Quick answers
- Is endodontic treatment the same as a root canal? No. A root canal is one procedure within endodontic treatment, which also includes pulp capping, retreatment, and apicoectomy.
- Do I need a root canal or just a filling? If pain stops within seconds of cold, usually a filling. If pain lingers, builds on its own, or wakes you at night, usually a root canal.
- Can antibiotics fix it? No. Antibiotics reduce swelling but cannot reach infected tissue inside a tooth that has lost its blood supply.
- Does it hurt? The procedure relieves pain rather than causing it. Most patients compare it to having a filling placed.
- Can a tooth be treated more than once? Often yes, through retreatment.
- Who provides it here? Dr. Irena Vaksman and our dental team, with referral to an endodontist for complex cases.
Do I need a root canal, or just a filling?
The deciding factor is whether the pulp can still heal, and symptoms alone cannot tell you. Pain that disappears within a few seconds of cold usually means the pulp is irritated but recoverable, which points to a dental filling. Pain that lingers after the cold is gone, starts on its own, or wakes you at night usually means the inflammation is past the point of recovery, which points to root canal treatment.
Testing confirms which one applies. This is the most common question we are asked, and it is the reason the first visit is diagnostic rather than treatment.
How we find out what is wrong inside your tooth
An endodontic diagnosis comes from objective testing, not from the description of the pain. Two patients can report identical symptoms and need entirely different treatment.
| Test |
What it does |
What the result suggests |
| Cold test |
Applies a cold stimulus to check pulp response |
No response may mean the pulp is no longer alive; pain lasting well after the cold is removed may mean irreversible inflammation |
| Percussion test |
Light tapping on the tooth |
Tenderness suggests inflammation has reached the ligament and bone around the root |
| Palpation |
Pressure on the gum over the root |
Soreness or a raised area may mean infection near the root tip |
| Bite test |
Biting on a small pointed instrument, tooth by tooth |
Sharp pain on release is a classic sign of a cracked tooth |
| Periodontal probing |
Measures gum attachment around the tooth |
One isolated deep reading can indicate a fracture or a combined gum and pulp problem |
| Digital dental X-rays |
Shows decay depth, root anatomy, and bone around the root tip |
A dark area at the root tip usually indicates long-standing infection |
| Comparison with neighboring teeth |
Tests healthy teeth to establish a baseline |
Confirms which tooth is actually causing the pain |
Referred pain is common. Upper and lower molars on the same side share nerve pathways, so patients often point to the wrong tooth or even the wrong jaw.
What your diagnosis means
Testing produces two diagnoses: one for the tissue inside the tooth, one for the tissue around the root tip. Together they determine treatment.
| Diagnosis |
What is happening |
Usual treatment direction |
| Normal pulp |
The pulp responds normally and settles quickly |
No endodontic treatment needed |
| Reversible pulpitis |
The pulp is irritated but can still heal |
Remove the cause, place a filling, monitor |
| Irreversible pulpitis |
Inflammation is past recovery; pain lingers and can wake you |
Root canal treatment or extraction |
| Pulp necrosis |
The pulp has died and no longer responds to testing |
Root canal treatment or extraction |
| Symptomatic apical periodontitis |
Inflammation has spread to bone around the root tip; biting hurts |
Root canal treatment, retreatment, or surgery |
| Asymptomatic apical periodontitis |
Infection visible on X-ray with no pain |
Treatment still indicated — no pain does not mean no disease |
| Acute apical abscess |
Active infection with swelling and rapid onset |
Urgent drainage and emergency dentist care |
| Chronic apical abscess |
Long-standing infection draining through a bump on the gum |
Root canal treatment or retreatment |
| Previously treated |
Canals were filled before and symptoms have returned |
Retreatment, apicoectomy, or extraction |
The asymptomatic category surprises most patients. A tooth with a dead pulp can feel completely normal while infection continues in the bone, which is why these are often found during a routine dental exam.
Which endodontic treatment does your tooth need?
Once the diagnosis is set, the options narrow to one or two.
| Treatment |
When it is considered |
What it involves |
| Pulp cap |
Deep decay close to a still-healthy pulp |
A protective material is placed over the area and the tooth is restored and monitored |
| Pulpotomy |
Inflammation limited to the upper pulp, more common in younger patients |
The affected upper pulp tissue is removed and healthy tissue below is protected |
| Root canal treatment |
Irreversible pulpitis or pulp necrosis in a restorable tooth |
The pulp is removed, canals cleaned and sealed, tooth restored — see root canal treatment |
| Retreatment |
A previously treated tooth with returning symptoms or infection |
Old filling material is removed, canals re-cleaned and resealed |
| Apicoectomy |
Infection persists at the root tip and retreatment is not practical |
The root tip and infected tissue are removed surgically — see apicoectomy |
| Extraction and replacement |
Vertical root fracture, severe bone loss, or too little tooth remaining |
Tooth extraction followed by dental implants or dental bridges |
One factor outweighs most others: whether enough sound tooth structure remains to support a lasting restoration. A tooth with a healthy pulp but no remaining wall can be a worse candidate than a badly infected tooth with solid structure.
What determines the cost of endodontic treatment?
Cost depends on which treatment your diagnosis calls for, which tooth is involved, and what restoration follows. These are the factors that move the number:
- Canal count. Molars have three or more canals and cost more than single-canal front teeth.
- Initial treatment versus retreatment. Reopening and re-cleaning a previously treated tooth takes longer and costs more than first-time treatment.
- Surgical versus non-surgical. An apicoectomy is priced separately from root canal treatment.
- The restoration afterward. A back tooth usually needs a dental crown, billed as a separate fee. Budget for it from the start, since leaving a treated tooth unrestored risks losing it.
- Diagnostic imaging. X-rays are standard; advanced imaging is occasional and usually handled by a specialist.
We give you a written estimate after the evaluation, once we know which tooth and which treatment. Contact us for a personalized estimate.
Does dental insurance cover endodontic treatment?
Most PPO plans cover a portion of endodontic procedures. The percentage, annual maximum, deductible, and any waiting period vary by plan, and coverage for the crown is calculated separately from the root canal itself. We accept most PPO plans and verify your benefits before treatment begins. Patients without insurance can use our membership plan or flexible payment options.
How tooth position changes treatment
Canal anatomy varies by tooth type, which affects appointment length, complexity, and the restoration that follows.
| Tooth type |
Usual canal count |
What this means |
| Front teeth |
Typically one |
Most straightforward; internal discoloration is often the main concern afterward |
| Premolars |
One or two |
Moderate complexity; often need cusp coverage afterward |
| Molars |
Three or four, sometimes more |
Most complex; a dental crown is usually recommended |
Upper first molars frequently have a fourth canal that is narrow and easy to miss, and lower molars can have unusual curvature. These variations are a common reason a molar is referred out and a common reason a treated molar later needs retreatment. For appointment length, see how long does a root canal take.
When we treat and when we refer to an endodontist
General dentists are trained and licensed to perform endodontic treatment, and many cases are handled well in a general practice. An endodontist completes two or more years of additional training focused on the inside of the tooth and takes on the most complex cases.
Cases we treat in our South San Francisco office:
- Front teeth and premolars with straightforward anatomy
- Molars with accessible canals
- Emergency pain relief and drainage
- Pulp capping and deep decay management
- The restoration that follows endodontic treatment
Cases we refer for specialist care:
- Calcified canals that are difficult to locate
- Severely curved or unusual root anatomy
- Complex retreatment
- Surgical endodontics beyond routine scope
- Suspected vertical root fracture requiring 3D imaging
- Persistent pain with no clear source after standard testing
We coordinate the referral, share diagnostic records, and complete the final restoration ourselves so your care does not fragment between offices.
What affects long-term success
Endodontic treatment has a strong track record, but outcomes are not uniform. The factors that matter most:
- The seal on top. A well-treated canal still fails if bacteria leak back in through a broken temporary filling or a delayed permanent restoration.
- Timing of the final restoration. Months under a temporary filling increases the risk of contamination and fracture.
- Cusp protection on back teeth. A treated molar has less structure and can split under chewing force.
- Pre-existing infection. Teeth with established bone loss heal more slowly and are monitored longer.
- Cracks. A crack extending into the root changes the outlook regardless of how well the canals are treated.
- Ongoing care. A treated tooth still develops decay at the margins.
Healing is confirmed by follow-up X-rays over time, not by symptom relief alone — comfort usually returns well before bone recovers.
Symptoms that mean you should be seen
Book an evaluation if you notice:
- Pain lingering more than a few seconds after hot or cold — see why are my teeth sensitive
- Pain that wakes you at night or is relieved by cold water
- Tenderness biting on one specific tooth
- A single darkened tooth, especially after an old injury
- A bump on the gum that comes and goes
- A previously treated tooth that hurts again
- Facial or gum swelling near one tooth
Swelling with fever, or difficulty swallowing or breathing, is a medical emergency requiring immediate care. For other urgent situations see dental emergency what to do.
What happens at your evaluation
The first visit is diagnostic, not treatment. It includes a review of your symptoms and history, examination of the tooth and surrounding tissue, the pulp and periapical testing described above, X-rays as needed, and a discussion of options with costs and timing. If you are in pain, comfort is addressed the same day. Sedation dentistry is available for dental anxiety.
Endodontic treatment at Vaksman Dental Group
Vaksman Dental Group is a general dental practice at 1241 Mission Road in South San Francisco, CA 94080, led by Dr. Irena Vaksman, DDS. We are located near El Camino Real and the South San Francisco BART station, and see patients from San Bruno, Daly City, Brisbane, Colma, Pacifica, Millbrae, and Burlingame.
What patients get here for endodontic care:
- Same-visit evaluation for tooth pain when scheduling allows
- Digital imaging for diagnosis and follow-up
- A clear explanation of prognosis before treatment begins
- Coordinated referral with records shared for complex cases
- Restorative care completed in-house afterward
- PPO insurance accepted, membership plan available
Schedule an endodontic evaluation in South San Francisco
If a tooth is painful, sensitive to temperature, tender to bite on, or was treated before and is bothering you again, an evaluation will tell you what is happening inside the tooth and what your options are.
Book online or call Vaksman Dental Group at (650) 588-3710. We are at 1241 Mission Road, South San Francisco, CA 94080, open Monday through Friday, 8:00 AM to 5:00 PM.
Medical review and sources
This page was written and reviewed by Dr. Irena Vaksman, DDS, and is reviewed at least every 12 months against current clinical standards. Clinical information reflects guidance from the following professional sources:
This page is general information, not a diagnosis. Only an in-person examination can determine what your tooth needs.
