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A general dentist is qualified to perform a wide range of routine procedures in the mouth, including basic root canal treatments, which in simple cases provide an appropriate and complete solution. An endodontist, by contrast, is a dentist who has dedicated at least three years of supervised clinical and academic residency to this field alone, has passed the Scientific Council exams and holds an official specialist license from the Ministry of Health. Their entire professional routine is devoted solely to diagnosing facial and jaw pain and saving natural teeth.

This gap is reflected in both practical experience and specialized equipment. According to the American Association of Endodontists, a root canal specialist performs an average of about 25 root canal treatments every week, compared with only about two treatments for a general dentist. This intensive experience, along with routine use of a dental treatment microscope and advanced 3D imaging, provides a decisive advantage in particularly complex situations: treating molars with branched or calcified canals, treating severe dental trauma, and retreating root canal treatments that failed in the past – a procedure that makes up a significant share of the cases referred to specialists in Israel.

The "reputation" of root canal treatment is an old and inaccurate story. Today, with local anesthesia and advanced technology, a root canal treatment hurts no more than a regular filling. In fact, its purpose is to stop the pain caused by the inflammation inside the tooth.

After the treatment, there may be sensitivity or mild pain in the first few days.

Sometimes. Throbbing pain is a well-known sign that a root canal treatment is needed, but not the only one. Sometimes the pulp is already dead or infected, and the tooth doesn't hurt at all. In such situations, the finding is discovered during an examination or on an X-ray.

The absence of pain does not necessarily indicate a healthy tooth. When deep decay, a crack or old trauma damages the pulp, the inner tissue and the nerve inside it may undergo gradual necrosis and die slowly and "silently". Because the nerve fibers in the tooth are no longer alive and no longer transmit pain signals to the brain, the patient feels nothing in daily life, even while bacteria continue to multiply inside the root canals.

Despite the absence of pain, the internal infection does not stop, but seeps from the root tip into the surrounding jawbone, creating chronic inflammation. This silent process gradually destroys the bone supporting the tooth and is clearly visible as a dark spot on a routine X-ray. Performing a root canal treatment at this stage is critical: it cleans out the source of the infection, stops bone loss, and prevents a sudden outbreak of severe pain, swelling or an acute abscess in the future.

In most cases, the answer is no; antibiotics cannot replace dental treatment and do not resolve the source of the problem. When inflammation or infection develops in the pulp, the internal blood supply to the tooth is damaged or completely destroyed, so a medication taken by mouth that reaches the bloodstream cannot reach the inside of the root canals in an effective concentration to kill the bacteria. Official clinical guidelines of the American Dental Association emphasize that antibiotics should not be taken to relieve tooth pain caused by inflammation of the pulp without evidence of a spreading infection, since in these situations their effectiveness is nil and they expose the patient to unnecessary side effects and the development of bacterial resistance.

The only treatment that solves the problem at its root is physical intervention by a dentist or a root canal specialist, which includes opening the tooth, cleaning and removing the infected tissue and bacteria, alongside the use of appropriate pain relievers to ease the symptoms.

If a previous root canal treatment did not succeed and the pain, swelling or inflammation has returned, that certainly doesn't mean the tooth has to be extracted. In most cases there are excellent ways to save it, and the first choice is almost always root canal retreatment. In this procedure, the tooth is reopened, the old filling material is removed, and the canals are thoroughly cleaned and disinfected – often with the help of a microscope that reveals hidden canals missed the first time.

In cases where it is not possible to redo the treatment through the crown of the tooth – for example, when there is a crown and a strong post that might break, or when the inflammation at the root tip is particularly persistent – the solution is minor surgery at the root tip (apicoectomy). In this procedure, the root tip is accessed directly through the gums, the infected tip and the surrounding inflammation are removed, and the canal is sealed from below. This is a targeted treatment that leaves the tooth and the crown intact in place, recovery is quick with only mild discomfort, and most people return to their normal routine the very next day.