Are root canals a dental emergency?

Romesh Nalliah
Root canal infections may or may not be painful. If painful you would consider this an emergency! Root canal-related pain leads to over 400,000 hospital emergency department visits each year and considerable costs:

Most root canal treatments can be prevented through regular dental check-ups, which can diagnose problems in earlier stages and lead to more conservative treatment solutions.
A root canal is a treatment for an abscessed tooth or tooth that has broken off into the inside part of the tooth called the pulp. A tooth that has broken into the pulp or a tooth that is knocked out of the mouth is a dental emergency. Should either of these two conditions occur, call your dentist as soon as possible to arrange treatment. 
A cavity caused by bacteria that reaches the nerve inside the tooth makes a root canal necessary. These are slow growing and are not dental emergencies. Emergencies can arise as the infection travels through the root canal space to the bone. Once the infection reaches this point, the bacteria is caught between a rock (the tooth) and a hard place (the bone). The infection continues to grow causing swelling, inflammation, possibly fever, and spread of infection into other surrounding tissues. Decayed teeth often can be treated and the infection resolved before they reach this point.  It is important to go to your dentist when you first notice symptoms to decrease the likelihood of a dental emergency.
Stanislav Moline
Root canal problem may be symptomatic (pain, swelling, fistula) and asymptomatic. The former is usually perceived as dental emergency; however regardless of symptoms, postponing the treatment always results in worsening of the condition - further decay, calcification of canals, which will result in higher cost of postponed treatment or tooth loss.

Word of caution: antibiotics for most of the part are not effective whenever there is the root canal treatment is required. It is because antibiotics are either not needed (inflamed non-infected tooth) or unable to reach the canals due to little blood supply left (infected tooth).

Read more on this topic at official AAE website:

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Root canal treatment or endodontic therapy is often the indicated treatment when someone has a toothache. The symptoms are spontaneous pain, lasting sensitivity to cold which is then relieved by heat in the earlier stage of pulpal deterioration and lasting sensitivity to heat which is relieved by cold in later stages of pulpal degeneration. As the pulp ("nerve area") dies an abscess may form which creates pain on biting and touch, tenderness to palpating tissue near the involved tooth and possibly swelling. This is due to the infection at the tip of the tooth.

Obviously it is best to avoid dental emergencies. Often there may be evidence on radiographs (x-rays) of a chronic infection at the tip of the tooth or decay which is either into the pulp or very near it. Both of these conditions are indications for root canal treatment prior to an emergency. DON'T WAIT TILL IT HURTS.

Also, there are situations when a tooth has an extensive large filling and requires a crown. In this case it may be indicated to electively have the endo treatment performed prior to the crown services.
Whether a root canal is an emergency depends on how we arrived at the diagnosis. Often, it's simply a large cavity that has affected the tooth root. You may not have even experienced any pain yet. We'll take an x-ray, and if a root canal needs to be done, we'll schedule one.

However, if you have an abscess / infection (and trust me, you'll know when you have one), that *is* an emergency that needs to be addressed quickly. Typically, we'll prescribe an antibiotic to curb the infection, and then do the root canal.
I will answer this from a slightly different angle, as the other posters gave you a good idea of the clinical definition of emergency.

From the perspective of dental insurance companies root canal treatment is TREATED as a dental emergency, in this sense:  Many dental insurance companies will require a pre-authorization for what is classified as major dental treatment. Although endodontic, or root canal treatment can be classified by the insurance company as a major service, it is recognized that it is sometimes performed on an emergency basis. For that reason the industry standard is NOT to require pre-authorization of root canal treatment. They do however require that a post-treatment x-ray be sent in with the claim for payment.
No, I would classify root canals as normal complications of dental treatment. If not treated at an early stage, these complications could become dental emergencies. Rarely, a tooth nerve will die and require root canal treatment for no apparent reason, but almost always the likelihood for the root canal treatment can be anticipated by the dentist which is why routine examinations with x-rays at your dentist are so important -- to prevent dental emergencies. If you or your children are involved in contact sports then the use of a protective athletic mouth guard may also prevent dental emergencies
Divyang Patel

A root canal treatment diagnosis itself does not mean it is a dental emergency. But if that tooth is left untreated then it can lead to a serious infection leading to a life threatening situation in some cases. So the diagnosis of a root canal treatment should not be left untreated for long time.

The need for a root canal is not a dental emergency itself, but if your mouth is in pain because one of your teeth needs root canal therapy, it can definitely feel like one!

Root canal treatment generally involves the removal and replacement of a tooth’s pulp. The pulp is soft tissue containing blood vessels, nerves and connective tissue. When the pulp is diseased or injured, the pulp tissue dies. If you don't remove it, your tooth gets infected and you could lose it. Most of the time, a root canal is a relatively simple procedure with little or no discomfort involving one to three visits. Best of all, it can save your tooth and your smile!
Steven M. Katz, MD

The need for root canal therapy may or may not be a dental emergency. When the pulpal tissues (nerve and blood vessels) die, pain and swelling may accompany this process. Often times this mandates an emergency visit to the dentist. Other times the patient will have few or no symptoms. These patients can be seen at regularly scheduled visits.

A root canal treatment is a procedure to clean out an  infected tooth. If a root canal and crown cannot resolve the pain, the tooth may need to be extracted completely.

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Important: This content reflects information from various individuals and organizations and may offer alternative or opposing points of view. It should not be used for medical advice, diagnosis or treatment. As always, you should consult with your healthcare provider about your specific health needs.