Do You Really Need a Root Canal? The Truth for Markham Patients

Few dentistry words trigger more anxiety than "root canal." The phrase alone is enough to make some patients avoid booking an appointment entirely — which, as we will explain, is one of the most counterproductive things you can do when a root canal is genuinely needed.

The reality is that the reputation of root canal treatment is decades out of date. Modern root canal therapy is routinely performed under local anaesthetic, typically takes one to two appointments, and — according to the American Association of Endodontists — is no more uncomfortable than having a filling placed. What actually hurts is the infection that makes the root canal necessary in the first place.

This guide gives Markham patients the honest, complete picture: what a root canal is, how to know if you need one, what the procedure actually involves, what happens if you delay it, and what it realistically costs in Ontario.

What Is a Root Canal?

A root canal — formally known as endodontic treatment — is a procedure that removes infected or damaged tissue from inside a tooth, cleans and disinfects the root canals, and seals the tooth to prevent re-infection. The goal is to save a tooth that would otherwise need to be extracted.

Every tooth contains a soft inner chamber called the pulp — a network of nerves, blood vessels, and connective tissue that runs from the crown of the tooth down through the roots. When a tooth is healthy, the pulp is protected beneath layers of enamel and dentine. When decay, a crack, a failed filling, or trauma allows bacteria to reach the pulp, infection develops. Once the pulp is infected, it cannot heal on its own. Without treatment, the infection spreads — first to the bone surrounding the root tip, then potentially to adjacent teeth and beyond.

A root canal removes the source of the infection, preserves the natural tooth structure, and ends the pain.

Is a Root Canal Painful?

This is the most searched question about root canals — and the answer consistently surprises patients.

No. A properly performed root canal should not be significantly more painful than having a cavity filled.

The persistent belief that root canals are agonising comes from experiences that pre-date modern local anaesthesia and rotary endodontic instruments — techniques that are now several decades old. Today, the procedure is performed under effective local anaesthetic that numbs the tooth and surrounding tissue completely. Most patients feel pressure and movement during the procedure but report no sharp pain.

According to Harvard Health Publishing and the American Association of Endodontists, the vast majority of patients rate root canal treatment as no more uncomfortable than a standard filling. A 2016 survey by the AAE found that patients who had experienced root canal treatment were six times more likely to describe the procedure as painless than patients who had never had one — meaning fear is almost universally worse than the reality.

What patients sometimes confuse with procedure pain is post-treatment soreness — a mild tenderness in the treated tooth and surrounding jaw that typically lasts two to four days after the appointment and resolves easily with ibuprofen and acetaminophen. This is normal inflammation as the tissue around the root tip heals, and it is not cause for concern.

The one exception worth noting: a severely infected tooth with significant abscess can sometimes be more difficult to numb completely, because the acidic environment of an active infection partially neutralises local anaesthetic. In these cases, your dentist may prescribe a short course of antibiotics to reduce the acute infection before the procedure, which significantly improves anaesthetic effectiveness and patient comfort. This is another reason not to delay treatment once symptoms appear.

How Do I Know If I Need a Root Canal?

Root canal treatment is needed when the dental pulp — the inner soft tissue of the tooth — becomes infected or irreversibly damaged. The following symptoms indicate that pulp involvement is likely and that you should seek a dental assessment as soon as possible.

1. Persistent, Severe Toothache

A deep, throbbing toothache that does not resolve on its own — particularly one that wakes you at night or intensifies when you lie down — is one of the most reliable indicators of pulp infection. The throbbing quality is caused by increased pressure within the confined pulp chamber as infection and inflammation develop.

Not all toothaches require a root canal. Mild tooth pain that comes and goes may have other causes. It is the persistence, severity, and spontaneous onset of pain (pain that occurs without an obvious trigger like biting down) that distinguishes pulp infection from other types of tooth sensitivity.

2. Prolonged Sensitivity to Heat or Cold

Mild, brief sensitivity to cold is common and often caused by enamel wear or gum recession. What signals pulp involvement is sensitivity that lingers — pain that continues for 30 seconds or more after the cold or hot stimulus is removed. Lingering heat sensitivity in particular is a strong indicator of irreversible pulpitis (inflammation of the pulp) and warrants immediate assessment.

3. Pain When Biting or Applying Pressure

If a specific tooth is consistently painful when you bite down, chew, or press on it, this suggests either pulp involvement or infection that has spread to the periodontal ligament surrounding the root. A tooth that was previously treated but has become painful again under pressure may have a recurring infection and require retreatment.

4. Darkening of the Tooth

A tooth that gradually darkens — becoming greyish or significantly more yellow than its neighbours — may be experiencing internal pulp breakdown. This discolouration occurs when the pulp tissue begins to decompose internally, releasing breakdown products that stain the dentine from the inside. This can occur following trauma to a tooth even years after the original injury, without any obvious pain.

5. Swelling of the Gum Near the Tooth

A small pimple-like swelling on the gum near the root of a tooth — sometimes called a dental fistula or parulis — is a drainage point for a chronic abscess. The body creates this channel to allow pressure from the infection to release. If you notice a recurring pimple on your gum that occasionally releases a bad-tasting fluid, this is a strong sign of chronic pulp infection requiring root canal treatment.

6. Facial or Jaw Swelling

Swelling of the face, jaw, or neck indicates that a dental infection is spreading beyond the tooth root into the surrounding bone and soft tissue. This is a dental emergency. If you have facial swelling combined with tooth pain in Markham, seek same-day care immediately — at Hwy7 Family Dentistry or, if the swelling is progressing rapidly, at Markham Stouffville Hospital ER.

7. No Symptoms at All

This is the point that surprises most patients: a significant proportion of teeth that require root canal treatment have no symptoms whatsoever. A tooth whose nerve has died completely — through longstanding decay or old trauma — may feel entirely normal while harbouring a chronic infection at the root tip that is silently destroying the surrounding bone.

This is why dental X-rays at routine check-ups are not optional extras — they are the only reliable way to detect these asymptomatic infections before they become acute emergencies. A tooth that looks and feels fine can show a clearly visible periapical lesion (infection at the root tip) on an X-ray, detectable months or years before it becomes painful.

What Happens During a Root Canal? Step by Step

Understanding the procedure removes much of the fear around it. Here is exactly what happens at a root canal appointment.

Step 1 — Diagnosis and X-ray Before beginning any treatment, your dentist takes a periapical X-ray to assess the extent of infection, the length and anatomy of the root canals, and the condition of the surrounding bone. In complex cases, a cone beam CT scan may be recommended for a three-dimensional view of the root canal system.

Step 2 — Local anaesthetic The area around the tooth is numbed thoroughly with local anaesthetic. Your dentist will wait until the tooth is fully numb before proceeding. If you feel anything sharp at any point during the procedure, raise your hand — your dentist will add more anaesthetic before continuing.

Step 3 — Rubber dam placement A thin rubber sheet called a dental dam is placed around the tooth. This isolates it from the rest of the mouth, keeps the area clean and dry throughout the procedure, and prevents any debris from being swallowed. It is a standard safety measure and most patients find it comfortable.

Step 4 — Access opening A small opening is made through the top of the tooth to access the pulp chamber beneath. You may feel pressure but should feel no pain.

Step 5 — Removal of infected pulp and canal shaping Using a series of fine, flexible instruments, your dentist removes the infected pulp tissue from the pulp chamber and root canals. The canals are then carefully shaped using progressively larger instruments — or rotary nickel-titanium files in modern practice — to prepare them for filling. This is the core of the procedure and the step that takes the most time.

Step 6 — Irrigation and disinfection The canals are thoroughly flushed with antimicrobial solutions — typically sodium hypochlorite — to eliminate remaining bacteria and debris. This step is critical to the long-term success of the treatment.

Step 7 — Canal filling Once cleaned, dried, and confirmed bacteria-free, the canals are filled with a biocompatible rubber-like material called gutta-percha, which is compacted to seal the canals completely. A sealer cement is used to ensure no gaps remain.

Step 8 — Temporary or permanent restoration The access opening is sealed with either a temporary filling (if a second appointment is needed) or a permanent filling. In most cases — particularly for back teeth that bear significant chewing force — a dental crown is recommended following root canal treatment to protect the now-brittle tooth from fracture.

The entire procedure typically takes 60–90 minutes per appointment. Most root canals are completed in one or two visits.

What Happens If You Delay or Avoid a Root Canal?

This is the section most dental content skips — and it is the most important for patients who are considering "waiting to see if it gets better."

A tooth infection does not resolve on its own. Without treatment, here is what happens:

The infection spreads. Bacteria from an infected pulp do not stay contained within the tooth. They migrate through the root tip into the surrounding bone, causing a periapical abscess — a pocket of pus that destroys the bone around the root. From there, the infection can spread to adjacent teeth, the jaw, and — in serious cases — into the spaces of the face and neck.

The pain intensifies. A tooth that is mildly uncomfortable today will become acutely, severely painful as the abscess develops. Many patients who delay treatment end up seeking emergency dental care in Markham in significantly more pain than they would have experienced had they treated the infection early.

The tooth becomes unsaveable. A tooth with a contained pulp infection can almost always be saved with root canal treatment. A tooth that has been left untreated until the bone around the root has been substantially destroyed may no longer be a candidate for root canal — extraction becomes the only option, followed by the cost and inconvenience of an implant or bridge.

The cost increases significantly. A root canal in Ontario costs $700–$1,500. A dental extraction costs $150–$400 — but is then followed by an implant ($3,000–$6,000) or bridge ($2,000–$4,000) to replace the missing tooth. Delaying a root canal to save money almost always results in spending far more.

The message is straightforward: if your dentist has recommended a root canal, or if you have symptoms that suggest pulp infection, acting promptly saves the tooth, saves money, and spares you significantly more pain than the procedure itself involves.

Root Canal vs Extraction: Which Is Better?

Some patients ask whether simply removing the tooth is a better or cheaper option than saving it with a root canal. In most cases, the answer is no — and here is why.

Preserving your natural tooth is almost always the preferred outcome. Natural teeth function better than any replacement — they distribute chewing force more naturally, maintain the integrity of the surrounding jawbone, and do not require the adjacent teeth to be modified (as a bridge does) or the jawbone to undergo a surgical implant procedure.

When a tooth is extracted without replacement, the jawbone at that site begins to resorb within months — a process that can affect the stability of surrounding teeth and change facial structure over time. Replacing a missing tooth properly costs significantly more than saving it with a root canal and crown.

That said, there are genuine situations where extraction is the better choice — primarily when the tooth is so extensively damaged or has so little remaining structure that it cannot be reliably restored, or when severe bone loss makes long-term retention unlikely regardless of treatment. Your dentist will give you an honest assessment of whether a particular tooth is worth saving.

What Does a Root Canal Cost in Markham, Ontario?

Root canal costs in Ontario follow the Ontario Dental Association (ODA) Suggested Fee Guide, with most Markham practices pricing within this framework. As a general guide for 2025–2026:

Tooth Type	Approximate Cost Range
Front tooth (single canal)	$700 – $900
Premolar (1–2 canals)	$800 – $1,100
Molar (3–4 canals)	$1,000 – $1,500
Crown (often required after)	$1,000 – $2,000

Most extended health insurance plans in Ontario cover 50–80% of root canal treatment costs, classified as a major restorative procedure. Check your plan's annual maximum — a molar root canal plus crown can approach the annual cap of many standard plans.

The Canadian Dental Care Plan (CDCP) covers endodontic treatment for eligible patients who do not have private dental insurance and whose adjusted family net income is under $90,000. If you are eligible, the CDCP can significantly reduce your out-of-pocket costs. Ask our team about CDCP coverage when you call.

Recovery: What to Expect After a Root Canal

Most patients return to normal daily activities the same day or the following day. Here is what to expect during recovery:

Days 1–3: Mild soreness or tenderness around the treated tooth is normal and expected. The tooth may feel slightly sensitive to biting pressure. Take ibuprofen 400mg every 6 hours and add acetaminophen 500mg between doses for the first day or two if needed.

Days 4–7: Soreness should be reducing noticeably. If it is increasing rather than decreasing — or if swelling develops — contact your dentist, as this can occasionally indicate that treatment needs to be reviewed.

What to avoid: Chewing hard foods on the treated side until the permanent crown is placed. A root-canal-treated tooth without a crown is more fragile and at risk of fracture.

When to call your dentist: If pain is worsening rather than improving after 3 days, if visible swelling develops, if a temporary filling falls out, or if you develop a fever.

Frequently Asked Questions

Is a root canal painful? 

With modern local anaesthetic and techniques, a root canal should be no more painful than having a cavity filled. The procedure is performed under full anaesthesia — most patients feel pressure and movement but no sharp pain. Post-treatment soreness lasting two to four days is normal and manageable with over-the-counter pain relief. The infection that requires a root canal is consistently more painful than the procedure that treats it.

How do I know if I need a root canal? 

The main signs are: persistent severe toothache, sensitivity to heat or cold that lingers after the stimulus is removed, pain when biting or chewing, darkening of a tooth, a pimple-like swelling on the gum near a tooth, or facial swelling. Importantly, some teeth that need root canals have no symptoms at all — detectable only on X-ray. If you have any of these symptoms, book a dental assessment promptly rather than waiting.

How long does a root canal take? 

Most root canals take 60–90 minutes per appointment and are completed in one or two visits, depending on the complexity of the root canal anatomy and the severity of the infection.

Can I eat before a root canal? 

Yes — eating a normal meal before your appointment is fine. Local anaesthetic will numb the area for several hours after the procedure, so avoid chewing on the treated side until sensation fully returns.

What happens if I don't get a root canal? 

A tooth infection does not resolve without treatment. Without a root canal, the infection will spread to the surrounding bone, causing an abscess. The pain will worsen significantly. The tooth will eventually become unsaveable and require extraction — followed by the significantly higher cost of an implant or bridge to replace it.

Does OHIP cover root canals in Ontario?  OHIP does not cover dental procedures including root canals. Most extended health insurance plans cover 50–80% of the cost. The Canadian Dental Care Plan (CDCP) covers eligible patients. Ask our team about your coverage options when you call.

Do I need a crown after a root canal?  For most back teeth — premolars and molars — yes. A root canal removes the pulp tissue that provides moisture and nutrition to the tooth, leaving it more brittle and prone to fracture under chewing force. A crown protects the tooth and is strongly recommended for long-term success. Front teeth with sufficient remaining structure may sometimes be restored with a filling only.

Book Your Root Canal Consultation in Markham

If you have symptoms that suggest a root canal may be needed — or if you have been putting off a referral your previous dentist recommended — the right time to act is now. The longer a pulp infection is left untreated, the more complex and costly the treatment becomes, and the less likely the tooth is to be saved.

At Hwy7 Family Dentistry, located at 4560 Hwy 7 E, Unit 500, Unionville, Markham, we provide comprehensive endodontic treatment using modern techniques and effective anaesthesia. We accept most dental insurance plans and are registered with the Canadian Dental Care Plan. Same-day and urgent appointments are available.

📞 Call us at (905) 604-1995 🌐 Book your appointment online