Are Root Canals Covered by Dental Insurance?

Root canals have long been one of the most misunderstood and feared dental procedures. Despite the anxiety they often evoke, root canals play a crucial role in preserving dental health. For those facing this procedure, one common concern is whether it will be covered by dental insurance.

In this detailed blog post, we will explore what a root canal is, the symptoms that might indicate the need for one, the process itself, and the potential need for additional procedures like dental crowns. We’ll also discuss aftercare, the costs involved, and the specifics of insurance coverage.

What is a root canal?

A root canal is a dental procedure designed to treat infection at the center of a tooth. This procedure becomes necessary when the pulp, a soft tissue inside the tooth that contains nerves, blood vessels, and connective tissue, becomes inflamed or infected. Inflammation or infection can occur due to deep decay, repeated dental procedures on the tooth, large fillings, or cracks and chips in the tooth. Sometimes, even trauma to the face can result in damage to the pulp, necessitating a root canal.

Symptoms indicating the need for a root canal

Several symptoms can indicate that a root canal may be necessary. These include:

Persistent pain: If you experience severe tooth pain that doesn’t subside, especially when eating or applying pressure, it could be a sign that the pulp inside your tooth is infected.

Sensitivity to heat and cold: Lingering sensitivity to hot or cold temperatures, even after the source of the pain (such as ice cream or a hot drink) has been removed, may suggest that the nerve inside the tooth is damaged.

Swelling and tenderness: Swelling in the gums around a tooth, along with tenderness or sensitivity, could indicate an infection that has spread from the pulp to the surrounding tissues.

Discoloration of the Tooth: A tooth that has become darkened or discolored, particularly after trauma, might indicate pulp damage.

“Pimple” on the gums: The presence of a persistent or recurring bump that looks like a pimple on the gums near a tooth can indicate an abscess, which often requires a root canal to resolve the underlying infection.

What type of dentist performs root canals?

Root canals are typically performed by either a general dentist or an endodontist. Endodontists are dental specialists who focus on diagnosing tooth pain and performing root canal treatment. While general dentists are qualified to perform root canals, they may refer patients to an endodontist for complex cases or if specialized care is required.

Endodontists receive additional training beyond dental school, allowing them to handle intricate cases, such as those involving multiple root canals or severely damaged teeth.

What happens during a Root Canal?

The root canal procedure is designed to remove the infected or inflamed pulp from inside the tooth, clean the interior, and then seal it to prevent future infections. Here’s what typically happens during the procedure:

Preparation and anesthesia: The dentist will begin by taking X-rays to assess the extent of the infection and then administer local anesthesia to numb the area around the affected tooth.

Rubber dam isolation: A rubber dam is a device used to isolate a tooth or a group of teeth that prevents contamination into the root canal chamber. Any contamination into the root canal chamber can result in a failed root canal treatment.

Accessing the pulp chamber: A small opening is made in the crown of the tooth to access the pulp chamber.

Removing the infected pulp: Using specialized tools, the dentist will remove the infected or damaged pulp from the pulp chamber and the root canals.

Cleaning and shaping the canals: The canals are carefully cleaned, disinfected, and shaped to prepare them for filling.

Medication if needed: Depending on the severity of the infection, the dentist or endodontist may place a medication within the canal and have the patient return after about 1 week to evaluate the condition of the tooth. Once the condition of the canal is favorable, the dentist will move on to the next step of the root canal treatment.

Filling the canals: The cleaned canals are filled with a biocompatible material, typically gutta-percha, to seal them and prevent future infection.

Sealing the Tooth: The opening in the tooth is sealed with a temporary or permanent filling.

The final step: After a root canal treatment, the inside of the tooth is hollowed out and fragile. So in most cases, a full coverage crown is put on the tooth to prevent the tooth from fracturing. A root canal treatment without a crown will likely not last in the long term.

Why do root canals have such a bad reputation?

Root canals have historically been the dental treatment that people dreaded, largely due to the misconception that they are extremely painful. However, advances in dental technology and anesthesia have significantly improved the experience. Today, most patients report that a root canal feels no more uncomfortable than having a cavity filled. The lingering fear of root canals is often a result of outdated information and the natural anxiety many people feel about dental procedures in general.

Average cost of a root canal

The cost of a root canal varies depending on several factors, including the location of the tooth and the complexity of the procedure. On average, the national cost of a root canal treatment (without insurance) ranges from $700 to $1,500 per tooth.

Do I need a dental crown after a root canal?

After a root canal, the affected tooth may be weakened and may require additional protection. This is where a dental crown comes in.

What is a dental crown?

A crown is a cap that is placed over the tooth to restore its shape, strength, and appearance. Crowns are especially important after a root canal because the removal of the pulp can make the tooth more brittle and prone to fracture. Placing a crown helps protect the tooth from further damage and ensures it can function normally.

What does getting a dental crown involve?

The process of getting a crown typically involves two visits to the dentist:

1. First Visit: Preparation: During the first visit, the dentist will reshape the tooth to make room for the crown. This may involve filing down the tooth or building it up if significant portions are missing. After reshaping, an impression of the tooth is taken and sent to a dental lab where the crown is custom-made. A temporary crown may be placed to protect the tooth in the meantime.

2. Second Visit: Placement: Once the permanent crown is ready, you’ll return to the dentist to have it placed. The dentist will remove the temporary crown (if you needed one), check the fit and color of the permanent crown, and then cement it in place.

Average cost of a dental crown

The cost of a dental crown can vary depending on the material used (porcelain, metal, or a combination of both) and the dentist’s location. On average, a crown in the US (without insurance) can cost between $800 and $3,000 per tooth.

Are root canals covered by dental insurance?

Whether a root canal is covered by dental insurance depends on your specific plan. Most dental insurance plans provide some level of coverage for root canals, typically under the category of major dental work. However, the extent of coverage can vary widely.

Percentage of coverage

Many insurance plans cover a percentage of the cost, often ranging from 50% to 80%, after the deductible has been met. Some plans may cover the entire procedure if it’s deemed medically necessary.

Limitations and exclusions

Some dental insurance plans may have exclusions or limitations that could affect coverage. For example, if the root canal is considered elective or cosmetic rather than medically necessary, it may not be covered.

Why insurance may not cover the cost of a root canal

In some cases, insurance may not cover the full cost of a root canal. This can happen if the procedure exceeds the plan’s annual maximum, which is the total amount the insurance will pay for all dental services within a year (typically $1,000 – $1500).

Additionally, if the insurance company deems the procedure to be unnecessary or if there is a waiting period for major dental work, coverage may be denied or delayed.

Options to reduce the cost of root canals

For those whose insurance does not fully cover the cost of a root canal, dental savings plans are a great alternative. Unlike traditional insurance, dental savings plans don’t have annual spending limits or restrictions on when and how often you can get dental care.

Most dental savings plans provide reduced rates on root canals. Typically, you can save 20-50%* on the cost of root canals with a dental savings plan. Check individual plan details for specific saving details.

The quickest way to find a plan that fits your needs is by using the calculator at the bottom of this page. You’ll be shown the plans in your area, and see how much each can save you on root canals and more.

Summing it up: Root canals and dental insurance

Understanding whether root canals are covered by dental insurance involves examining your specific plan and its coverage details. While most insurance plans do offer some level of coverage for root canals, factors such as annual maximums, waiting periods, and the specific terms of your policy can all influence how much you’ll pay out of pocket.

If your insurance doesn’t fully cover the cost, exploring dental savings plans can offer significant discounts and help make a root canal procedure (and virtually all dental care) more affordable. Always consult with your dentist and insurance provider to understand your coverage and explore all available options for managing the costs associated with root canals and related dental procedures.

All cost averages obtained from the DentalPlans.com procedure search tool, and independent research.