How Women in Dentistry Can Empower Others
June 30, 2022
The Importance of Informed Consent for Endodontic Treatment
July 15, 2022
Whether it comes from patients or general dentists, one thing that I get asked pretty often is this: “Why do root canals take 2 visits sometimes? And how is it decided whether a root canal will take one appointment or multiple?”
This is actually a really, really important question.
Naturally my first response is: Well, it depends on the case.
But after years of experience, I have learned that there are some factors that guide my decision as an endodontist whether to treat a tooth with a single visit or more than one.
I’ll walk you through a few scenarios.
The Emergency Patient
When I get an emergency patient who needs same day treatment that I have to work into my schedule, that patient won’t be getting treatment done in one visit. The reason for this? It’s simply because of time.
I don’t want to have to reschedule tons of patients who may have had their appointments for months—so I typically don’t treat these emergency cases to completion.
I’ll do a pulpectomy or a full pulpal debridement in order to make sure the patient has enough pain control to move on with their life and schedule a follow-up to complete their root canal in the meantime.
Retreatments
One big reason why root canals take 2 treatments is often because of retreatments. The majority of patients that come to me for a retreatment get done in two separate visits, since they always tend to have a more serious infection than a patient that’s just getting an initial root canal.
Occasionally I’m able to treat these patients in a single visit if it’s an anterior tooth and I want to get the patient back to their general dentist quickly to have the tooth restored with a post and a core.
Another scenario that might require just one visit is if there’s retreatment just because of some coronal leakage, and there’s no real periapical radiolucency. In a case like that I just refresh the gutta percha and—voilà!—the case is done.
So, while there are some exceptions to the “retreatments require multiple visits” rule, typically, these are patients that will need to visit the clinic again.
The Symptomatic Patient
Here’s another twofer: if a tooth is too symptomatic. That is, if the patient comes in with a lot of pain, it’s often just not a good idea to do a root canal in one visit.
Okay, so symptomatic patients often need 2 root canal visits. Why?
Because I always want my patients to go back to their general dentist pain free. In order to control their pain, if they’re feeling really bad before treatment, I will usually medicate the tooth with calcium hydroxide and make sure they can function normally by the time they go back to get their final restoration. This takes extra time—which usually means two visits.
Swelling
If a patient is swollen or they are draining in any way, then I prefer two visits to treat them. I want their infection to be completely resolved before I start to obturate that canal.
It’s always a good idea to make sure your canals are bone dry before you obturate. And that’s a good reason to pencil in two appointments.
Pain During Treatment
When a patient feels me working during a root canal, even with adequate anesthesia, I will extend the treatment to two visits. This is one of those scenarios that can be really touch-and-go. I often have every intention of filling the tooth in one visit, but if a patient is really uncomfortable, then I prefer to take a little more time.
This is pretty unusual, but I believe good things take time. I think one of the best things about root canal therapy is that you can just close it up and come back to it another day. This means you never have to (and never should!) rush a treatment. Always take your time and make sure your patient is pain free before they get their crown.
The Large Periapical Radiolucency
Sometimes when a periapical radiolucency is WAY too big, I want to extend my work over the course of two visits because occasionally these cases need some surgical intervention in between—they just won’t heal with root canal therapy alone.
When I anticipate a post-operative flare up because of the size of the lesion, two visits is much better than one.
Special Cases
Here’s a catch-all: when there’s something special going on a tooth—maybe some resorption, or special anatomy (like C-shaped anatomy)—then I will schedule multiple visits.
If you see anything that throws you through for a loop, or is just not super common, I suggest two visits to make sure you have a working plan.
Difficult Teeth
The last common reason why a root canal might take 2 visits is because you’re working on a hard tooth.
I’ll be completely honest: Not every root canal is a slam dunk for me. Some cases that I think are going to be so straightforward based on the radiograph are actually really tough when I get inside the tooth.
What can you do then? Spread the treatment out over two visits and make sure you do the best root canal you possibly can!
Why Do Some Root Canals Take 2 Visits? Talking Through Scheduling with Your Patients
When I talk to a patient during their evaluation and am orienting them about their procedure, I let them know that they should expect two visits for their root canal, but I also let them know that I’ll try to get it done in just one. This language makes sure that their expectations are managed and appropriate. I never promise anybody one visit, although I do make it happen about 85% of the time.
I take this approach because root canals are SO technique sensitive and I want to take my time, do it right, and give every patient the highest quality of care.
My reasoning for never promising a single visit and spreading out the treatment across two visits when necessary is that I never want to look at that tooth ever again! I want to make sure that when that tooth is treated with a root canal by me, they don’t have to come through my door ever again for the same problem.
I hope this information is helpful for you going forward.
What’s your approach to discussing treatment and planning with your patients? Let me know in the comments!
– Sonia
26 Comments
Great information. I would agree with everything you said! Whenever I send a patient to endo I always tell them they will likely not be done the day I send them. Thanks dr. Chopra!
Great job Meena – you’re setting your patient up for success!
-Sonia
As a patient, I must understand my dentist. Root canal procedure is not easy. Although they are specialist, they also need time to evaluate the case of their patients.
Absolutely, it is so important to spend time prior to the procedure to make sure that everyone understands each other.
-Sonia
Antibiotic is frequently used either pre Rct or Post Root Canals opening to control periapical infection . It is believed that it reduces pain soon.What is your opinion. Thank you
Great piece of information
Lal,
I try NOT to use an antibiotic. I like to use the powers that exist in our own bodies. I think that there too much overuse of antibiotics.
-Sonia
Dr. Chopra, can you explain the difference between pulpectomy and pulpal debridement? If they are different, when do you choose to do which? Thanks!
Very rarely I get cases…even after completing a beautiful root canal treatment…n thinking that its a sure success…the patient comes back after a one or two months…complaining of pain…and when I check all the symptoms…clinically and radiographically…I’m not really convinced about the cause of pain…I remain perplexed…it happened with a lower premolar..I continue with a retreatment…and yet the problem exists…I wonder if it’s got to do with atypical facial pain…
1000%
Being an endodontist , even I get these doubts about number of visits ..this information you shared is actually very very useful..Thanks a ton doctor for such useful tips .
Thank you so much for reading!
-Sonia
These cases happen. These are the cases that I redo with long-term calcium hydroxide, typically for one month and they get better.
-Sonia
Xiao,
Pulpectomy indicates a vital tooth and pulpal debridement indicates a necrotic pulp. Both are completing instrumentation to the apex.
-Sonia
Thank you doctor for rhea valuable advise…
Thank you so much!
Nithya,
Thanks for reading!
-Sonia
Major pain started a week after pulpectomy very intense. The doctor said it’s a flare up and I will wait 4 days until Thursday to get root canal. What should I do in the meantime?
Hi Mindy,
Thank you so much for your question. In order for Dr. Chopra to be able to assist you regarding on your case, she would need to see you as a patient. She practices in Charlotte, North Carolina. You may book an appointment with her practice here: https://www.ballantyneendo.com/
For patients who do not live near her practice, sShe does have a virtual consultation option you can use, which if you aren’t in the Charlotte area that you can book here: https://bookus.page/soniachopradds/soniachopra/virtual-consult
Please scroll down to read the Disclaimers and Terms & Conditions prior to booking your virtual consult. Since she cannot see you in-person, bear in mind that she will not be able to take x-rays, touch or feel your mouth, or do diagnostic testing. By booking this virtual consultation, you guarantee that Dr. Chopra will be able to spend 30 minutes with you to go over any images your dentist has provided you with (you may need to request them from your provider), and provide all of the insights that are possible within a virtual conversation. After you pay, we’ll reach out to schedule your call.
Another option for you is to see one of the Endodontists Dr. Chopra trusts in other states. Please refer to her listed on her patient resources page here: https://drsoniachopra.com/patient-resources/
I’m feeling sensitivity and slight pain after my dentist opened the cavity drilled to the canals then put a dressing on fake filling is this a common procedure to leave the pulp at this stage
Hi Danielle, Dr. Chopra’s support team here. Thank you for reaching out about your case and I’m sorry to hear about your situation. In order for Dr. Chopra to give you an opinion on your case she would need to see you as a patient.
If you are near the Charlotte area you can book a consult directly with her office here: https://www.ballantyneendo.com/ Dr. Chopra also offers virtual endodontic consults, which you can book using this link:
https://bookus.page/soniachopradds/soniachopra/virtual-consult. Please scroll down to read the Disclaimers and Terms & Conditions prior to booking your virtual consult. After you pay, we will reach out to schedule your call!
Great post! Your detailed explanation of why root canals sometimes require two visits is very insightful. It’s reassuring to know that factors like emergency cases, retreatments, and the presence of symptoms or swelling influence the decision for multiple appointments. Your emphasis on patient comfort and thorough treatment to ensure long-term success is appreciated. This clear communication helps manage expectations and underscores the importance of personalized dental care. Thanks for sharing this valuable information!
Thank you so much for your kind feedback, Helena! I’m glad you found my post valuable!
Dr. Sonia provides an excellent breakdown of the factors that determine whether a root canal requires one or two visits. By carefully considering factors like infection severity, patient comfort, and tooth complexity, she ensures high-quality care and manages patient expectations effectively. Her thoughtful, patient-centered approach is a great example of what makes for an outstanding endodontist.
Thank you so much for your kind words, Robin!
Great insights! Dr. Sonia Chopra’s explanation on why root canals often require two visits is both informative and reassuring. Understanding that factors like severe infection, swelling, and the need for thorough cleaning contribute to the decision for multiple appointments helps patients set realistic expectations. It’s comforting to know that these measures are in place to ensure the best long-term outcome for our dental health.