In the past, the diagnosis “inflamed dental nerve” was often a death sentence for a tooth. Extraction was the quick – but final – solution. Today, the situation has changed fundamentally. Modern endodontics (the treatment of the inner structures of the tooth) is one of the most highly specialised disciplines in dentistry, with a single clear goal: to preserve your natural tooth biologically. Because no implant is as good as the original.
Nevertheless, root canal treatment is still surrounded by frightening stories and outdated misconceptions. It is time to separate facts from myths.
Why Does a tooth hurt in the first place?
To understand the treatment, it helps to look beneath the hard outer surface of the tooth.
- The outside is protected by enamel (the hardest substance in the human body)
- Beneath it lies dentin .
- At the centre is the pulp (often referred to as the “dental nerve”), a highly complex tissue consisting of nerve fibres, blood vessels and connective tissue.
When bacteria penetrate this protected chamber—usually through deep decay or a crack—the tissue becomes inflamed (pulpitis). Because the tooth is rigid and cannot expand, the inflammation causes intense pressure, leading to the characteristic throbbing toothache. If the tissue dies, bacteria can migrate into the jawbone and form painful abscesses.
The Modern Procedure: High-Tech Instead of “Pulling the Nerve”
Today, root canal treatment is a microsurgical procedure inside the tooth. The goal is not only pain relief, but complete elimination of bacteria. A state-of-the-art treatment follows these steps:
1. Absolute Isolation (Rubber Dam)
This is the most important factor for long-term success. An elastic rubber sheet (rubber dam) is placed around the tooth.
- The advantage: The tooth is completely isolated from the rest of the mouth. No saliva—full of bacteria—can enter the tooth, and no disinfecting solutions reach your mouth. You can breathe and swallow comfortably throughout the procedure.
2. Seeing the details (Dental Microscope)
Root canals are often extremely fine and curved. Many canal openings are invisible to the naked eye. Using a dental microscope with up to 25× magnification, we can detect even hidden accessory canals that were frequently missed in the past and later caused reinfection.
3. Electronic Length Measurement
Instead of relying solely on two-dimensional X-rays, we determine the exact length of the root canals electronically. This method is extremely precise and reduces unnecessary radiation exposure.
4. Three-dimensional cleaning and disinfection
Infected tissue is removed using highly flexible nickel-titanium instrumentsthat adapt to the curvature of the root. However, mechanical cleaning alone is not enough. The canals are intensively irrigated, often with ultrasound-activated solutions, to reach microscopic side canals that no instrument can access.
5. A hermetic seal
Once the tooth is free of bacteria, the hollow canal system is sealed three-dimensionally and bacteria-tight with a biocompatible natural material (gutta-percha).
Does it hurt?
This is the most common question – and the clear answer is no. In cases of acute inflammation, anaesthesia can be slightly more challenging at first (the so-called “hot tooth”). However, with modern local anaesthetics and specialised injection techniques, treatment is usually completely pain-free. During longer cleaning procedures, many patients even fall asleep once the pain has subsided.
Is the effort worth it?
Absolutely. A successfully treated tooth can last a lifetime with proper care. It remains firmly anchored in its natural position and provides a stable foundation for crowns or bridges. When it comes to this complex treatment, rely on experience and modern technology – your tooth deserves its second chance.