Are all root canals painful for the patient?

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Root canal? Ouuuuch! These are the scariest words for the majority of people when they hear root canal. They always associate with pain and suffering and therefore are always scared of getting a root canal. Do root canals always hurt? the answer is yes and no! There are a lot of factors that can affect the amount of discomfort you may have after a root canal treatment.
1-  The condition of the tooth prior to getting a root canal.
Did you have pain prior to your treatment? If your answer is yes, then there may be some discomfort after your treatment since symptoms prior to your treatment indicate that the area at the end of your root is inflamed, and is ” pressurized” so after working on the tooth, you may initially get some discomfort.
2- Does your tooth have a “lesion” or what we refer to as a “cyst” or infection at your root end?
You may not have any pain at all prior to your root canal treatment and possibly doubted your dentist when he or she told you that “Your X-ray shows you have an infection.” We refer to cyst or root canal infection as it is easily understood by the public. You may not have experienced any pain at all, but once we start working on the tooth, the “cyst” or tissues at the end of the root get irritated from the disinfectant solutions we use. The discomfort should last only a few days though. You can take NSAIDs (Non-Steroidal Anti-Inflammatory Drugs) such as Ibuprofen (generic for brand names like Advil or Motrin), Naproxin (Alleve) to reduce the inflammation which causes the pain. Acetaminophen (Tylenol) does not reduce inflammation so it has limited capability to reduce your root canal pain. I usually tell my patients to sleep with their head elevated which helps in reducing the pressure and makes it very comfortable, very easy,  simple and effective.
If my patients have pain on the tooth that needs a root canal, I usually divide the treatment into two or three sessions as it will reduce pressure and give some time to the tooth to calm down, therefore it will less likely cause agonizing pain. It has a downside for both the patient and me in that we have to spend more chair time but I do it to make them more comfortable and help them experience less pain.
3- Sometimes pain after a root canal has to do with the dentist not properly cleaning all the canals and finishing the root canal properly.
But I want to emphasize if you have some pain after your root canal treatment, do not automatically assume the dentist did a “bad job”. That is not correct.
4- Another factor is the complexity of some teeth that can not always be anticipated.
Every tooth of every person has different anatomy. Some may have extra canals or multiple branches that would be hard and sometimes impossible to remove all the nerves. Those situations are quite common and you may need additional treatments other than the root canal treatment.
Ask your dentist if he or she feels comfortable with doing your root canal. Tell your dentist all the medications you are taking, if you are allergic to medications or have liver or kidney issues as some people should avoid Ibuprofen if they have kidney issues and avoid Tylenol if they have liver issues. If you have doubts, get a second or even third opinion. With the right dentist, you can have a painless root canal!