Root Canal Treatment in Littleton, Colorado

A toothache does not always mean you need a root canal—but persistent pain, lingering temperature sensitivity, pain when biting, swelling or an infection around a tooth should not be ignored.

At Canyon View Dentistry, our first priority is determining why your tooth hurts and what treatment is actually appropriate.

Root canal treatment, also called endodontic treatment, is used when the soft tissue inside a tooth—the dental pulp—has become irreversibly inflamed, infected or has died. The goal is to remove the diseased tissue, disinfect and seal the inside of the tooth, relieve the source of infection or inflammation, and preserve your natural tooth whenever reasonably possible.

Just as importantly, not every sensitive or painful tooth needs a root canal. Diagnosis comes first.

At Canyon View Dentistry, we take the time to listen to your symptoms, evaluate the tooth clinically, review appropriate imaging, explain what we are seeing, and discuss your options before treatment begins.

On this page: What is a root canal? · Symptoms · Diagnosis · Treatment · FAQs · Research

What Is a Root Canal?

Every tooth has several layers.

The outside of the tooth is covered by enamel. Beneath the enamel is dentin. Deeper inside the tooth is a space containing the dental pulp, which includes nerves, blood vessels and connective tissue.

The pulp is important while the tooth is developing. Once a permanent tooth has fully matured, however, it can continue functioning without its pulp because the tissues surrounding the root continue to support the tooth.

A root canal treats disease inside the tooth.

During root canal treatment:

1. The tooth is thoroughly numbed.
2. The tooth is isolated to keep the treatment area clean.
3. A small opening is made into the tooth.
4. Inflamed, infected or dead pulp tissue is removed.
5. The root canals are carefully cleaned and shaped.
6. The canal system is disinfected.
7. The canals are filled and sealed with a biocompatible material.
8. The tooth is restored to protect it and return it to function.

The American Association of Endodontists describes modern root canal therapy as a procedure intended to remove infected or inflamed pulp, eliminate bacteria from the root canal system, prevent reinfection and save the natural tooth.

Why Would a Tooth Need a Root Canal?

The pulp inside a tooth can become damaged for several reasons.

Common causes include:

• Deep tooth decay
• A cavity that has progressed close to or into the pulp
• A cracked or fractured tooth
• Trauma or an injury to the tooth
• Repeated dental procedures on the same tooth
• Leakage or recurrent decay around an older filling or crown
• A restoration that has failed
• Infection inside the tooth
• Previous trauma that damaged the pulp even though the tooth did not visibly break

Sometimes the injury happened months or even years earlier.

When the pulp is unable to recover, bacteria can eventually enter the root canal system. Infection may then extend through the end of the root into the surrounding bone and tissues, potentially producing an abscess.

Symptoms That May Mean You Need a Root Canal

Symptoms vary considerably from patient to patient.

Some infected teeth are extremely painful. Others produce very few symptoms.

Lingering sensitivity to hot or cold

Brief sensitivity does not automatically mean a root canal is necessary.

What concerns us more is temperature sensitivity that continues after the hot or cold stimulus has been removed, particularly when the pain lasts for an extended period.

The American Association of Endodontists identifies lingering thermal pain as an important symptom associated with significant pulpal damage.

Spontaneous tooth pain

Pain that begins without eating, drinking or touching the tooth can indicate inflammation inside the tooth.

Patients may describe it as:

• Aching
• Throbbing
• Pulsing
• Sharp
• Pressure
• Pain that comes in waves

Tooth pain that wakes you up at night

Nighttime tooth pain can be particularly concerning when it occurs spontaneously or becomes difficult to control.

Pain when biting or chewing

Pain when biting can have several causes, including:

• A cracked tooth
• Inflammation around the tooth root
• Decay
• A loose restoration
• Trauma from the bite
• Pulpal disease

For that reason, biting pain needs to be diagnosed rather than automatically treated as a root canal problem.

A “pimple” or bump on the gum

A small bump on the gum near a tooth may represent a draining sinus tract from an infection around the tooth root.

Sometimes patients notice:

• A recurring gum bump
• Drainage
• An unpleasant taste
• A bump that disappears and later returns

Interestingly, a draining infection may cause relatively little pain because pressure is being released.

That does not necessarily mean the infection has resolved.

Swelling around a tooth or gum

Localized swelling may indicate infection and should be evaluated promptly.

Facial or jaw swelling

Swelling extending beyond the immediate gum tissue warrants urgent evaluation.

A tooth that becomes darker

Following trauma, the pulp inside a tooth may become damaged or die. One possible sign is a tooth gradually becoming darker than neighboring teeth.

Discoloration alone does not establish the diagnosis, but it is something we want to evaluate.

A cracked or broken tooth

Cracks can allow bacteria to reach the pulp.

Whether the tooth can be restored depends on where the crack extends, how much healthy tooth remains and whether the root itself has been compromised.

Deep decay

A cavity approaching the center of a tooth may eventually expose or irreversibly inflame the pulp.

Early treatment can sometimes prevent the problem from reaching this stage.

Can I Need a Root Canal Without Having Pain?

Yes.

Pain is only one piece of the diagnostic picture.

A pulp can gradually lose vitality and eventually become necrotic, meaning the tissue inside the tooth has died. In some situations, the nerve is no longer capable of producing significant pain even though infection remains.

This is why diagnosis may incorporate pulp testing, examination, X-rays and other findings rather than relying on symptoms alone.

A lack of pain does not necessarily mean a tooth is healthy.

How Canyon View Dentistry Evaluates a Toothache

One of the most important parts of root canal treatment happens before the procedure ever begins.

We want to identify the correct tooth and determine what is actually causing the symptoms.

Many conditions can feel surprisingly similar.

Pain that seems to come from one tooth may actually arise from another tooth, a cracked restoration, the bite, gum tissue, the jaw muscles or occasionally another source entirely.

That is why we combine your symptoms with clinical testing and imaging.

Step 1: We Listen to the History of the Problem

The way pain behaves can provide important diagnostic information.

We may ask:

When did the problem begin?

Was there an obvious trigger such as a broken tooth, new filling, crown, accident or biting on something hard?

Does the tooth hurt on its own?

Spontaneous pain can be different diagnostically from pain that only occurs when biting.

Is the tooth sensitive to cold?

If so, how long does the discomfort last after the cold is removed?

Does heat trigger the pain?

Does biting hurt?

Does it hurt when biting down, when releasing the bite or both?

Does the pain wake you up at night?

Can you identify a specific tooth?

Sometimes pulpal pain is difficult for patients to localize.

Have you noticed swelling or drainage?

Have you had trauma to this tooth in the past?

Even an injury years earlier can occasionally become clinically relevant later.

Has this tooth had previous dental treatment?

Large fillings, crowns and repeated procedures are important parts of the history.

What We Look for During the Examination

Decay

We evaluate whether decay is present and how deeply it appears to extend.

Existing fillings and crowns

We look for:

• Recurrent decay
• Leakage
• Fractures
• Open margins
• Broken restorations
• Loss of tooth structure

Cracks

A cracked tooth can mimic many other dental problems.

Cracks are particularly important because the location and extent of the crack can influence whether a tooth can be predictably saved.

Gum swelling or drainage

A localized swelling or draining tract can help us identify the source of an infection.

Tooth discoloration

A darker tooth may be associated with previous trauma or pulpal changes.

Periodontal probing

We may measure the gum attachment around the tooth.

An unusually deep isolated periodontal pocket can sometimes provide important information about a crack, fracture or periodontal problem.

Tooth mobility

Movement of the tooth may also help us understand the condition of its supporting tissues.

Diagnostic Tests for Root Canal Problems

A root canal diagnosis should generally be based on multiple findings rather than one test by itself.

The American Association of Endodontists describes diagnostic testing that may include thermal testing, electric pulp testing, palpation, percussion, periodontal probing, bite testing and radiographic examination.

Cold Testing

Cold testing helps us compare how the affected tooth responds with neighboring teeth.

We are evaluating:

• Whether the tooth responds
• How strongly it responds
• Whether the sensation disappears quickly
• Whether the sensation lingers

The response helps us evaluate the health of the pulp.

Percussion Testing

The tooth may be gently tapped and compared with nearby teeth.

Tenderness may indicate inflammation in the tissues surrounding the end of the root.

Palpation

We may gently evaluate the gum and tissues around the root for tenderness or swelling.

Bite Testing

If a crack is suspected, different parts of the tooth may be tested during biting.

Pulp Vitality Testing

Depending upon the situation, additional testing may be used to determine how the pulp is responding.

Dental X-Rays and Root Canal Diagnosis

Dental X-rays provide important information that cannot be obtained just by looking at the tooth.

We may evaluate:

• The depth of decay
• Previous restorations
• Existing root canal treatment
• Bone changes around the root
• The shape and number of roots
• Previous dental treatment
• Signs of infection around the root tip
• Other conditions that may mimic tooth pain

However, an X-ray is still only one part of the diagnosis.

The clinical examination and the patient’s symptoms matter too.

When Is a CBCT 3D Scan Helpful?

Canyon View Dentistry has the ability to use CBCT—cone beam computed tomography—when the clinical situation warrants additional three-dimensional information.

A CBCT creates a detailed 3D view of the tooth and surrounding structures.

It can sometimes help evaluate:

• Complex root anatomy
• Difficult-to-identify infections
• Suspected fractures
• Previous root canal treatment
• Resorption
• Unusual anatomy
• Persistent symptoms when conventional imaging does not fully explain the problem
• Surgical or retreatment planning

CBCT is not necessary for every root canal evaluation. The American Association of Endodontists and American Academy of Oral and Maxillofacial Radiology recommend using it selectively when the additional information is likely to improve diagnosis or treatment planning rather than as routine screening.

Does Every Toothache Need a Root Canal?

No.

This is an important distinction.

Tooth pain can occur because of:

• A cavity
• A cracked tooth
• A loose filling
• A high bite
• Gum disease
• Exposed root surfaces
• Temporary inflammation after dental work
• Tooth grinding or clenching
• Sinus-related pressure
• A damaged restoration
• Reversible pulpal inflammation
• Irreversible pulpal inflammation
• Infection around the root

Some teeth can be treated with a filling or other restoration.

Some may benefit from treatment designed to preserve healthy pulp tissue.

Others require root canal therapy.

And occasionally a tooth is too structurally compromised to predictably restore and extraction becomes the more appropriate option.

The diagnosis determines the treatment—not simply the presence of pain.

When Should a Root Canal Be Treated?

When a tooth has been diagnosed with irreversible pulpal inflammation, pulp necrosis or a root canal infection, delaying definitive treatment generally does not make the underlying problem disappear.

Symptoms may temporarily improve.

That can be misleading.

For example, a severely painful tooth may suddenly stop hurting after the pulp dies. The reduction in pain does not necessarily mean the disease has resolved.

Untreated infections can progress into the tissues surrounding the tooth and may eventually produce an abscess.

Early evaluation also gives us an opportunity to determine whether the tooth remains restorable.

When Should I Call the Dentist?

Schedule an evaluation promptly if you have:

• Persistent tooth pain
• Lingering sensitivity to hot or cold
• Pain when chewing
• Pain that wakes you at night
• A cracked tooth
• A broken tooth
• A recurring bump on the gum
• Drainage from the gum
• Swelling near a tooth
• A tooth becoming darker
• Pain that continues after recent dental treatment
• A toothache that is getting progressively worse

When Is a Tooth Infection an Emergency?

Dental infections should be evaluated promptly, particularly when swelling is developing.

Seek urgent dental care for significant swelling, an abscess, fever or symptoms that are rapidly worsening.

Seek emergency medical care if swelling is affecting your ability to breathe or swallow, or if significant facial or neck swelling is developing. These can be signs that infection has spread beyond the immediate tooth.

Will Antibiotics Fix an Infected Tooth?

This is a common question.

For many infections originating inside a tooth, antibiotics alone do not eliminate the source of the problem inside the root canal system.

The American Dental Association recommends definitive dental treatment rather than antibiotics alone for most localized pulpal and periapical dental conditions in otherwise healthy adults. Depending on the diagnosis, definitive treatment may include root canal procedures, drainage or another dental treatment.

Antibiotics may become appropriate when there are signs that infection is spreading or systemic symptoms such as fever or malaise are present.

Your dentist determines whether antibiotics are appropriate based on the clinical situation.

What Happens During a Root Canal?

Knowing what is happening can make the procedure much less intimidating.

1. We Make Sure You Are Comfortable

Local anesthetic is used to thoroughly numb the tooth and surrounding tissues before treatment begins.

At Canyon View Dentistry, patient comfort is part of the procedure—not an afterthought.

If you are anxious, have had difficulty getting numb in the past or have concerns about dental treatment, please tell us.

We would much rather know before we begin.

We can explain what you will experience, make sure the anesthetic is effective, give additional anesthetic when clinically appropriate and pause whenever necessary.

2. The Tooth Is Isolated

A protective dental dam is placed around the tooth.

This isolates the tooth from saliva and helps maintain a clean treatment environment.

3. The Root Canal System Is Accessed

A small opening is created in the tooth so the internal pulp chamber and root canals can be reached.

4. Diseased Pulp Tissue Is Removed

Small instruments are used to remove inflamed, infected or necrotic tissue from inside the tooth.

5. The Canals Are Cleaned and Shaped

The root canal spaces are carefully cleaned, disinfected and shaped.

6. The Root Canal System Is Sealed

After cleaning and shaping, the canals are filled with a biocompatible material, commonly gutta-percha, and sealed.

7. The Tooth Is Restored

A root canal treats the inside of the tooth.

The outside of the tooth still needs to be structurally protected.

Depending upon the amount of remaining tooth structure and the location of the tooth, the final restoration may involve a bonded restoration, buildup and/or crown.

Back teeth frequently require significant protection because of the chewing forces they experience.

Will I Need a Crown After a Root Canal?

Many teeth—particularly molars and premolars—require a crown or another strong definitive restoration after root canal treatment.

The reason is not that a root canal automatically makes every tooth fragile.

Often, the tooth already has substantial structural loss from:

• Decay
• A large existing filling
• A fracture
• Previous dental procedures
• The access needed to treat the root canal system

The final restoration is an important part of protecting the tooth from reinfection and fracture.

A systematic review examining long-term survival of root-canal-treated teeth identified placement of a crown after treatment as one factor associated with improved tooth survival.

Your dentist will evaluate how much healthy tooth structure remains and recommend the restoration appropriate for your individual tooth.

Root Canal Treatment or Extraction?

When a tooth can be predictably saved and restored, root canal treatment allows the natural tooth to remain in place.

Benefits of preserving a natural tooth can include maintaining:

• Natural chewing function
• Normal tooth position
• Natural appearance
• Normal biting relationships
• Support for surrounding teeth

Extraction may nevertheless be appropriate when a tooth cannot be predictably restored—for example, with certain severe fractures, extensive structural destruction or advanced periodontal support loss.

We believe patients should understand both the diagnosis and reasonable treatment alternatives before making that decision.

How Successful Are Root Canals?

No dental procedure can be guaranteed.

Research, however, supports root canal therapy as a well-established method of retaining teeth.

An updated systematic review involving 42 studies reported pooled primary root canal treatment success rates of approximately 92.6% using less-strict healing criteria and 82.0% using strict criteria, while also noting limitations in the overall quality and variability of the available evidence.

Another systematic review evaluating tooth survival rather than radiographic healing found pooled survival estimates ranging from approximately 86% to 93% over follow-up periods between 2 and 10 years.

Individual prognosis varies depending upon factors such as:

• The condition of the tooth before treatment
• Presence and size of an infection
• Cracks or fractures
• Tooth anatomy
• Remaining tooth structure
• Quality of the root canal treatment
• Quality and timing of the final restoration
• Periodontal health
• Oral hygiene
• Recurrent decay
• Future trauma

The goal is not simply to complete a root canal. It is to create a treatment plan that gives the entire tooth a reasonable opportunity for long-term function.

Root Canal Care at Canyon View Dentistry

Dental pain can be stressful—especially when you do not know what is causing it or what treatment you may need.

At Canyon View Dentistry, our approach starts with understanding the problem.

We want you to know:

What we found.

What the testing tells us.

What we can see on your imaging.

What your treatment options are.

Why treatment is being recommended.

What you should expect before, during and after the procedure.

We prioritize patient care, communication and comfort throughout the process.

When root canal treatment is appropriate, we will also determine whether the case can be predictably treated in our office or whether the anatomy or complexity makes referral to an endodontist—the dental specialist focused on root canal treatment—the better option.

The objective is the same either way:

Relieve the source of the problem, protect your health and preserve your natural tooth whenever reasonably possible.

Questions to Ask About a Root Canal

We encourage patients to understand their diagnosis.

Questions you may want to ask include:

• What is causing my tooth pain?
• What did my cold or vitality testing show?
• Do you believe the pulp can recover?
• Is there infection around the root?
• Can you show me the problem on my X-ray?
• Is there evidence of a crack?
• Would a CBCT provide useful additional information?
• Is the tooth structurally restorable?
• Are there alternatives to root canal treatment?
• What happens if I wait?
• Will this tooth need a crown afterward?
• What is the expected prognosis?
• Should this be treated by my general dentist or an endodontist?

A patient who understands why treatment is being recommended can make a much more informed decision.

Evidence & Additional Patient Resources

For patients who want to learn more, these resources provide additional evidence-based information.

American Association of Endodontists — Root Canal Treatment
Patient education explaining why root canal treatment is performed, what happens during treatment and what patients can expect.
AAE Root Canal Treatment Information

American Association of Endodontists — Root Canal Treatment Step by Step
Detailed explanation of diagnosis, anesthesia, dental dam isolation, canal cleaning, sealing and final restoration.
AAE Root Canal Step-by-Step Guide

European Society of Endodontology — Clinical Practice Guideline
A 2023 evidence-based clinical practice guideline addressing diagnosis and treatment of pulpal and apical disease.
View the Guideline on PubMed

Outcomes of Primary Root Canal Therapy — Updated Systematic Review
An updated systematic review of longitudinal clinical studies evaluating root canal treatment outcomes.
View the Systematic Review on PubMed

Tooth Survival After Root Canal Treatment — Systematic Review
A systematic review examining survival of teeth following nonsurgical root canal treatment.
View the Tooth Survival Study on PubMed

American Dental Association — Antibiotics for Dental Pain and Swelling
Evidence-based guidance explaining why definitive dental treatment is prioritized over antibiotics alone for most localized pulpal and periapical dental conditions.
ADA Antibiotic Guideline

American Association of Endodontists — CBCT in Endodontics
Information about when three-dimensional imaging can help with endodontic diagnosis and treatment planning.
AAE CBCT Information

Experiencing Tooth Pain?

Tooth pain can be difficult to interpret on your own.

If you are experiencing lingering sensitivity, pain when biting, spontaneous tooth pain, swelling, a cracked tooth or a recurring bump on your gum, the next step is to determine why it is happening.

At Canyon View Dentistry, we will evaluate the tooth, explain what we find and help you understand your treatment options.

Our goal is not simply to treat a tooth.

Our goal is to take care of the person attached to it.

Schedule a Tooth Pain or Root Canal Evaluation

If something does not feel right, contact Canyon View Dentistry to schedule an evaluation. Early diagnosis can often provide more options for relieving discomfort and preserving your natural tooth.

This information is provided for general patient education and is not a substitute for an individual dental examination, diagnosis or treatment recommendation.