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!

My toothbrush wears down after one week!

Question:

Hi
The bristles on my toothbrush begin to wear away after 1 week of usage twice a day!  What should I do? Should I change my brush every week?

Answer:

This is a clear sign that you are brushing your teeth entirely too hard.  Remember, brushing, when done the right way, is great for your teeth.  However, brushing too hard is actually bad for your teeth.  It prematurely wears away enamel and can eventually cause sensitivity close to the gum line.  Enamel does not regenerate and you may eventually need a restoration (filling) if you continue to brush with great force.  Continue to brush after each meal but just remember that light to medium force is all you need to accurately clean your teeth.  The bristles in your toothbrush should at least last 2-3 months (see our article on when to change your toothbrush).  Any time less than this is an indication that you may brush too hard.  Also, if you happen to use a soft bristles, step it up to medium strength bristles.  These may last a little longer in your situation.

Good Luck!