A modern root canal is a calm, largely painless procedure that saves a tooth by removing infection from inside it. With a numbed tooth, the experience is much like having a filling. At The London Smile Clinic in Fitzrovia, root canals are carried out by Dr Mariana Alves, an endodontist who trained at Harvard University.
Say “root canal” and watch the room tense up. The phrase has become shorthand for the worst thing a dentist can do to you.
Here’s the problem with that reputation. It’s built on stories from decades ago, before modern anaesthetic, before dental microscopes, before clinicians trained exclusively in this one procedure. The version in your head and the version Dr Alves performs are barely the same treatment.
Let’s take the fear apart, piece by piece.
What a root canal actually does
Inside every tooth is a soft core of nerve and blood vessels, called the pulp. When decay or a crack lets bacteria reach it, the pulp becomes infected. That’s what causes the throbbing, the sensitivity to hot and cold, the ache that won’t settle.
A root canal removes that infected pulp, cleans and shapes the empty canals, then seals them. The tooth stays in place. You keep your own tooth instead of losing it and facing an implant or a bridge later.
So the treatment people dread is, in fact, the thing that ends the pain and saves the tooth. The infection causes the agony. The root canal stops it.
Why the old reputation is out of date
The fear is real, and it has roots, just not in current practice.
Years ago, with weaker anaesthetic and no magnification, the procedure could genuinely be uncomfortable and unpredictable. Modern endodontics is a different discipline. Dr Mariana Alves works under a dental microscope, which magnifies the inside of the tooth so the canals can be cleaned thoroughly and precisely.
She qualified in dentistry at the University of Lisbon in 2010, then completed her Master’s in Endodontics at Harvard University in 2015. Since then her practice has been limited exclusively to endodontics and endodontic microsurgery. She doesn’t do fillings or check-ups. She does this, all day, to the standard her training demands.
That combination, a Harvard education and a microscope, is a long way from the drill-and-hope reputation the procedure can’t seem to shake.
What it actually feels like
Here’s the part that surprises patients most. With the tooth properly numbed, most people feel little or nothing during the procedure itself.
The area is numbed with local anaesthetic first, exactly as it would be for a filling. Once it’s working, you feel pressure and movement rather than pain. Many patients are so relaxed they’re surprised when it’s over. The relief afterwards, once the infection is dealt with, is usually the strongest sensation of the whole thing.
Dr Alves is described as an expert at handling anxious patients, and that’s deliberate. Her stated mission is to subvert the root canal’s terrifying reputation and create a friendly, calm and comfortable experience for people who arrive expecting the worst.
Old fear versus modern reality
It helps to lay the myths next to the facts.
| The fear |
The reality with a modern endodontist |
| It’s agonising |
The tooth is fully numbed, so most patients feel pressure rather than pain. |
| It takes forever |
Treatment is often completed in one or two visits, depending on the tooth. |
| It’s better to just pull the tooth |
Saving your natural tooth is almost always the better long-term outcome. |
| Any dentist does it the same way |
An endodontist uses specialist equipment, including a microscope, and focuses exclusively on root canal treatment. |
| The pain comes back |
A properly treated and well-sealed root canal removes the infection that caused the pain in the first place. |
If you’ve been avoiding treatment because of that left-hand column, the right-hand column is the one that’s actually true in 2026.
What to expect on the day
A little knowledge takes a lot of the worry out.
You arrive, Dr Alves talks you through the plan and checks how you’re feeling. The tooth is numbed. Once you’re comfortable, she isolates the tooth, cleans out the infected pulp under magnification, shapes the canals and seals them. Depending on the tooth, this might be done in one visit or split across two.
Afterwards the tooth may feel a little tender for a few days, easily managed with ordinary painkillers, and most people are back to normal life straight away. In many cases the tooth is later strengthened with a crown to protect it long term, which our team will discuss with you.
Is a root canal right for you?
If you’ve got a tooth that’s aching, sensitive to heat or cold, or has flared up around an old filling, there’s a good chance the pulp is involved, and a root canal may be exactly what saves it.
The alternative to treating an infected tooth is usually losing it. Replacing a tooth with an implant or bridge costs more and takes longer than keeping the one you have. Saving the natural tooth is almost always the better route, both clinically and financially.
UK root canal fees vary with the tooth and its complexity, commonly from around £500 for a simpler front tooth to £1,200 or more for a complex molar with specialist care. As of June 2026, Dr Mariana Alves carries out endodontic treatment at The London Smile Clinic in Fitzrovia, close to Marylebone, Soho and Bloomsbury. Your exact fee is confirmed after assessment. You can see related care on our general dentistry pages.
FAQ
Does a root canal hurt?
Not in the way people expect. The tooth is numbed with local anaesthetic first, so during the procedure most patients feel pressure and movement rather than pain, much like having a filling. The ache people associate with root canals is usually the infection beforehand. Dr Mariana Alves, who trained at Harvard, focuses specifically on keeping the experience calm and comfortable.
How many appointments does a root canal take?
It depends on the tooth. A simpler tooth may be completed in a single visit, while a more complex molar with several canals might be split across two appointments. Dr Alves works under a dental microscope, which lets her clean the canals thoroughly and precisely. Your exact plan is explained at your assessment at The London Smile Clinic before treatment begins.
Is it better to have a root canal or take the tooth out?
Keeping your own tooth is almost always the better outcome. Removing a tooth leaves a gap that usually needs an implant or bridge later, costing more and taking longer than saving the natural tooth. A root canal removes the infection while preserving the tooth in place. Dr Mariana Alves’s practice is limited exclusively to saving teeth this way.
Why see an endodontist rather than a general dentist?
An endodontist focuses only on the inside of the tooth and its root canals, working under magnification for precision. Dr Mariana Alves trained in endodontics at Harvard University and practises exclusively in this field, including endodontic microsurgery. For an anxious patient or a complex tooth, that focused experience and the calm environment she’s known for can make a real difference.
How much does root canal treatment cost in London?
UK root canal fees vary with the tooth and complexity, commonly from around £500 for a simpler front tooth to £1,200 or more for a complex molar treated by a specialist endodontist. A protective crown afterwards is often a separate cost. The London Smile Clinic confirms your exact fee after assessing the tooth, and the full plan is explained before any treatment starts.
What to do next
If a painful tooth has been worrying you, or the words “root canal” have kept you out of the chair, the kindest thing you can do is have it looked at early. The sooner an infected tooth is assessed, the more likely it can be saved comfortably.
Call The London Smile Clinic in Fitzrovia on 020 7255 2559, or use the contact page to arrange an assessment with Dr Mariana Alves.
