What to expect at your first endodontic appointment

Most people arrive at an endodontic consultation knowing two things: that a tooth hurts, or that someone has told them it needs a root canal. What actually happens at the appointment is rarely explained in advance, and the gap gets filled with worry. This guide closes the gap.

Before you arrive

Bring a list of your medicines and medical conditions, and any recent X-rays of the tooth (or ask your dentist to send them). Eat something beforehand if you can; you may be numb for a couple of hours afterwards if treatment is started on the day. If dental visits make you anxious, say so when you book — the appointment is planned differently when we know.

The conversation

The appointment begins with your account of the problem, and it is given proper time because it is the most useful diagnostic tool there is. You will be asked what the pain feels like, what sets it off and what eases it, whether it wakes you, how long it has been going on and what has already been tried. "I'm not sure which tooth it is" is a perfectly normal answer, and a common one.

The examination and tests

Your teeth, fillings, gums and bite are examined under magnification. Then the suspect teeth are tested, usually alongside a healthy neighbour for comparison: a cold stimulus and sometimes a small electric pulp tester check whether the nerve is alive and how it reacts; gentle tapping and pressure check for inflammation around the root; a bite test on a small plastic instrument picks up cracked cusps. None of these tests is painful, although the cold can be briefly sharp — that reaction is itself informative.

X-rays

Small digital X-rays are taken of the tooth and its neighbours. They show infection around the root tips, hidden decay, the quality of any existing root filling and the shape of the canals. Occasionally a three-dimensional scan is needed to settle a question a plain film cannot, and that is arranged separately.

The diagnosis and the plan

Once the cause is clear, it is explained in plain language: which tooth, what has happened to it and what the options are — root canal treatment, retreatment, surgery, monitoring, or sometimes a referral back to your dentist because the problem is not endodontic at all. You are told the realistic outlook for the tooth and the fee. All of this goes in writing, so that you can read it at home and decide without anyone standing over you.

Will treatment start on the day?

Only if you want it to and time allows. If you are in severe pain, the priority is to relieve it, which usually means opening the tooth under local anaesthetic and placing a soothing dressing. Otherwise treatment is booked for a separate appointment of 60 to 90 minutes.

How long does it take?

Allow about 45 minutes for the consultation. Emergency appointments may be shorter and focused on comfort; the full assessment is finished once you are settled.

If you are nervous

Tell us. The consultation is a good place to say what worries you and what has gone wrong in the past. Angel Ognemirov has completed training in oral and intravenous dental sedation, so whether sedation would help is one of the things that can be discussed. More on the treatment for nervous patients page.