Root canals are necessary dental procedures for when an infection affects the core of your tooth known as the dental pulp that contains your tooth’s blood vessels and nerve endings. Bacteria can enter this innermost layer of your tooth through a chip, fracture, or cavity and cause the soft tissue to become infected and ultimately lead to necrosis (death of cells and tissue). Root canal treatments aim to clean away this decay and save your tooth before it falls out or has to be extracted. Here are 10 symptoms of needing a root canal caused by this bacterial infection that means you should seek endodontic care. 

1. Chipped or Cracked tooth

No matter how much we wish it sometimes, your teeth are not indestructible. If, for instance, you bite down hard on something or experience some sort of trauma while playing a contact sport your tooth can chip, or even worse fracture. If you don’t schedule an appointment with a dental professional to repair your damaged tooth soon bacteria may take over and cause painful inflammation and infection of your tooth’s inner nerves. 

2. Tooth Pain When Chewing and Biting

Nobody loves it when you go to bite down on a crisp apple or a handful of tasty trail mix and you suddenly experience a jarring toothache. If you are experiencing this type of pain, especially long after you stop chewing, it is a good sign that you need to visit an endodontist to check for loose fillings, cracked teeth, or cavities. This pain can also indicate inflammation around your roots and internal decay of your dental pulp. Normally your enamel and dentin layers around healthy teeth guard the pulp chamber against infections, but if this protective shield is compromised bacteria can infect it causing decay and swelling. When this swelling occurs it will have nowhere to expand, so it pushes against your tooth’s inner wallers causing pressure and pain, especially when biting. This is one of the most common signs you need a root canal. 

3. Spontaneous pain

Random and persistent tooth sensitivity is a pretty clear sign you need a root canal. Your teeth should never experience a toothache without stimulation. If your tooth is spontaneously or persistently experiencing random pain it may be a sign of decaying nerves in your dental pulp. This root canal pain symptom can also either be a constant toothache or go away and come back periodically. 

4. Sensitivity to Cold

Does cold weather or eating ice cream cause you serious oral discomfort? This is a pretty common sign of needing a root canal procedure. Most patients have some sensitivity to cold, but if it is so severe that you find yourself avoiding cold in a particular area or the cold sensitivity lingers for longer than 2-3 seconds, the nerve is most likely inflamed beyond repair. Bacteria or receding gum lines have most likely caused your tooth’s roots and nerves to become exposed. Dentinal tubules (pathways to your inner tooth) are normally protected from outside forces, but when exposed they can fill up with fluid and trigger pain when cold liquids or air stimulates them. 

5. Sensitivity to heat

If you go to drink a warm cup of tea and suddenly wince from pain in one of your teeth, you need to see a dental professional. This root canal pain symptom is a pretty strong signal that something is wrong. Sensitivity to hot temperatures is never normal and is often indicative that the nerve in a tooth is dying. 

6. Sensitivity to Sweets

Everyone loves to indulge in the occasional sweet, but if you are experiencing an uncomfortable feeling every time you eat something sweet, that is likely a root canal pain symptom and means you should see an endodontist or dentist. A sensitive tooth due to sweets will sometimes indicate a leaking filling or simply presence of decay, but is usually an indicator that the bacteria have reached the nerve. 

7. Chronic Bad Breath

You’ve brushed your teeth several times, tried mouthwash, and even flossed (seriously you actually flossed this time), but you still can’t shake your bad breath then this may be a sign of needing a root canal. If your oral care routines can’t fix the problem then you likely have a bacterial infection. The bacteria that causes root canal infections emits an unpleasant odor and sometimes leaves behind a bad taste in your mouth as it destroys your teeth. It’s best to quickly get this treated so people don’t look at you funny or try to escape when you talk to them. 

8. Noticeable Swelling Around the Tooth or a “Pimple” on the Gums

If you run your tongue along your gums and notice a bump around one of your teeth you probably have a periapical abscess – a pocket of pus around the root of your tooth. This indicates an active infection that has eroded through the bone and is now causing swelling or is actively draining into the mouth. An abscess like this can be painful, but not always. This type of infection will not go away on its own and will require treatment. If left untreated, the abscess could rupture or it could spread the infection into your jaw and other areas around your mouth. In extreme circumstances, patients can develop sepsis where a life-threatening infection spreads throughout your entire body. 

9. Tooth Discoloration

As the bacteria in your dental pulp continues to deteriorate the tissue inside your infected tooth you may start to notice your tooth turning from pearly white to a sickly grayish, dark pink, or black color. The bacteria in your dental pulp is now causing the internal tissue to lose its supply of blood and die. You will probably notice this discoloration easier when it happens to your anterior (front) teeth. This is a clear sign you need a root canal. 

10. Tooth Feels Loose

As the bacterial infection continues to eat away at your tooth it will eventually begin to weaken the bonds that keep your teeth connected to your gums. When these roots start to loosen, your tooth may begin to wiggle and feel loose. Eventually, the decay around your tooth’s roots will get so bad that your tooth will fall out.  Here’s the good news though – if treated in time the tooth can be saved, preventing costly procedures to replace it with multiple visits to the dentist. 

About the Author

Dr. Harris has been a practicing dentist and oral surgeon since 2005. In 2012, he received his Master’s of Science in Dentistry and a certificate in Endodontics. He founded East Coast Endodontics shortly after receiving his master’s degree. He also currently holds a part-time position as a Clinical Assistant Professor for the Endodontics department at Virginia Commonwealth University. View his full bio.