What are the downsides of having a root canal?

A root canal is one of the most recognised dental procedures in the UK, but it comes with a set of risks and drawbacks that patients deserve to understand before agreeing to treatment. The downsides range from post-procedure discomfort and the possibility of reinfection to longer-term concerns about tooth fragility and the overall success rate of the procedure.

Is Having a Root Canal Unhealthy? What the Evidence Actually Shows

The short answer is that a root canal is not inherently unhealthy, but it does carry specific risks that are worth weighing carefully. The procedure involves removing infected or inflamed pulp from inside the tooth, sealing the canal, and leaving what is essentially a non-living tooth in your mouth. Some patients and practitioners raise concerns about residual bacteria that can remain in the dentinal tubules even after thorough cleaning, which in rare cases may contribute to low-level infection that goes undetected for some time.

There is also a broader debate, largely rooted in older, now-discredited research, that suggested root-treated teeth could release toxins linked to systemic illness. Modern dentistry and the British Dental Association have consistently rejected these claims as lacking scientific basis. That said, for patients with compromised immune systems, any procedure that leaves a treated but non-vital tooth in place warrants a more careful conversation with their dentist about the balance of risk.

Common Root Canal Risks and How Frequently They Occur

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Can Root Canals Cause Problems Later in Life?

One of the most common concerns patients raise is whether a root canal will hold up over the long term, and the honest answer is that it very much depends on aftercare and individual circumstances. A tooth that has undergone root canal treatment is structurally weaker than a living tooth because it no longer receives nutrients through the pulp. This makes it significantly more prone to fracturing, particularly if a crown is not placed over the tooth promptly after the procedure.

Retreatment is another long-term consideration that many patients are not warned about upfront. Studies published in peer-reviewed dental journals suggest that around 5 to 15% of root-treated teeth will require further intervention, whether that means a second root canal, an apicoectomy (a minor surgical procedure to remove the tip of the root), or ultimately extraction. The longer a root-treated tooth remains in the mouth, the greater the cumulative risk of complications, and patients should factor that reality into their decision-making.

Table 2: Root Canal vs. Tooth Extraction: Long-Term Comparison

Why Dentists Sometimes Try to Avoid Recommending Root Canals

It might surprise patients to learn that many dentists prefer to exhaust other options before recommending a root canal, and the reasons are largely practical rather than ideological. The procedure is technically demanding, can span multiple appointments, and in complex cases involving curved or calcified canals, carries a meaningful risk of incomplete treatment. Referring a patient to an endodontist (a root canal specialist) is often more appropriate, but that route comes with longer waiting times and higher private fees.

There is also the straightforward clinical reality that a root canal only makes sense if the tooth has sufficient structural integrity to survive the procedure and support a crown. When a tooth is too heavily decayed or cracked below the gum line, a dentist may conclude that attempting a root canal would ultimately lead to extraction anyway, making extraction the more sensible first step. This is not an avoidance of the procedure for the wrong reasons; it is sound clinical judgement in the patient’s best interest.

Should Root Canals Be Avoided? Weighing Up Your Options

The NHS provides clear guidance on dental treatments available under NHS charges, and root canal treatment is included within Band 3 pricing when clinically appropriate. You can review current NHS dental charges and your entitlements at www.nhs.uk/nhs-services/dentists/dental-costs. For patients who are exempt from dental charges, the GOV.UK guidance on help with NHS dental costs is available at www.gov.uk/help-nhs-costs.

Whether a root canal should be avoided depends entirely on the individual patient’s clinical situation, overall health, and long-term dental goals. For someone with an otherwise healthy tooth that has become infected, a root canal is frequently the most conservative and cost-effective way to preserve natural dentition and avoid the chain of costs that come with extraction and replacement. Avoiding treatment altogether is rarely the right answer, as untreated dental infections carry their own serious risks including abscess, bone loss, and in severe cases systemic spread of infection.

What Are the Downsides of Having a Root Canal? A Final Summary

Understanding the downsides of a root canal allows patients to make genuinely informed decisions rather than simply accepting or refusing treatment out of anxiety. The procedure has a strong track record when performed on suitable teeth by experienced practitioners, but it is not without its complications, and being transparent about those is what separates good dental care from pressure-driven decision-making.

The most significant downsides centre on the structural vulnerability of the treated tooth, the possibility of reinfection over time, and the cumulative cost if retreatment or extraction becomes necessary further down the line. Patients who take the time to understand these risks, ask the right questions, and follow through with appropriate aftercare, including getting a crown fitted where recommended, give their treated tooth the best possible chance of lasting decades.

Ultimately, the conversation about whether to proceed with a root canal should be a two-way dialogue between patient and dentist. No two cases are identical, and factors such as the tooth’s position, the extent of decay, the patient’s immune health, and their financial circumstances all play a genuine role in determining whether a root canal is the right path forward.

• Root canal treatment weakens the tooth structurally, making a crown an essential follow-up step for most patients, particularly for molar teeth subject to high biting forces.
• Reinfection and the need for retreatment affect a meaningful minority of root-treated teeth, so patients should understand that the procedure is not always a permanent fix on the first attempt.
• For many patients, root canal treatment remains a far better option than immediate extraction, but only when the tooth is clinically viable and the patient commits to proper long-term maintenance.

What Are the Downsides of Having a Root Canal: Frequently Asked Questions