Irreversible pulpitis
The nerve is inflamed past the point of recovery. Pain lingers for minutes after a hot or cold trigger, arrives unprovoked and often wakes you. The pulp has to be removed for the pain to stop.
Wimpole Street opens 1 October 2026. For a dental emergency today, call South Kensington 020 7183 2362 (open 7 days) or St Paul's 020 7183 3709 (Mon–Fri).
South Kensington
Open seven days a week
St Paul's, City of London
Open Monday to Friday
Emergency dentistry · Wimpole Street, Marylebone
Emergency root canal: stopping nerve pain and keeping the tooth
When toothache is caused by an inflamed or infected nerve, the fastest reliable route to relief is to remove that nerve. That is what an emergency root canal does. The first appointment concentrates on opening the tooth, clearing the pulp and dressing the canals so the pain stops; the fine work of shaping and sealing follows at a calmer visit. Wimpole Street will offer this from 1 October 2026. Until then the same dentists carry out emergency root canal at South Kensington and St Paul’s.
Before you are seen
Right now: what to do
- 01
Take ibuprofen or paracetamol as directed on the pack. For nerve-type toothache, anti-inflammatories tend to work better; check with a pharmacist if you have asthma, stomach problems or take other medication.
- 02
Avoid heat. Hot drinks frequently make an inflamed nerve throb violently, whereas sipping cold water can briefly calm it. If cold helps, tell the dentist; it points to a particular stage of nerve damage.
- 03
Keep the tooth clean. Brush and floss gently around it; trapped food increases pressure inside a cavity.
- 04
Do not chew on that side, and avoid sticky or hard foods that might break down a tooth already weakened by decay.
- 05
Raise your head at night with an extra pillow to reduce the pounding.
- 06
Never place aspirin, alcohol or clove oil against the gum; these damage soft tissue and do nothing for the nerve inside the tooth.
Take any painkiller only as directed on the pack, never place aspirin against the gum, and ask a pharmacist if you already take other medicines.
Diagnosis
What's likely causing it
Necrotic pulp with abscess
The nerve has already died and infection has spread to the bone around the root tip. The tooth is tender to bite and may feel slightly high. Root canal drains the infection through the tooth itself.
Deep decay under a filling or crown
Bacteria have leaked beneath an old restoration and reached the pulp silently. The first sign is often a sudden, severe ache from a tooth that seemed fine.
Cracked tooth
A fracture line has allowed bacteria into the pulp chamber. If the crack is confined to the crown of the tooth, root canal followed by a crown can save it.
Trauma
A knock months or years earlier can quietly cut off the blood supply to the nerve. The tooth may darken slightly before pain or a gum boil appears.
Previously treated tooth
A root canal from years ago can become re-infected if a canal was missed or the filling on top has leaked. Re-treatment follows the same emergency principles.
At the clinic
How the emergency visit runs
- Step 1
Confirm the diagnosis
Cold testing, tapping and a digital X-ray establish that the nerve is the culprit and that the tooth is worth saving.
- Step 2
Profound anaesthesia
Inflamed nerves resist anaesthetic, so we allow extra time and use supplementary techniques until the tooth is fully numb before starting.
- Step 3
Access and extirpate
A small opening is made through the top of the tooth and the inflamed or dead pulp is removed from the chamber and canals. Pressure relief is usually immediate.
- Step 4
Disinfect and dress
The canals are irrigated with an antibacterial solution and an antiseptic dressing is sealed inside with a temporary filling.
- Step 5
Book completion
The canals are shaped, measured and filled at a second appointment of about an hour. A crown is then recommended for most back teeth.
Fees
Emergency fees
The root canal fee is for the whole treatment across its two visits, including the emergency stage; you are not charged twice because it started as an emergency. Crowns are quoted separately once we have seen how much tooth remains.
| Item | Fee |
|---|---|
Emergency assessment New-patient rate (usual fee £95). | £30 |
Digital X-ray Usually two or three images across the course of treatment. | £20 |
Root canal – front tooth Incisors and canines, typically a single canal. | from £695 |
Root canal – premolar Usually one or two canals. | from £795 |
Root canal – molar Three or more canals; more time and instruments. | from £895 |
Crown after treatment Protects a root-treated back tooth from splitting. | from £995 |
Extraction (alternative) If you decide against saving the tooth. | £250–£650 |
Indicative prices for Wimpole Street, identical to our South Kensington and St Paul's clinics. Whatever is recommended is set out in writing, with the cost, before any treatment starts.
Once you are home
Afterwards
- Some soreness on biting for two to four days is normal as the tissues around the root settle. Ibuprofen taken as directed usually covers it.
- The temporary filling is softer than tooth. Avoid chewing on that side and stay away from sticky foods until the tooth is finished.
- If the temporary comes out, phone us; bacteria can re-enter the canals within a day or two.
- Sharp, escalating pain or new swelling in the days after the first visit is unusual and should be reported without delay.
- Complete the second visit within two to four weeks. A dressed canal is a holding position, not a finished root canal.
- Once the tooth is filled, have the crown fitted promptly; an unprotected root-treated molar is at real risk of fracturing.
FAQ
Questions patients ask
The procedure is done under local anaesthetic and, because inflamed nerves can be stubborn, we take time to confirm the tooth is fully numb before starting. Most patients say the relief when the pressure is released far outweighs any discomfort from the injection.
Extraction is quicker and cheaper on the day, but replacing a missing tooth with a bridge or implant costs considerably more and nothing functions quite like your own root. Where the tooth is restorable, root canal is usually the more economical choice over five to ten years.
In an emergency, no. Infected canals benefit from a period under antiseptic dressing, and an appointment booked at short notice is rarely long enough to shape and fill canals to a high standard. Splitting the work also means you are not in the chair for two hours while in pain.
Usually not. Removing the infected pulp deals with the source directly. Antibiotics are added only when infection has spread into the face or you have a fever.
With a good seal and a crown where indicated, many root-treated teeth serve for decades. Success depends on the quality of the seal, how much tooth remained and whether the final restoration keeps bacteria out.
Our South Kensington clinic sees emergencies every day of the week, and St Paul’s covers Monday to Friday. Phone whichever suits, describe the pain, and a slot will be held for you.
Also on this site
Other emergencies we treat
Marylebone, W1
Emergency care at Wimpole Street from 1 October 2026
Register your interest and we will contact you as the Marylebone diary opens. Anything that hurts today should go to South Kensington or St Paul's, where the same clinicians keep emergency slots each day.
Opening 1 October 2026
Wimpole Street is not yet seeing patients. Until then, please book or call our South Kensington clinic on 020 7183 2362 or our St Paul's clinic on 020 7183 3709. Questions about the new clinic: wimpolestreet@md.co.uk.
Until we open
Need an appointment before 1 October 2026?
The same clinical team already works from two other Medical & Dental clinics. Book at either one now and, if you prefer, move your ongoing care to Wimpole Street once the doors open.
South Kensington
- 20 Old Brompton Road, London SW7 3DL
- Open seven days a week
- 020 7183 2362
St Paul's, City of London
- 5 Ave Maria Lane, London EC4M 7AQ
- Open Monday to Friday
- 020 7183 3709
