Why I Chose to Spend My Career Doing the Treatment Everyone Else Avoids

If you ask most dentists what their least favourite treatment is, root canals are usually somewhere near the top of the list. They’re long, they’re technical, they happen in a confined space, and they have a reputation — entirely undeserved, in my view — for being unpleasant for the patient. A lot of general dentists are happy to hand them off to someone else.

I am that someone else. My practice is now limited entirely to root canal treatment, both at BDS Dental and at a small number of other clinics across London. Last year I completed over 500 root canals. I’m a dentist with a special interest in endodontics, and I’ve done further training and qualifications to support that — a postgraduate diploma, and currently a master’s. But the formal credentials, honestly, aren’t the most important part. The most important part is the experience that comes from doing the same procedure several times a day, several days a week, for years.

I want to use this short series of blog posts to talk about root canal treatment as it actually is now — what it involves, what you’ll experience as a patient, how the technology has changed, and what happens in the rare cases when treatment doesn’t work first time. Before I get to any of that, I want to start with the question I get asked most: why on earth would you choose to do this for a living? Because the honest answer to that question tells you most of what you need to know about how I work.

How I ended up doing this full-time

I started as a general dentist. I did everything — fillings, crowns, extractions, hygiene, cosmetic work, the lot. And early on I noticed something. If I looked at my diary at the start of the day and saw a root canal booked in, my day got better. The opposite of what most of my colleagues felt.

I think I’d assumed for a while that this was a phase. It wasn’t. The pattern just kept repeating. The root canal days were the days I went home happy. So eventually I asked myself the obvious question: if I’m enjoying this part of my work this much, why don’t I do more of it?

I started taking internal referrals from other staff at the practice I was working at — they had patients who needed root canals, they didn’t particularly want to do them, and I did. My diary started to fill with the work I enjoyed most. The more I did, the more I noticed I was enjoying my job overall. And at that point I made the decision to commit to it properly. I did further training. I limited my practice to endodontics. I built my career around the treatment most of my profession was happy to send elsewhere.

What I actually love about root canals

When people ask why I enjoy this work, I usually give them a list of reasons, because there isn’t a single one.

Predictability. Root canal treatment, done properly, works. The success rate for primary treatment in experienced hands is around 90 per cent, and with very experienced practitioners it gets close to 95. That’s a reliable, predictable outcome — which, when you spend your day doing the same procedure over and over, is genuinely satisfying. You finish the appointment, the patient is out of pain, and a few months later the x-rays confirm what you already knew: the tooth is settled, the infection is gone, the result is good. There’s a clean answer at the end. That’s quite rare in dentistry, where a lot of decisions live in grey areas. With root canal therapy, you’ve solved a problem.

Every tooth is different. This sounds like a contradiction with the point about predictability, but it isn’t. The technique is predictable, but each tooth has its own anatomy — the number of canals, how they branch, how they curve, how calcified they’ve become with age — and figuring that out is a different puzzle every time. The upper first molar, for instance, is famous in our profession for having four canals where you might initially see three. One of them can be very difficult to find. Working out where it is, getting to it, and cleaning it properly is satisfying in a way that I find hard to put into words. Each appointment is a small problem-solving exercise with a real answer at the end.

The confined space. This bit might sound odd. The whole procedure happens inside a tiny opening in the top of your tooth, with the canals themselves being narrower than a millimetre at points. I genuinely enjoy working at that scale — fiddly, specific, technically precise. It’s a part of dentistry where small movements matter enormously, and that suits how my brain works.

The jeopardy. I’ll admit to this one even though it sounds a bit dramatic. There’s a moment near the end of every root canal where I take the final x-ray and it tells me whether everything I’ve done — all the measurements, all the cleaning, all the careful sealing — has actually landed where I intended. That moment of waiting and then finding out matters to me. The risk of getting it slightly wrong, the discipline of making sure I don’t, the relief and satisfaction of seeing the result confirm what I planned. That cycle, several times a day, doesn’t get old.

Transforming the patient’s experience. This is the one I think matters most. Patients arrive for root canals genuinely worried. The reputation of the treatment is so bad that many people have been dreading the appointment for weeks. Quite often someone has been in significant pain for days beforehand. They sit down in the chair with the assumption that the next ninety minutes are going to be horrible. The single biggest professional satisfaction I get is when those same patients sit up at the end and say that was nothing like I’d been expecting. Calling it enjoyable is probably a stretch — I’m under no illusions there. But pain-free, calm, and over with much less drama than the patient had braced themselves for? That happens almost every time. And it never stops being a good feeling.

What it is and isn’t

I want to draw one contrast, because it explains a lot about how I think about this work.

Cosmetic dentistry — veneers, smile makeovers, that sort of thing — is mostly subjective. The patient has a particular look in mind. You discuss it, you agree on a plan, you carry it out, and the success of the result is partly in how the patient feels about what they see in the mirror. That’s a legitimate kind of dentistry, and there are colleagues of mine who are very good at it. It just isn’t quite my thing.

Root canal treatment is the opposite of subjective. The patient comes in with a clearly defined problem — bacteria has invaded the nerve inside their tooth, the tooth is inflamed or infected, they’re often in pain, and the tooth needs treating. I clean the inside of the tooth properly, I seal it, and the problem is resolved. The patient gets to keep the tooth. The infection is gone. The pain is gone. They move on with their life.

There’s something deeply satisfying about that as a piece of work. You arrive at a problem. You apply a defined technique to it. The problem is solved. You’ve done someone a real, tangible service. Then you do the next one.

Why I work at BDS Dental

I work across several practices in London, but I do one day a week at BDS. There are a couple of reasons it’s the day I most look forward to.

The first is clinical. Root canal treatment doesn’t end when I finish my part — the tooth then needs a high-quality restoration on top to seal what I’ve done from the rest of the mouth. The crown or onlay placed afterwards is, in real terms, as important to the long-term success of the root canal as the root canal itself. At BDS, I’m working with Ian and Ellie, who are excellent restorative dentists. I know that when I hand a tooth back to them, it will be sealed properly with high-quality materials. That makes my own work worthwhile. The opposite — doing meticulous root canal treatment and watching it get undermined by a poor restoration — is one of the more frustrating things in this job, and it doesn’t happen here.

The second is the practice itself. BDS is unusual in that it’s a high-quality, high-standard practice with a genuine family feel. Those two things often don’t sit together. The places that have the family feel are often a bit haphazard on standards. The places with the highest standards can feel impersonal. BDS manages both, which I think is rare. The nursing team and the admin team are excellent. The clinical standards are high. And yet patients walk in and feel welcomed, and as a clinician I stop in between appointments to chat with Ellie and Ian and the rest of the team in a way that doesn’t happen at every clinic I work in.

That combination matters more than people realise. It’s what allows the practice to do the things you’d want a dentist to do — take the time, choose the conservative option, treat each patient as an individual — while still maintaining the technical standards that complex restorative work needs.

What this series is going to cover

In the next four pieces I’ll get into:

What a root canal treatment actually is, in plain English — what’s happening inside the tooth, when it’s needed, and what we’re trying to achieve.

What you actually experience as a patient — including the cold-pellet test I do to make sure your tooth is genuinely numb before I start, why nearly a quarter of my patients fall asleep mid-treatment, and how I deal with the rare cases where the anaesthetic doesn’t take.

How modern endodontics has changed. If your last root canal was a decade or two ago, the procedure has improved beyond recognition — 3D imaging, automated file systems, integrated apex locators, sonic and ultrasonic irrigation. It’s a faster, more comfortable, and more predictable treatment than it used to be.

And finally, what happens in the rare cases when a root canal doesn’t work — including retreatment, surgical options, and why extraction is something we resort to only when there’s no other choice.

If you’ve been told you need a root canal and you’ve been dreading it, I hope this series helps. The treatment has come a very long way. It really isn’t what it used to be.

Dr Daniel Rabinowitz is an associate dentist at BDS Dental with a special interest in endodontics, a postgraduate diploma in the field, and a master’s in progress. To book a root canal consultation, contact the practice here.