Anaesthetic and Sedation for a Root Canal
Local anaesthetic is the default and is included in the procedure — it has no separate line on any schedule we read. Sedation is a different thing entirely, billed by the quarter hour, and it is worth knowing what that costs before you say yes.
Local anaesthetic is the default, and it is already in the price
The NHS page on root canal treatment, last reviewed on 3 October 2025, states it plainly: "Before having root canal treatment, you'll usually be given a local anaesthetic, so you'll be awake but will not feel any pain." The American Dental Association's patient page says much the same: "There is little to no pain because your dentist will use local anesthesia so you don't feel the procedure."
There is a second, quieter piece of evidence for this, and it comes from the schedules. Local anaesthetic has no line of its own on any of the three documents this site reads. Procedures that involve it are priced with it included — Montana's extraction line even says so on the schedule, noting that it includes local anaesthesia, suturing and post-operative care. Nobody bills you separately for it because it is not an extra.
We are not going to tell you it will not hurt. We cannot know that, no page can, and a promise like that is exactly the kind of thing this site refuses to make. What we can tell you is what two national sources publish about how it is normally done.
Sedation is a separate decision, and a separate bill
Sedation is not a stronger anaesthetic. It changes how aware and how anxious you are; the local anaesthetic still does the numbing. It is the answer to a different problem — fear, a strong gag reflex, a very long appointment, or a medical reason — and it is charged for.
The striking thing about how it is billed is the unit. It is sold by the quarter hour.
| What it is | Code | Pennsylvania | Montana |
|---|---|---|---|
| Nitrous oxide | D9230 | $44.00 | $35.57 |
| Minimal sedation, single drug by mouth | D9244 | $111.00 | $19.76 |
| Moderate sedation, intravenous, first 15 minutes | D9239 | $128.50 | $94.85 |
| Each further 15 minutes of IV sedation | D9243 | $128.50 | $94.85 |
| Deep sedation or general anaesthesia, first 15 minutes | D9222 | $122.00 | $102.75 |
| Each further 15 minutes | D9223 | $122.00 | $102.75 |
Read the bottom four rows again. Those are per-quarter-hour amounts, and the AAE says most root canals take one to two appointments at roughly ninety minutes each — the NHS says two or more appointments of one to two hours, sometimes longer. Do the multiplication before agreeing to anything, and ask for it in writing.
Two conditions on the table worth noticing, because they are the kind of thing that only shows up on the bill. Pennsylvania's nitrous oxide line is limited to patients under 21. Montana's palliative treatment line stops at age 20 as well. A schedule saying a service exists is not the same as a schedule saying it is available to you.
Why sedation and anaesthetic get confused
They are answering different questions, and the words get used interchangeably in a way that costs people money.
Anaesthetic is about sensation. A local anaesthetic blocks the nerves supplying one part of your mouth, and it is what stops you feeling the work. Every published description of this procedure that we read treats it as the normal, expected part of the appointment.
Sedation is about awareness. It does not numb anything. Somebody sedated and not anaesthetised would feel the procedure perfectly well and mind about it less, which is why sedation is always in addition to the local anaesthetic rather than instead of it.
The practical upshot is that "will I be put out for it?" and "will it hurt?" are two different questions with two different answers, and only one of them has a line on the bill. If the concern is pain, the answer is the local anaesthetic, and it is already included. If the concern is being awake and aware for an hour and a half with your mouth open, that is the one worth discussing — and the one worth pricing.
The other thing that is included, and the one thing that is not
Worth knowing what a procedure fee normally covers, because it makes an itemised quote much easier to read.
Montana's schedule spells it out on the extraction line: the fee includes local anaesthesia, suturing and post-operative care. That is the general pattern — the routine things that happen inside an appointment are bundled into the fee for the appointment, which is why you will not find a line for cotton wool, a rubber dam or a follow-up phone call.
Washington's endodontic schedule makes the same point from the other direction. It carries a line for isolating a tooth with a rubber dam and marks it "Bundled" rather than giving it a price. The schedule is saying: this happens, and it is not separately payable.
What is not bundled is anything that required a decision: sedation, a specialist's time, the restoration afterwards. Those are the lines to look for on a quote, because those are the ones that move the total.
What to ask before the appointment
- Is local anaesthetic all that is planned, and is it included in the quote?
- If sedation is being suggested, which kind, and why this one?
- How is it billed — flat, or by time? What is the expected total?
- Who administers and monitors it, and what are their qualifications?
- Do I need somebody to take me home?
- What happens if the anaesthetic does not take hold properly?
That last one is worth asking out loud. It is a real situation, it has straightforward answers in the chair, and knowing in advance that there is a plan for it is worth more than reassurance.
One thing to raise before anything is injected
Tell whoever is treating you about your medical history, the medicines you take, and any previous reaction to a dental anaesthetic. That is not a formality, and it is the part of the appointment where the information only you have actually changes what happens.
We will not go further than that. Which agent, how much, and what interacts with what are clinical decisions made by a licensed person with your history in front of them. No web page is in a position to contribute to that conversation, and this one is not going to pretend otherwise.
Why the anaesthetic question is asked so often
Because of the reputation. The American Association of Endodontists' page on root canal myths addresses it directly: "Modern root canal treatment is designed to eliminate pain, not cause it", and "In most cases, the pain people associate with root canals is actually caused by the infection inside the tooth—not the procedure itself."
They are an interested party, and it is still a reasonable point. The thing that hurts before the appointment is the reason for the appointment.
What happens afterwards is a separate question with its own sources, and it has its own chapter: what is ordinary in the days after treatment and what is a phone call. The cost of the treatment itself, with and without the crown, is on our page pricing root canal treatment from three published fee schedules.
Questions about being numb
Will I be awake during a root canal?
With local anaesthetic, yes. The NHS's wording is that you will usually be given a local anaesthetic, "so you'll be awake but will not feel any pain". Sedation is an additional, separately billed choice that changes how aware you are, and it is not the standard approach.
Is the anaesthetic included in the price?
Local anaesthetic has no separate line on any of the three schedules we read, and Montana's extraction line explicitly states that local anaesthesia is included. Sedation is the opposite: it has its own codes, and the significant ones are billed per fifteen minutes.
How much does sedation for a root canal cost?
On the two schedules that carry the lines, intravenous moderate sedation is allowed at $128.50 in Pennsylvania and $94.85 in Montana — for the first fifteen minutes, with each further fifteen minutes charged again at the same rate. Against appointments the AAE describes as roughly ninety minutes each, that adds up quickly, and it is worth asking for the expected total rather than the rate.
Can I have a root canal if I am terrified of dentists?
This is worth saying to the practice before you book rather than on the day, because it changes what they plan. Options exist, they have costs attached, and a practice that knows in advance can allow the time. What we cannot do is advise you on which option to take.
What if the anaesthetic does not work on me?
It is a known situation with practical answers in the chair, and the right time to raise it is at the start of the appointment, especially if it has happened to you before. Tell them about any previous reaction or failure to go numb — that is genuinely useful information and only you have it.
Carry on
The prices behind all of this are on what a root canal costs on three fee schedules.
Do You Need a Crown After a Root Canal?
On the schedules that price both, the crown is roughly half of the total bill — and the endodontists' own guidance says it depends mostly on which tooth it is. Back teeth generally get one; front teeth often do not.
Endodontist or General Dentist: Who Does Root Canals
Both do. An endodontist is a specialist with at least two further years of training after dental school, and by their own association's figure only about three per cent of dentists are one.