How Do I Know if I Need a Root Canal? 7 Common Signs Explained

Why Do You Need Root Canal Treatment for Tooth Decay?

Dental caries have painful symptoms and a severe impact on the oral health. The inability to adhere to basic oral hygiene is a primary cause of tooth decay. Bacteria inside the oral cavity make their way into the tooth interior and grow inside, causing tooth decay. It causes pulp inflammation, and the infection may spread to surrounding oral tissues. 

Typically, it starts with immense pain and discomfort, which is when you start feeling something isn’t right. Seeing your dentist can rule out the exact cause of pain. Dentists perform root canal treatment to clear the infection and ease the symptoms. Worsened decay is serious and can lead to complications. It is better to see your dentist as and when you start noticing any of the tooth decay symptoms.  

How Do I Know if a Root Canal Is Infected?

Below, we elaborated on the 7 common signs that show up when the root canals are infected. 

Deep Pain in the Tooth

Pain deep inside the tooth structure is the most common symptom that shows up in infected root canals. While not every toothache indicates decay, pain that fades away with time can be ignored. However, the immense, throbbing pain deep inside the tooth should not be ignored and is serious. Be it a persistent pain or sharp, occasional pain that goes off and revisits for no reason can be a warning signal. Note that tooth pain due to decay worsens with time or shows up without any trigger. The inflamed tooth pulp swells up, putting pressure on the surrounding tissues and nerves. This tingling sensation manifests as intense pain deep inside.   

Swollen Tooth With Tender Gums

The inflamed pulp inside the infected tooth swells up due to the bacteria growth.^[1] The infection spread to adjacent gums and bone structures. The spread of infection is evident with the visual signs of redness of the tender gum tissues. While this seems like a minor visual symptom, the swelling causes severe discomfort when you chew, bite, touch, or apply pressure on the tooth structure. Swollen gums can be due to many reasons. You may rule out the exact cause of tooth decay when you notice lingering pain around the swollen structures. 

Discolored Gums and Tooth

A discolored tooth is a common visual manifestation of the decayed tooth. Typically, a tooth appearing grayish or still darker is likely to develop cracks or chips in the near future. Teeth maintain the natural shade as they receive a continuous blood supply.  However, it may show discoloration as the blood supply cuts off due to pulp infection. Eventually, the tooth dies. Note that the growing tooth decay in the tooth interior is manifested with increasing discoloration or darkening. 

Sensitivity to Hot or Cold Foods

Tooth sensitivity is the sudden sense of sharp pain over short stretches in response to specific stimuli. Enamel is the hardest structure that protects the interior sensitive parts of a tooth. In cases of tooth decay, the bacteria that reside in the oral cavity enter the interior parts of the tooth. Gradually, it weakens and erodes the enamel, creating tiny channels or holes in the harder enamel to gain access to the interior tissues. Weakened enamel exposes the softer dentin to the exterior.^[2] Dentin has microscopic tubules that are connected with the nerves, and you will feel a sudden sensitivity when tubules are exposed to the triggers. Typically, acidic content in the food, or hot or cold foods, causes tooth sensitivity.   

Loose Tooth 

Healthy teeth are held tightly within the jawbone in tiny sockets by the periodontal joints, which are strong fibrous ligaments. In severe tooth decay, the bacteria in the pulp spreads to the gums, causing chronic infection. Periodontitis, a common gum problem, is associated with the damage of gingiva, cementum, alveolar bone, and periodontal ligaments.^[3] Further, the swollen gums also accumulate fluids, which loosens the tooth within its bony socket. The overall result is you see an infected tooth that is loose and mobile. 

Pain When You Apply Pressure

Pain in the tooth when you apply simple pressure or normal bite force is an indication of infection. Bacteria growing inside the tooth pulp cause pulp inflammation. In some cases, causes nerve damage, affecting the sensitivity of the underlying nerves. Moreover, the bacteria inhabiting the tooth release waste products that pose pressure and irritation to surrounding tissues, which cause pain when you apply pressure.  

Small Pimples or Boils Around the Gums

The bacteria which seeps inside the tooth can grow deep within, reaching the pulp. It can spread to the adjacent tissues and cause small boils around the gums, especially close to the tooth root. Infection causes pus formation and fluid build-up around the bone supporting the tissues. While abscesses is a common medical term for pus-containing boils, they vary based on the underlying cause and location. Periapical abscesses are the most general type with regard to tooth decay. While pus formation is a result of the body’s immune response to the infection, periapical abscesses are painful and are a clear indication of underlying infection. It is indeed a serious symptom that may spread to the neck or facial tissues when left unattended.^[4]  Patients experience fever and discolored teeth, along with clearly visible boils.   

Note that one or a combination of a few symptoms indicate tooth decay. Don’t hesitate to see your dentist if you notice any of these symptoms. Remember, an early intervention can avoid the worsening of symptoms, preventing further complications. The dentist will clean the infected root canals and disinfect them. They will close the canals with dental material and restore the tooth functioning using permanent restoration. They use either fillings or crowns to close the exposed canals. Fixing permanent restorations further prevents the oral bacteria from leaking into the teeth. Are you wondering about making the choice of filling or a crown? We understand that an informed decision can smoothen your experience. Below, we answered a few questions that most patients ask us. Read along to find some useful information.

How Do I Know if I Need a Root Canal or a Filling?

Dentists consider root canals or filling for tooth decay; however, the choice depends on the severity of the decay. Minor tooth decay or dental caries in the early stages are treated using low-cost dental filling. Patients typically manifest symptoms of sensitivity or occasional toothaches. However, severe tooth decays that show up as pus-filled boils or discolored teeth with severe pain indicate infected and inflamed pulp. In this case, dentists perform root canal treatment to save the tooth from further damage.

How Do I Know if I Need a Root Canal or a Crown?

Ideally, endodontists clean and restore the decayed tooth by performing root canals and placing dental crowns. Some patients with minor decays are fixed with dental fillings. However, severe tooth decay results in a weakened enamel portion that has a greater tendency to break. Dentists fix crowns in patients when the teeth have lost most of their structure but are still viable. While crowns are relatively expensive compared to fillings, your dentist will help you know the pros and cons. In some cases, they also offer cheap dental crowns (all-metal crowns) for molars or premolars. While all-metal crowns offer poor aesthetics, they are hardy, highly durable, and last longer. 

How Do I Know if I Need a Root Canal or Extraction?

Tooth extraction is typically the end option for tooth decay. Dentists recommend tooth extraction only in severe decay that actively spreads to the surrounding tissues. Further, extraction is recommended in cases of extensive damage, like deeper cracks within the gums with too little tooth portion that can barely carry out normal functions.  In most cases, they try to retain the decayed tooth as extraction leaves the socket empty, which carries certain complications. The teeth adjacent to an empty tooth socket drift inside, altering the alignment over the long term. 

Note that a root canal-treated tooth is a success when you adhere to perfect aftercare. It is liable for further damage when the procedure isn’t carried out properly or in poor oral hygiene conditions. In this context, we answered two commonly asked questions below. 

How Do I Know if I Need a Root Canal After a Crown?

A root canal after getting a crown is needed when the crown breaks or develops cracks. Ideally, dental crowns are hardy and last for several years. However, you need to be cautious about what you eat. Biting or chewing hard and crunchy foods causes crowns to develop cracks or breaks. An intact crown acts as a protective barrier against the entry of food debris or bacterial build-up into the tooth. However, even small crevices on the crown can harbor bacteria, causing reinfection. You will notice sensitivity and pain in response to hot or cold foods. Few patients experience pain and also broken crown pieces. 

How Do I Know if I Need a Root Canal After a Filling?

You may need a root canal after a filling in case it leaks or catches an infection. You will notice symptoms like pain, sensitivity, and occasional headaches. Few experience discomfort in the oral cavity, bad breath, and salty tinge around the reinfected tooth. Dentists confirm this by visual examination and performing dental X-rays. How I know if I need a root canal retreatment? If lingering doubts still trouble you, we explained it briefly in the article, ”Why is my root canal tooth hurting after years?”. Read on to bust any myths and gain a clear understanding of when a retreatment might be necessary. While symptoms like pain, sensitivity, or boils are the common signs of a root canal, your dentist confirms the infection before proceeding with treatment.

How Does a Dentist Decide You Need a Root Canal?

Before beginning the treatment, your dentist will examine the affected tooth and learn about your symptoms. They look for visual symptoms like discoloration or chipping.^[5] Further, they understand the intensity of pain by gently tapping on the tooth. Dentists check the pulp vitality by exposing the tooth to hot or cold stimuli. Further, they perform certain tests like the electric pulp test (EPT).^[6] Using a small battery, they send the electrical signals through the tooth. Ideally, the viable tooth shows sensitivity, and an unhealthy nerve shows no pain or sensitivity. In some cases, dentists also perform X-rays to detect the decays below fillings or smaller decays between the teeth. Once the presence of tooth decay is confirmed, they discuss the treatment plan and proceed further.

Treatment for the Symptoms of Root Canal Infection

Your dentist will carry out the root canal treatment under local anesthesia. They drill a hole in the infected tooth and gain access to the interior parts of the tooth structure. Next, they clean the root canals and disinfect them. They collect the impressions for crown preparation and cover the cleaned root canals using temporary filling. Once the permanent restorations are ready, they fix them permanently to restore the tooth function. Check the article for a detailed root canal step-by-step procedure. 

Root Canal Treatment: Busting Some Common Myths

Below we provide the facts for some common myths around root canal treatment.

#1 Undergoing Root Canal Treatment Is Extremely Painful

Root canals, when left untreated, get worse and cause immense pain. The treatment will be carried out under local anesthesia so you won’t feel any pain. Advanced technology offers various sedative dentistry choices to make you feel relaxed during the treatment. 

#2 Root canal treatment kills the tooth and makes it non-functional

Root canal treatment, in fact, restores the tooth’s normal functioning. The dentist removes the infected pulp and inflamed portion while leaving the tooth structure intact. In rare cases where a large portion of enamel is broken or cracked, the dentist will restore its function by fixing a dental crown. 

#3 Extraction Is Better Than Getting Root Canal Treatment

Tooth extraction is recommended in cases of severe infection. Root canal treatment aims at saving the tooth, as extraction is associated with side effects. In general, tooth extraction leaves an empty socket into which the adjacent try to drift in, causing alignment problems. 

#4 It’s Better To Wait Before Getting Root Canal Therapy

Root canal treatment is conducted for tooth infection and decay. Waiting for a couple of days before treatment can make no difference. However, waiting weeks or months can worsen the infection and symptoms. It can actively spread to the surrounding teeth and gum tissues, leading to further complications.

An informed decision starts with the right knowledge. When you know the symptoms, causes, and treatment options, you’re not just prepared—you’re empowered to make the best choice for your well-being. At Envoy Health, we believe expert advice is the first step toward healing. That’s why we partner with top dental professionals worldwide to bring you exceptional care. Sign up on our platform today and take charge of your dental health with confidence.

References

1. Tooth Decay
2. The Stages Of Tooth Decay
3. Mechanism Of Alveolar Bone Destruction In Periodontitis — Periodontal Bacteria And Inflammation
4. Bilateral Maxillary and Mandibular Periapical Abscesses
5. Tooth Decay
6. Preserving Pulp Vitality For Teeth With Post-Vital Pulp Therapy Symptoms By Retrying Pulp-Preserving Procedures: A Retrospective Clinical Study