In-Practice: Does My Patient Need a Root Canal?

In-Practice: Does My Patient Need a Root Canal?

Hey, dental besties!

@Toothlife.Irene here. If you read through our focus this month you’ll know that we’re taking a good hard look at root canals: how to identify and how to keep them healthy! Because there are several ways to identify if a tooth requires a root canal, here, I’m going to break down some of the common methods and diagnostic tools you can use in greater detail. There will even be a link to some downloadable resources!

Patient's symptoms and dental history

Dentists often begin by listening to the patient's concerns and asking about their symptoms. Symptoms such as severe toothache, prolonged sensitivity, swelling, and previous dental trauma or procedures can indicate the need for a root canal. If there is sensitivity, when does it happen? Does it go on and off at all hours of the day and night or only triggered when eating hot and cold? This will help you and the doc make a diagnosis. 

Clinical examination

Visually examine the affected tooth and surrounding tissues, looking for signs of infection, such as swelling, redness, or a small bump (indicating a dental abscess).

Dental X-rays

X-rays are crucial in evaluating the internal structures of the tooth and identifying signs of infection or inflammation. X-rays can show decay extending into the pulp, changes in the shape of the root canals, and bone loss around the tooth. Radiographs can show calcification in the canals as well as internal or external resorption.

Percussion and palpation tests

These tests involve tapping on the tooth or applying pressure to check for tenderness or pain. Discomfort during these tests can indicate an infected or inflamed pulp. Usually done with the back of a metal instrument or mirror.

Electric pulp testing

This test assesses the vitality of the tooth's pulp by using a small electric current. If the pulp does not respond as expected, it may indicate the need for a root canal. The electric test is performed with an electric pulp tester (EPT). This monopolar device flows high-frequency electrical current from the probe tip through the tooth. While the current is flowing through the tooth, viable A-delta nociceptive fibers will be stimulated, resulting in a tingling or “zinging” sensation to the patient.

Performing the electric test accurately requires a well-dried and isolated tooth. It is recommended to dry the tooth with gauze and place a cotton roll in the vestibule to isolate. One should not dry the tooth with an air syringe because if the tooth is very sensitive, as in cases of pulpitis, it will cause the patient unnecessary pain. The probe tip is coated with a contact medium, such as petroleum jelly, topical anesthetic or toothpaste with the optimal placement of the tip is on the incisal third for anterior teeth.

Thermal testing

The use of hot or cold stimuli to evaluate the tooth's response. Prolonged sensitivity or intense pain, when exposed to temperature changes, may suggest the need for a root canal. The lack of temperature sensitivity may also indicate a necrotic pulp. (search Endo Ice for cold test) 

Cone beam computed tomography (CBCT)

Most Endodontic offices will advise a more comprehensive imaging or when the extent of infection is unclear, dentists may use CBCT scans to obtain three-dimensional images of the tooth and surrounding structures. CBCT provides a more detailed view and aids in treatment planning.


It is important to note that the combination of these diagnostic methods and the dentist's clinical judgment is crucial in determining whether a root canal is necessary. Each patient's case is unique, and the final decision is made based on a comprehensive evaluation of the individual's dental health.

As promised, here is a link to a downloadable resource for you to use during and after your root canal assessments. They can be added to a device or printed and laminated for use in any operatory system! Use code FREESOURCE until June 7 for a discount!

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