How much pain is experienced before, during, and after root canal treatment?

shutterstock_73929085 dental pain bearded man

Root canal procedures are commonly believed to be the most painful dental treatment yet only 17% have described it as their most painful dental experience. The aim of this review was to determine the influence of root canal treatment on pain prevalence and severity and estimate the prevalence and severity of pre-treatment, treatment, and post-treatment pain in patients receiving root canal treatment.

The Medline, Cochrane, Embase, and PsycINFO databases were searched and supplemented by hand searches of the most recent two years of the following journal titles: American Journal of Dentistry, International Endodontic Journal, Journal of Dentistry, Journal of Endodontics, Journal of Oral Rehabilitation, Oral Surgery Oral Medicine Oral Pathology and Oral Radiology, and Endodontics, Pain, and Quintessence International. Only articles published in English were considered. L’Abbe plots were used to evaluate the influence of root canal treatment on pain prevalence and severity.

They found that pain prevalence and severity decreased substantially after treatment as shown below:

Pre-treatment24 hour post treatment1 week post treatment
Mean (SD)Mean (SD)Mean (SD)
Pain prevalence81% (28%)40% (24%)11% (14%)
Pain severities54% (24%)24% (12%)5% (5%)
(100-point scale)
They concluded:

Pre-treatment root canal associated pain prevalence was high but dropped moderately within 1 day and substantially to minimal levels in 7 days. Pre-treatment root canal–associated pain severity was moderate, dropped substantially within 1 day of treatment, and continued to drop to minimal levels in 7 days. Supplemental anaesthesia was often required during root canal treatment.

Pak JG, White SN. Pain prevalence and severity before, during, and after root canal treatment: a systematic review. J Endod. 2011 Apr;37(4):429-38