Pain in tooth after root canal

Question:

“I have two root canals one on my upper left and the other on my upper right.  I have experienced episodes of pain in both since having the procedures done ~5 yrs ago. The most recent episode was a continuous sort of throbbing pain that persisted for three days before I decided to go to my dentist.  Each time one of these pain episodes occur my dentist takes x-rays and pokes around but is unable to provide an explanation and prescribes antibiotics.  A few days after taking the antibiotics the pain has dulled and goes away.  I no longer feel that this is an effective method in dealing with a persistent problem.  Antibiotics are discontinuing the pain, antibiotics attack and eliminate bacteria, so bacteria are a likely culprit to causing the pain.  Is a pain causing but not so severe bacterial infection able to be seen in an x-ray?  Should I request that my dentist remove the crown for a more thorough examination or is episodes of pain treated by antibiotics a part of the territory of living with a root canal? Lastly, am I supposed to even feel anything being that the pulp tissue is removed?”

Answer:

To specifically address your question, if the problem is alleviated by antibiotics, that’s a sure sign that there is a bacterial re-contamination.  This can be caused by a number of reasons that are outlined in our older article, called Failed Root Canal.  However, it is not normal for you to be feeling pain 5 years after a root canal.  The purpose of a root canal is to completely remove the source of infection, thus removing the source of pain.  It sounds like there may have been a missed canal (lateral canal, or a small canal at the apex), or a leaky crown, but the bacteria has found some kind of way to reinvade and re-infect the area.  It may be best to visit an Endodontist to have him/her reassess your tooth.  The Endodontist specializes in only root canals and has the technology to more closely examine your tooth condition.  Below we have detailed information regarding root canals.

What is a Root Canal Treatment?

A root canal treatment (also called root canal therapy) is a procedure that is done in order to attempt to save a tooth, usually after it has become badly decayed or infected. If the affected tooth is not treated, the infection or decay will usually spread to the tissues surrounding the tooth, including the bone.

Does a root canal hurt?

In most cases, the procedure is not painful, though there may be some sensitivity afterwards. Most cases of discomfort are felt if there was pain before the procedure (it goes away as the tooth heals), or if there is any complication such as a missed canal. One of the wonderful things about a root canal treatment is that the source of the pain is removed, the canal(s) thoroughly cleaned and disinfected, and the canals filled to prevent re-invasion of bacteria. Many patients retain their root canal treated teeth for life.

It’s important to note too that in most cases where there is discomfort after, the source is not in the tooth itself but in the periodontal ligament (PDL) surrounding the tooth. The infection in the tooth often spreads to the PDL (and in some cases the bone), which by itself is the cause of much sensitivity and discomfort.

What to do after a root canal

The root canal procedure has a success rate ranging between 68-95%. It is a welcome procedure for patients who have the opportunity to try and save their tooth or teeth. After the procedure is completed, a few things to know and expect:

• If there was tooth pain or an infection before the procedure, you may have some sensitivity for a few days after. This is because the tooth is healing from the tooth inflammation that was present before. Your dentist will most likely prescribe NSAIDs for the pain and inflammation. Antibiotics are used to treat oral bacterial infections, in cases where a tooth or teeth may have developed an infection.
• Avoid chewing on the tooth being treated until a permanent crown is placed. This will help you to avoid damaging or re-contaminating the tooth.
• Ensure that you complete the procedure by having a crown (cap) placed over the tooth. This helps protect the tooth from being exposed again to bacteria, and provides structural support and protection for a tooth that is no longer as strong on its own.

Pain years after root canal

Though not very common, there can be root canal pain years later. Reasons for pain after a root canal procedure include:

• Tooth fracture.
• A failed dental restoration (usually a crown) that has allowed bacteria to invade the tooth, causing a re-infection.
• The material sealed inside the canal(s) break down, allowing bacteria to recontaminate the tooth.
• Missed canal – not all canals were located, cleansed, and sealed during the procedure

Failed root canal

After root canal pain, a dentist will re-examine the tooth including the crown to determine the condition of the tooth and what needs to be done. It is sometimes tricky to isolate the problem, but two common approaches to relieving the recurrence of inflammation and infection include:

• A root canal retreat. Re-treatment is sometimes successful, and involves thoroughly cleaning and refilling the canals.
• Endodontic surgery may be needed in other cases. The most common endodontic surgery used to attempt to treat this is an apicoectomy (also called root-end resection or root resection). Basically, the tip of the root and the infected tissue around the root tip are removed. A small filling may be placed at the root tip to seal the root canal.

In extreme circumstances, the tooth may be non-restorable and will need to be extracted. Comprehensive evaluation is necessary for diagnosis and treatment of each patient’s case. Depending on the extent of the infection, changes are sometimes seen on a dental radiograph (dental x-ray) that indicate the presence of an active infection.

We hope this information was helpful to you!

Pericoronitis Treatment

Question:

If we decide to extract the recurrent pericoronitis tooth [should we] give antibiotic before the extraction or after the extraction of tooth?
ThankYou

Answer:

Pericoronitis, infection of the soft tissue typically around the crown of an impacted tooth, usually has a tendency to recur if the causative agent (the tooth) isn’t removed.  The tooth should not be removed until all signs and symptoms of the pericoronitis have been resolved.  If not, incidence of postoperative complications, specifically postoperative infection and dry socket, are highly increased.  However, some sources indicate that IF the pericoronitis is mild, and if the tooth can be easily removed, than an immediate extraction may be performed.  In the end, the recommendation is to treat the pericoronitis, then proceed with the extraction.

Hope this helps and good luck,

SaveMySmile Team

Do I have dry socket?

Question:

Last week,  I had 2 teeth taken out by the dentist.  But today, there was some type of bloody-white “ooze” coming out of the area where one of the teeth came out.  I haven’t had any pain, just the ooze.  Is this dry socket?

Answer:

From what your describing, it definitely isn’t dry socket.  Dry socket is quite painful and occurs when you’ve lost the blood clot in your tooth socket and the bone is exposed.  This sounds like an infection.  After an extraction, for the first couple of hours you can expect some bleeding and some slight pain.  The dentist should have prescribed pain pills and antibiotics so as to avoid an infection.  Depending on the severity of the infection now, the dentist may just prescribe some more antibiotics.  But please visit your dentist right away and tell him/her that you have an infection.

Good luck!

Signs of Gingivitis

Gum disease, known as gingivitis (or it’s more severe form, periodontitis), refers to the inflammation of the gums (gingiva).  It results from accumulation of bacteria near the gum line, causing bacterial invasion into the tissues of the body.  If not addressed and treated, gingivitis will lead to recession of the gums, bone loss, tooth loss, and systemic disease.

Signs of Gingivitis

• Swollen gums
• Bleeding gums (especially when brushing or flossing)
• Shiny or red gums
• Associated pain
• Bad breath or foul smelling gums
• Gum recession (teeth appear longer)

Causes of Gingivitis

• Most often caused by plaque accumulation and poor oral hygiene habits
• Hormonal changes (i.e. pregnancy)
• Certain medications that may suppress the immune system

Gingivitis is a mild form of inflammation.  Unlike it’s more serious form, periodontitis, gingivitis can be treated quickly and easily if addressed in a timely fashion.

Treatment for Gingivitis

• Improve oral hygiene habits – Brush after each meal and floss every day.  If this regimen is followed precisely, the bleeding will eventually stop.
• Incorporate a mouth rinse, preferably with chlorohexidine, into your daily routine.  This can assist with the removal of unwanted bacteria.
• Visit the dentist and get a cleaning – The dentist will be able to effectively remove plaque and calculus, the main causes of gingivitis.  However, it’s up to you to maintain the plaque free mouth after this point.
• Antibiotics – If serious, the dentist may prescribe antibiotics to control the bacterial invasion.

All in all, gingivitis can easily be managed if addressed early.  Take the right steps in keeping up with your oral hygiene to maintain a healthy smile.

Have more questions?  Feel free to leave a commit or submit a question to be included in our FAQ’s.

Embarrassing Cold Sore on your Lips: Get the Facts!

Do you Have a Bump on the Lip or Inside the Mouth?

Cold sores (Fever Blisters), better known as herpes simplex virus type 1 (HSV-1), are small, irregular shaped, yellow or white ulcerations/sores located in the mouth, lips, or surrounding skin.  The sores typically start off as red, then collapse to form a yellowish ulcer.  These lesions are usually painful.

The first breakout of HSV-1 is more severe than recurrent episodes.  The initial breakout is oftentimes seen in children between 6 months and 5 years and is known as acute herpetic gingivostomatitis.

Recurrent breakouts usually appear on the lip or surrounding skin and are known as herpes labialis.  15-45% of the population has a history of herpes labialis.

What are the symptoms of Cold Sores?

The following symptoms will occur 6-24 hours before a breakout:

• Itching
• Burning
• Tingling
• Pain
• Redness of the skin

Shortly after, multiple small red lesions will appear.  The sores rupture within 2 days, crust over, and generally fully heal in 7-10 days.

If this is an initial breakout, the following symptoms may also occur:

• Sore throat
• Fever
• Muscle pain
• Headache

What causes cold sores?

The sores are caused by a DNA virus known as herpes simplex virus.  Unfortunately the virus remains in the system even when no breakout is present.  Breakouts can also be provoked by the following factors:

• Stress
• Ultraviolet light
• Pregnancy
• Trauma
• Respiratory illnesses
• Allergies
• Other diseases
• Menstruation

Is there treatment for cold sores [herpes labialis]?

Unfortunately there is no known treatment that can completely cure the disease.  However, there are several treatments that can be used to decrease or temporarily alleviate the symptoms of herpes.  These treatments include:

• Anti-viral medications such as Acyclovir
• Nonsteriodal anti-inflammatory medications (NSAIDS) such as ibuprofen, to alleviate the pain
• Over the counter topical anesthetic gels can also help to decrease pain and discomfort