth. Zirconia and E-MAX combine strength and aesthetics. The restoration is adapted to your bite to avoid overloading the restored tooth.
03
Follow-up visits
After a root canal and restoration, regular check-ups are recommended. They check the tooth and the seal of the restoration, and follow healing around the root on X-rays, so that problems can be caught early.
Root canal treatment near me: an English-speaking dentist in south Jerusalem
If you are looking for root canal treatment near you in Jerusalem and want to discuss it in English, the clinic is at 12 HaTnufa Street in Talpiot, south Jerusalem. Dr Haim Aseriel, a US-trained dentist (DDS, NYU College of Dentistry), examines the tooth, reviews the X-rays with you and explains the options, including whether the tooth can be saved. When a case is complex, or for a retreatment, the root canal can be done by an endodontist who treats patients at the clinic.
Opening hours: Sun 8:00–19:00 · Mon 9:00–19:00 · Tue–Wed 9:00–21:00 · Thu 8:30–21:00 · Fri 8:00–14:00. For severe pain, call 03-912-1879 to ask for an urgent appointment (see also emergency dentist in Jerusalem). You leave the consultation with a written treatment plan and quote, and read what other patients say in their Google reviews.
Root canal treatment: frequently asked questions
A root canal is a treatment that saves a damaged tooth: the dentist removes the infected or inflamed soft tissue (the pulp) from inside the root canals, cleans and disinfects the canals, then fills and seals them with a dedicated material. The tooth stays in the mouth and keeps working for chewing, instead of being extracted.
The most common sign that you may need a root canal is a strong, lasting toothache, especially pain that gets worse at night or when you chew or press on the tooth. Sensitivity to hot or cold that lingers after the stimulus is gone, swelling of the gum or a darkening of the tooth also call for an examination by a dentist.
A tooth can need a root canal without any pain: when the nerve inside has already died, an infection can develop silently and only show up on an X-ray. Treating it at that stage stops the infection from spreading into the bone around the root and preserves the tooth.
Not always. According to the American Association of Endodontists (AAE), it depends on where the tooth is: back teeth (molars and premolars), which do most of the chewing, generally need a crown, while front teeth do not always. Until it is permanently restored, the tooth is prone to fracture, so avoid chewing on it. In a 2020 study, a permanent restoration placed 60 days or more after the root canal was linked to a 73% higher likelihood of losing the tooth, so the restoration should not be delayed. A full crown is usually advised when the tooth has lost a lot of structure, while an onlay or inlay may be enough when the loss is more moderate.
Jerusalem Dental Clinic, at 12 HaTnufa Street in Talpiot, south Jerusalem, provides root canal treatment with consultations in English. Dr Haim Aseriel, a US-trained dentist (DDS, NYU College of Dentistry), examines the tooth; complex cases and retreatments can be treated by an endodontist who works at the clinic. Appointments are made by phone at 03-912-1879 during opening hours.
Sources
- American Association of Endodontists, What's the difference between a dentist and an endodontist? – View the page
- American Association of Endodontists, Patient FAQs – View the page
- American Association of Endodontists, Root Canal Explained – View the page
- Sadaf D, Therapeutics and Clinical Risk Management, 2020 – View the study
- American Association of Endodontists, Root Canal Post Treatment Care – View the page
- American Association of Endodontists, Endodontic Retreatment – View the page
- Carrasco-Labra A et al., Journal of the American Dental Association, 2024 – View the study
- National Institute of General Medical Sciences (NIH), Sepsis – View the page
