Root canals should not be painful if they are done with proper precaution. Prior to the procedure, the area surrounding the tooth will be numbed with a local anesthetic. If a patient is anxious about being conscious during a root canal, the patient may opt for nitrous oxide (laughing gas) or even sedation (general anesthesia). Most root canal procedures can be done by general dentists, but in more complex cases it would be wise for the dentist to refer the patient to an endodontist. An endodontist is a dentist with additional specialty training in treating tooth pain and performing root canal treatments.

The most commonly used filling material for a root canal is gutta percha, which is a rubber compound made from the sap of trees native to Southeast Asia. There are various cone sizes for the gutta percha based on the diameter and depth of the filling performed. Once the gutta percha is placed, the material is held in place with a sealer paste. Following the insertion of the gutta percha, the endodontist will place a simple filling over the canals through which they entered the tooth. After the filling is placed, the patient should feel no sensation in the treated tooth because all the nerves and connective pulp tissue are removed during a root canal.

Following a root canal, patients are encouraged to return to their general dentist to have a protective crown placed on the tooth. If the practitioner does not remove all the infected tissue during a root canal or a portion of the tooth is left unsealed, the patient may experience pain from a future infection. Overfilling of gutta percha can also lead to the failure of a root canal. In the event of subsequent infection
following a root canal, an endodontist may recommend an apicoectomy (root resection). During an apicoectomy, the filling material and gutta percha are removed and an incision is made in the gum tissue to access the canal from the side and remove additional inflamed tissue near the bone. Following the removal of infected tissue, a gutta percha root filling point is placed towards the end of the removed root and a simple filling is placed over the gutta percha. Similar to a non-surgical root canal, a patient is encouraged to return to their general dentist to have a protective crown placed on the treated tooth following an apicoectomy.

In some instances with more severe infections, restoration of an infected tooth may not be advisable. If there is no possibility of saving an infected tooth or there is a subsequent infection following an apicoectomy, extraction may be the only viable option. Following an extraction, a patient is often advised to replace the missing tooth with an implant to ensure optimal occlusion and functionality of the surrounding teeth.