One of the most common questions I hear from patients is: “How do I know if I need a root canal?” It’s a great question, and understanding the warning signs can help you seek treatment before a minor issue becomes a major problem.
Here are the seven most common signs that may indicate you need root canal treatment.
1. Persistent Tooth Pain
The most obvious sign is persistent pain in a specific tooth. This isn’t the occasional twinge that goes away—it’s pain that:
- Lingers for days or weeks
- May be constant or come and go
- Can radiate to your jaw, face, or other teeth
- Worsens when you bite down or apply pressure
The pain occurs because the nerve inside your tooth (the pulp) is inflamed or infected. Root canal treatment removes this damaged tissue and eliminates the source of pain.
Important: Not all tooth infections cause pain. Some infections develop slowly and may not hurt until they’re quite advanced. That’s why regular dental checkups are crucial.
2. Prolonged Sensitivity to Hot or Cold
It’s normal for teeth to feel a brief twinge when exposed to very hot or cold temperatures. What’s not normal is sensitivity that:
- Lingers for 30 seconds or more after the temperature stimulus is removed
- Causes sharp, shooting pain
- Worsens over time
- Doesn’t respond to sensitivity toothpaste
This prolonged sensitivity often indicates that the nerve inside the tooth is damaged and struggling to recover. When the pulp can’t heal on its own, root canal treatment is typically needed.
3. Darkening or Discoloration of a Tooth
Have you noticed that one tooth looks darker than the others? A grayish or yellowish tint can indicate:
- The pulp tissue inside is dying or dead
- Internal bleeding within the tooth
- Breakdown of internal tissue
This discoloration happens because damaged blood vessels and tissue inside the tooth break down, much like a bruise. While other conditions can cause tooth discoloration, a single dark tooth—especially one that was previously injured—often needs evaluation for root canal treatment.
4. Swollen or Tender Gums
Infection inside a tooth doesn’t stay contained. It can spread to the surrounding gum tissue, causing:
- Swelling near the affected tooth
- A small bump or “pimple” on the gums (called a fistula or parulis)
- Tenderness when touching the gum area
- Occasional drainage of pus (which may taste bad)
The bump on your gum is actually a channel for pus to drain from the infected tooth root. If you see this, you almost certainly need root canal treatment—and soon. Left untreated, the infection can spread to your jaw, other teeth, or even other parts of your body.
5. Pain When Chewing or Touching the Tooth
Does it hurt when you bite down or tap on a specific tooth? This sensitivity to pressure can indicate:
- An abscess (pocket of infection) at the root tip
- A cracked tooth that has allowed bacteria to reach the pulp
- Advanced decay that has reached the nerve
When the tissues around the tooth root become inflamed, even light pressure can cause significant discomfort. This is your body telling you something is wrong.
6. A Cracked or Chipped Tooth
Trauma to a tooth—whether from an accident, sports injury, or biting something hard—can damage the pulp even if the crack seems minor. Signs that a cracked tooth may need root canal treatment include:
- Pain when biting in certain directions
- Sensitivity to temperature
- Pain that comes and goes randomly
- A visible crack line (though many cracks are invisible to the naked eye)
The problem with cracks is that they create a pathway for bacteria to enter the tooth’s interior. Even if a cracked tooth doesn’t hurt immediately after injury, infection can develop weeks, months, or even years later.
7. Previous Dental Work on the Same Tooth
Teeth that have had extensive dental work may eventually need root canal treatment. This includes teeth with:
- Large or multiple fillings
- Crowns placed after significant decay
- Previous trauma or root canal treatment (retreatment may be needed)
Each time a tooth is drilled or repaired, it experiences stress. Over time, this cumulative trauma can overwhelm the pulp’s ability to heal. If a previously treated tooth starts causing problems, root canal treatment may be the solution.
When to See an Endodontist
Not every symptom means you definitely need a root canal. Other conditions—like gum disease, sinus infections, myofascial pain, or teeth grinding—can cause similar symptoms. That’s why proper diagnosis is essential.
You should see a dentist or endodontist promptly if you experience:
- Severe, constant tooth pain
- Facial swelling
- Fever along with tooth pain
- Pain that wakes you from sleep
- A visible abscess or draining fistula
Emergency situations: If you have significant facial swelling, difficulty breathing or swallowing, or a high fever, seek emergency medical care immediately. These can be signs that an infection is spreading.
The Good News About Root Canals
If you do need a root canal, here’s what you should know:
It’s not painful. Modern root canal treatment is performed with effective anesthesia. Most patients say it feels no different from getting a filling.
It saves your tooth. Root canal treatment has a success rate over 95%. A properly treated tooth can last a lifetime with good care.
It relieves pain. The procedure eliminates the infection causing your symptoms. Most patients feel significantly better within a day or two.
Early treatment is easier. Catching problems early often means simpler treatment and better outcomes. Don’t delay seeking care.
Have Symptoms? Schedule an Evaluation
If you’re experiencing any of these warning signs, don’t wait for the problem to get worse. Contact Phan Endodontic Partners for a thorough evaluation. We use advanced CBCT 3D imaging to diagnose problems accurately—sometimes identifying issues that traditional X-rays miss.
Same-day emergency appointments are available for patients in severe pain.
Call (310) 378-8342 to schedule your consultation.