Persistent Jaw Pain After Root Canal Treatment: Causes and Solutions

Jaw pain one week after root canal treatment?

Hello, doctor! About 10 days ago, I suddenly experienced severe pain on the right side of my jaw (at the joint), which felt like radiating throbbing pain, making it impossible to eat.
Prior to the onset of pain, I had been feeling discomfort for a week, and a dentist had taken X-rays, indicating no abnormalities.
On the day the pain started, the doctor I was supposed to see was unavailable, so I had to consult another doctor who applied hot water to the second-to-last molar on the lower right side.
A few seconds later, it triggered pain, and he diagnosed it as acute pulpitis, recommending immediate root canal treatment.
After two treatment sessions (with medication), although the severe pain at the base of my jaw is no longer unbearable, it has now transformed into a persistent dull ache (similar to the soreness felt after being punched in the jaw).
The pain intensifies in the evening and wakes me up at night, and even the painkillers prescribed by the doctor have little effect; I can only relieve the pain with ice packs.
I would like to ask: 1.
After the second treatment, the doctor mentioned that the pain should lessen in about three days, and if all is well, we could start on the dental crown.
However, it has been a week, and the dull, throbbing pain at the base of my jaw persists, while the tooth itself only has a slight sensation.
Is this normal? Could it be possible that the nerve was not completely cleaned out? The doctor mentioned that the nerve of this second-to-last molar is thin, long, and curved, making it difficult to clean, and he was concerned that a thin probe might break inside.
However, he did use a small metal piece (root canal measuring device) to check if it was cleaned properly.
2.
The painkillers prescribed by the doctor are not effective; can I go to the pharmacy to purchase pain relief medication on my own? 3.
During the consultation, the doctor suspected that in addition to acute pulpitis, there might also be symptoms of temporomandibular joint (TMJ) inflammation.
However, I can open my mouth wide without pain, and only when I open it very wide do I hear slight popping sounds.
The process of opening my mouth does not cause pain.
Additionally, although I have a history of herpes zoster affecting the eustachian tube, I have not experienced trigeminal neuralgia in recent years, and the pain is not sudden but rather a continuous dull ache in my jaw accompanied by migraines at the temples.
I do not have a fever or swelling at the painful site, which does not resemble cellulitis.
Since this tooth was filled about 10 years ago and there are no signs of cavities on the surface or X-rays, could it be possible that it is not acute pulpitis but rather some other condition?

Mr. Wang, 40~49 year old female. Ask Date: 2018/05/26

Dr. Zeng Guanghui reply Dentistry

1.
It is possible that the apical region of the tooth root is still inflamed, or there may be residual inflammatory substances within the canal.
Several sessions of debridement may be necessary to thoroughly clean the root canal before it can be filled.
2.
It is recommended to return for a follow-up appointment to have the physician prescribe anti-inflammatory and pain relief medications.
3.
If there is associated inflammation of the temporomandibular joint, it may affect jaw closure or cause soreness in the muscles in front of the ear during chewing.
It is advisable to consult a dentist for further examination.

Reply Date: 2018/05/26

More Info

Persistent jaw pain after root canal treatment can be a complex issue, often involving multiple factors. Based on your description, it seems that you are experiencing ongoing discomfort following a root canal procedure on your lower right molar, which was initially diagnosed as acute apical periodontitis. Here are some insights into your situation:
1. Understanding Pain After Root Canal Treatment: It's not uncommon to experience some level of discomfort after a root canal, as the procedure can cause inflammation in the surrounding tissues. However, the pain you describe—persistent and worsening at night—suggests that there may be underlying issues that need to be addressed. The fact that your pain has transitioned from severe to a dull ache is a positive sign, but the continued discomfort indicates that the issue may not be fully resolved.

2. Possible Causes of Persistent Pain:
- Incomplete Cleaning of the Root Canals: As you mentioned, the anatomy of the tooth's root canal system can be complex. If the canals were not entirely cleaned out, residual infection or inflammation could persist, leading to ongoing pain. This is particularly true for teeth with curved or narrow canals, which can be challenging to treat.

- Infection: If there is still an infection present, it may require additional treatment, such as further cleaning or even retreatment of the root canal.

- Periapical Issues: Sometimes, the area around the root tip can develop issues that are not immediately visible on X-rays. This could include a periapical abscess or chronic inflammation.

- Jaw Joint (TMJ) Issues: Given that you also mentioned potential jaw joint inflammation, it's possible that your pain could be related to temporomandibular joint (TMJ) dysfunction. This can occur due to stress, teeth grinding, or misalignment, and can manifest as pain in the jaw, headaches, and discomfort when chewing.

3. Pain Management: If the prescribed pain medication is not effective, it is advisable to consult your dentist or physician before purchasing over-the-counter pain relievers. They can recommend appropriate alternatives or adjustments to your current medication regimen. Additionally, non-pharmacological methods such as applying ice packs, practicing relaxation techniques, or using a warm compress may provide some relief.

4. Further Evaluation: Since your symptoms persist, it would be prudent to follow up with your dentist. They may recommend additional imaging, such as a cone beam CT scan, to get a better view of the root canal system and surrounding structures. This can help identify any hidden issues that may not have been apparent on standard X-rays.

5. Communication with Your Dentist: It's crucial to maintain open communication with your dental care provider. Share your ongoing symptoms and concerns, as they may need to adjust your treatment plan based on your feedback. If necessary, seeking a second opinion from an endodontist (a specialist in root canal treatment) may also be beneficial.

In conclusion, while some discomfort after a root canal is normal, persistent pain warrants further investigation. It's essential to address any potential complications early to prevent further issues. Your health and comfort should be the priority, so don't hesitate to advocate for yourself in seeking the appropriate care.

Similar Q&A

Understanding Persistent Tooth Pain After Root Canal Treatment

The upper left molar underwent root canal treatment two years ago and has been experiencing intermittent pain since then. The discomfort is described as a dull ache, particularly when biting down, with a sensation of pressure and pain near the gums. There is also pain when using ...

Dr. Huang Tingfang reply Dentistry
Dear Ms. DN, Hello! Based on what you've described, it sounds quite uncomfortable. Although it's common for teeth that have undergone root canal treatment to sometimes feel abnormal (such as experiencing pain near the gums, discomfort when using dental floss, and occas...

Chronic Pain After Root Canal Treatment: Unraveling Dental Complications

Last year, in mid-August, I experienced severe pain in my right front tooth and randomly visited a dentist for treatment. The doctor diagnosed it as a necrotic nerve and recommended root canal therapy. During the treatment, they disinfected the inside and placed medication, and I...

Dr. Zhu Guanyu reply Dentistry
Hello: The root canal of tooth 1 is a quite complex system, and not only is the treatment process intricate, but the restoration of the lesion also requires a significant amount of time. As for the underlying cause of the pain, further clinical oral and X-ray examinations are nec...

Persistent Upper Jaw Discomfort: Causes and Solutions

The right central incisor and lateral incisor of the maxilla have both undergone root canal treatment to remove the nerves, but the area of the maxilla (where the tongue can reach) still feels dull, and when biting down with these two teeth, there is a persistent dull pain in the...

Dr. Zhu Guanyu reply Dentistry
Hello, after root canal treatment, it is important to not only strengthen the tooth but also to continuously monitor the healing status of the periapical lesion. As you mentioned, pain upon pressure at the apex is indicative of this condition. If there is spontaneous pain or swel...

Persistent Tooth Pain After Filling: Is Root Canal the Only Solution?

I discovered cavities in the two teeth at the ends of my mouth. After having them filled on two separate occasions, I still experience pain when biting down on hard objects (sometimes). When I returned to the dentist, X-rays were taken, and the dentist mentioned that there were c...

Dr. Zhu Guanyu reply Dentistry
Hello, "Root canal treatment," commonly referred to as "nerve extraction," involves the removal of the nerves, blood vessels, and lymphatic tissue from the root canal system. The procedure includes enlarging and debriding the root canal, followed by sealing th...