Melike Yavuz

This is the question I hear most often from my patients, and the real reason most of them delay coming to the clinic. My answer is this: most of the pain associated with root canal treatment comes not from the treatment itself but from the inflamed process lived through before coming in. The pain that brings the patient to the clinic is the pain the treatment removes, not the pain it causes.

During the treatment we numb the area and work; I check my patient's comfort regularly throughout, and the moment they feel discomfort we pause. After treatment there can be sensitivity lasting a few days; that is an expected part of the tissues healing, and I prepare my patient for it in advance.

The truly sad part is the treatments postponed for months because of this fear. In a patient who comes early, the procedure is shorter and our chance of saving the tooth is higher. So I tell my patients the same thing every time: waiting because you fear the pain does nothing except make the thing you fear bigger.

I hear this sentence often from patients arriving at the clinic, and it carries two errors at once. In root canal treatment we clean the inflamed or damaged tissue inside the tooth; the tooth goes on being nourished through the tissues that surround it and doing its work in the jaw. None of its duties are lost: chewing, supporting the neighbouring teeth, stimulating the jawbone.

The second error is the belief that these teeth are destined for extraction. With a properly performed root canal and a properly planned restoration on top, these teeth can be used without trouble for many years. The choice of restoration after treatment is a subject I have also worked on academically; how the top of the tooth is sealed matters as much as the work done inside the canal. What loses a root-treated tooth is usually not the treatment itself, but the restoration and the check-ups neglected afterwards.

I had a patient who, I later learned, had booked and cancelled appointments many times before making it to the clinic. Because of a bad experience in childhood, simply sitting in a dental chair was a threshold in itself. At the first session we did not start treatment at all; I explained what we would do, what they might feel at each stage, and that if they signalled with their hand I would stop.

Halfway through the second session there was a silence, and I realised my patient had fallen asleep in the chair. When the treatment was over they could not believe it; no one was more surprised than they were that they had managed to sleep in the middle of a procedure they had spent years postponing out of fear.

What changed that day was not the tooth; it was their relationship with the dentist. The source of the fear is usually not the procedure itself but the feeling that control lies entirely with someone else. Hand that control back to the patient, and you watch even the most anxious shoulders come down.