7 Signs You May Need a Root Canal — See Dr. Swati Shivane at Swaram Dental Clinic

Persistent or Severe Toothache

A toothache that throbs, keeps you up at night, or feels worse when you lie down is one of the strongest indicators of pulp inflammation or infection. Unlike a dull ache from a minor cavity, pulp pain is often described as deep, spontaneous, and pulsating — sometimes radiating to the jaw, ear, or head. The throbbing quality is caused by increased pressure inside the pulp chamber as infection builds. If the pain comes and goes but keeps returning, or has become more intense over days, do not wait.

Prolonged Sensitivity to Hot or Cold

Some teeth are naturally sensitive, but sensitivity that lingers 30 seconds or more after the hot or cold stimulus is removed is a red flag. Healthy teeth respond briefly to temperature and stop. When the pulp is inflamed (a condition called pulpitis), it remains stimulated long after the food or drink is gone. Sensitivity that has shifted from "sharp and quick" to "dull and lingering" often means the pulp nerve is compromised and inflammation has progressed.

Pain on Biting or Chewing

Discomfort or sharp pain when you bite down or chew — especially if it seems localised to one tooth — can indicate that inflammation has spread to the periodontal ligament, the tissue that cushions the tooth root inside the socket. This happens when the infected pulp begins to affect the tissues just beyond the root tip. Pain on biting may also occur even without chewing, simply when the teeth touch. This symptom is easy to dismiss as a cracked tooth or gum issue; an X-ray is the only way to know for certain.

Darkening or Discolouration of the Tooth

A tooth that has turned grey, brown, or noticeably darker than its neighbours may have a necrotic (dead) pulp. When pulp tissue breaks down, the breakdown products can stain the dentine from the inside out. This discolouration is different from surface staining caused by tea or coffee — it comes from within the tooth and cannot be polished away. Internal discolouration, particularly after a previous injury or trauma to the tooth, should always be assessed by a dentist, as it frequently indicates pulp death even if there is no current pain.

A Pimple or Bump on the Gum (Sinus Tract / Parulis)

A small pimple-like bump on the gum near a tooth — sometimes called a parulis or gum boil — is the opening of a sinus tract. This is the body's way of draining pus from an abscess at the root tip. The bump may come and go, and it may even reduce pain temporarily as pressure is released, which can give a false sense that things are improving. In reality, a draining sinus tract means there is a chronic infection at the root of the tooth that requires treatment. It will not resolve without dental intervention.

Swollen or Tender Gum Near the Tooth

Localised swelling, tenderness, or puffiness of the gum directly adjacent to a tooth can be a sign that infection has spread from the pulp into the surrounding tissues. The gum may feel soft and spongy, look red or shiny, and be painful to touch. In more severe cases, swelling can extend to the jaw, cheek, or neck — a sign that the infection is spreading rapidly and requires urgent attention. If you have facial swelling with fever, this is a dental emergency.

Tooth That Previously Hurt But Now Has No Pain

This is perhaps the most deceptive sign of all. When the nerve inside a tooth dies from prolonged infection, the pain may simply stop — not because the problem has resolved, but because there is no longer a living nerve to transmit pain signals. The infection, however, does not stop. It continues to spread silently into the bone around the root. A tooth that has gone from acutely painful to suddenly painless, particularly without treatment, still needs to be assessed. An X-ray will often reveal a dark shadow (periapical lesion) at the root tip, confirming ongoing bone involvement.