Toothaches can be unpredictable. Some fade away on their own, others just need a small filling. But then there are the relentless ones — the deep, aching kind that won’t let you enjoy a hot cup of coffee or even chew comfortably. When pain lingers and worsens, your dentist may start considering something more serious: a root canal.
So how do they make that call? It’s not a guessing game. Dentists use clear signs, symptoms, and clinical tests to decide whether a root canal is truly necessary.
Signs You Might Need a Root Canal
Not every painful tooth needs a root canal, but there are a few telltale symptoms that signal something more serious might be happening inside the tooth:
- Constant, unrelenting pain
- Prolonged sensitivity to hot or cold
- Swelling or tenderness around the gums
- Darkening of the tooth (a possible sign of nerve damage)
- Pimple-like bump on the gums (indicating infection)
When these symptoms show up, your dentist will run tests to get a clearer picture of what’s going on.
Tests Dentists Use to Diagnose Root Canal Needs
Dentists don’t make treatment decisions based on symptoms alone. They use several tools and techniques to figure out whether the inner pulp of your tooth — the part containing nerves and blood vessels — is infected or damaged.
1. Cold & Hot Sensitivity Test
A cotton swab cooled with a special spray is placed on the tooth. If pain lingers after the stimulus is removed, or if there’s no response at all, it might indicate nerve damage.
2. Tapping Test
The dentist gently taps the tooth. If that causes sharp pain, it can be a sign of inflammation or infection at the root.
3. Pressure Test
Pain when chewing or biting down may suggest that the inner part of the tooth is inflamed or infected.
4. Dental X-Rays
X-rays help reveal what’s happening beneath the surface. A dark spot near the tooth root usually means infection or decay has reached the pulp.
Why Some Teeth Need Root Canals and Others Don’t?
A minor cavity only affects the outer layers of your tooth and can usually be fixed with a filling. But if decay or trauma reaches the pulp, the nerve becomes infected — and that’s when a root canal becomes necessary.
In some cases, a tooth may appear fine from the outside, but an old injury, deep filling, or unnoticed crack can cause the pulp to deteriorate over time.
Can a Tooth Heal Without a Root Canal?
Unfortunately, no. Unlike skin or bone, once a tooth’s pulp is infected or dead, it can’t regenerate. The only options are a root canal to save the tooth — or an extraction.
Some people try to tough it out, hoping the pain will disappear. And sometimes it does… but that often means the nerve inside the tooth has died, not that the infection is gone. Left untreated, the infection can spread and lead to bigger problems.
When Root Canal Treatment Is the Right Call?
If the goal is to save your natural tooth, a root canal is often the best solution. During the procedure, the damaged pulp is removed, the inner tooth is disinfected, and the space is sealed. The tooth may later be topped with a crown to restore full function and strength.
When Extraction May Be the Only Option
In cases where the tooth is too damaged — from a deep crack, severe decay, or widespread infection — removal might be the only choice. But dentists only suggest this when absolutely necessary, because losing a tooth can lead to jawbone loss, shifting teeth, and bite problems over time.
Can Root Canals Fail?
While root canal therapy has a high success rate, there are rare cases where retreatment is needed. This may happen if:
- A canal was missed during the first procedure
- The seal was compromised, allowing bacteria to return
- A crack developed in the tooth
In such cases, a retreatment or tooth extraction may be recommended, depending on the situation. Root canals can be performed by both general dentists and endodontists (specialists in treating tooth pulp and nerves). If your case is complex or has complications, you may be referred to a specialist for more advanced care.
Summing Up
Root canals aren’t something to fear — they’re often the best way to relieve pain and save your natural tooth. Your dentist will use a combination of your symptoms, diagnostic tests, and X-rays to make an informed decision. If you’re feeling ongoing tooth pain or discomfort, it’s best not to wait.
Bayside Dental and Orthodontics is here to help you with expert, compassionate care when you need it most. Call us today at (979) 330-4113 to schedule an exam or consultation. Relief could be just one appointment away.