Medically Reviewed by Dr. Matthew Tomala on July 14, 2026
Here is what most patients figure out a few hours after their root canal: the procedure did not cause the pain. The infected tooth did. The root canal is what finally stopped it. People come in braced for something that already happened. Patients tell us this all the time: they left wondering what they had been afraid of.
At Burien Endodontics, Dr. Matthew Tomala focuses exclusively on root canal therapy and other endodontic treatments, seeing patients from Burien, SeaTac, and the surrounding South King County area. Before your appointment, here is a plain-language rundown of what to expect.
What Is a Root Canal?
Inside each tooth, below the hard outer enamel, is a small space called the pulp. It holds nerves and blood vessels. Under normal circumstances, this tissue is completely sealed off. A deep cavity, a cracked tooth, a failing old filling — any of these can give bacteria a way in. The infection takes hold. Bacteria in a sealed space means swelling, pressure, and pain.
The procedure takes out that infected tissue, shapes the hollow canals inside the roots, then packs everything with gutta-percha — a rubbery, inert material that does not break down over time. The roots stay put. That is the misconception patients arrive with most often — they think root canal means removing the root. It does not. A crown from your general dentist comes later. The access opening and the removal of the inner tissue leave the tooth more brittle than it was — the crown handles that.
Signs You May Need a Root Canal
Sometimes it is obvious. You wake up at 3am with a tooth that will not quit, or the side of your jaw swells up. Other times an infection turns up on X-rays during a routine visit with almost no symptoms at all. Both are real infections. Both need treatment.
The ones we see most often: persistent tooth pain when biting down; lingering sensitivity to heat or cold; a draining bump on the gum that recurs; a tooth that has darkened noticeably; jaw or gum swelling near the affected tooth.
If you are dealing with any of those — or any dental pain that is not going away on its own — do not wait to be seen. The sooner you come in, the more options you have.
Before Your Root Canal
The first thing we do is imaging — a cone beam CT scan rather than a standard flat X-ray. Standard X-rays give you the outline of the root. That is about it. Extra canals in a lower molar? Not on a flat film. Hairline cracks? Invisible. How far the infection has spread into surrounding bone? Hard to say from two dimensions. Dr. Tomala uses the CBCT to map the root anatomy before starting. Fewer surprises mid-treatment.
Before the appointment, let us know about any medications, allergies, or health conditions that might affect your care. If dental anxiety is a real concern, ask about sedation options when you come in for your consultation. Our endodontics FAQ page covers a lot of the questions we hear most often from first-time patients.
During Your Root Canal Procedure
Once the area is fully numb, a rubber sheet called a dental dam goes over the tooth. It keeps saliva out of the working field. Not complicated, but it matters for maintaining a clean environment. A small opening gets made through the crown of the tooth to reach the pulp chamber and canals below.
Using dental operating microscopes and precision rotary instruments, the infected tissue comes out of each canal one at a time. From there: cleaning, shaping, disinfecting. We run laser-assisted disinfection and ultrasonic activation at Burien Endodontics alongside standard irrigation — the combination gets disinfecting solution into the canal walls and into the more irregular sections of root anatomy that straight-line flushing does not reach well. When the cleaning is done, gutta-percha goes in and the canals get sealed. Most people are out in one visit. Cases with unusual root anatomy sometimes need two — we will tell you which you are looking at before you sit down.
Your Root Canal Recovery
The first day or two, expect some soreness around the treated tooth when you bite down. That is the surrounding tissue adjusting after the procedure, not a sign anything went wrong. Ibuprofen or acetaminophen handle it for most people, and you do not need to avoid eating — just be gentle on that side until the crown goes on. Most people go back to work the same day or the following morning.
The American Association of Endodontists notes that root canal treatment followed by a proper crown has a strong long-term track record. If the pain increases rather than decreasing after the second day, or if swelling seems to be spreading, call us. That is not the expected pattern and we want to take a look. For a full breakdown of what recovery looks like for different endodontic procedures, see our guide on endodontic treatment recovery timelines.
Frequently Asked Questions About Root Canal Treatment
Do root canals hurt?
Not during the procedure. We numb the area fully before starting — what you feel is pressure, maybe some vibration from the instruments, not pain. There is usually soreness for a day or two afterward, and ibuprofen handles most of it. What tends to hurt far more is the infected tooth in the days before treatment. The root canal is what ends that cycle.
How long does a root canal take?
Standard cases run about 60 to 90 minutes. Front teeth with one root tend to go quicker. A lower molar with three or four canals takes longer. If it is a retreatment — a tooth that had a root canal before and did not fully heal — two appointments is more likely. We review your CBCT scan before treatment and give you a realistic time estimate going in.
What happens if I put off root canal treatment?
It does not clear up on its own. The infection spreads into the bone. Sometimes into a neighboring tooth. In worse cases, into the soft tissue of the face. Antibiotics can quiet the symptoms for a while but do not address the source. We see it regularly: a tooth that was salvageable six months earlier is past the point of saving by the time someone comes in. The sooner you come in, the more options you have.
Will I need a crown after a root canal?
For back teeth, almost always yes. The access opening and removal of the internal tissue leave the tooth more susceptible to fracture under normal chewing force. A crown protects the structure and prevents bacterial reentry. Some front teeth with limited structural loss can get away with a filling rather than a crown. Your endodontist and general dentist will walk you through which applies to your specific tooth.
Should I see an endodontist or my general dentist for this?
General dentists do root canals. Endodontists spend two to three years in post-graduate training focused entirely on root and pulp disease, then do root canals almost exclusively. For a routine case, either can get it done. But for curved root anatomy, retreatment of a tooth that did not heal the first time, or anything a general dentist has flagged as complicated — an endodontist is the right call. And the equipment in an endodontic office — the CBCT, the microscope — is typically a different level from what a general dentistry practice runs.
Dr. Matthew Tomala and the team at Burien Endodontics see patients who have been referred for root canal treatment and patients who are still trying to figure out what is causing their tooth pain. CBCT imaging, dental operating microscopes, laser-assisted disinfection — all standard here, not equipment we pull out for the difficult ones. Whether you are coming in with a referral or looking for a second opinion, we are ready to take a thorough look and give you clear answers about what is going on and what your options are.
To schedule an appointment, fill out our contact form and our team will follow up promptly.
About the Author
Dr. Matthew Tomala is the provider at Burien Endodontics, where his practice is focused entirely on endodontic treatment — root canal therapy, retreatment, and dental trauma assessment. He uses CBCT imaging, dental operating microscopes, and laser-assisted disinfection for patients across Burien, SeaTac, and greater South King County. Read full bio