Retreatment: Managing Pain After Root Canal Therapy

Secondary root canal treatment

Hello, Dr.
Huang.
I underwent root canal treatment in July.
There were no issues with the tooth while eating, but it hurts when I tap on it.
The doctor advised me to observe it for two weeks, but the pain persisted.
After another two weeks of observation, the pain continued, so the doctor removed the filling material and replaced the medication, advising me to observe again.
However, tapping on the tooth still caused pain, so I continued to observe.
I then had a crown placed, but the pain remained upon further observation.
During my recent visit, the doctor removed the medication inside the tooth and scheduled a follow-up appointment for redoing the root canal in three weeks (due to a full schedule).
After removing the filling, the crown was temporarily cemented.
However, once I got home, any contact with food caused pain, and brushing (especially on the occlusal surface) also hurt.
I would like to ask the doctor: 1.
If there is no medication inside the tooth for three weeks, could this lead to infection? 2.
Is it normal for the tooth to hurt when biting into food (not hard food) and while brushing? I did not experience any discomfort during the first root canal treatment.
3.
Will repeatedly removing the crown for further root canal treatment, after it has been temporarily cemented, cause damage to the crown? Thank you, doctor.

Niming, 20~29 year old female. Ask Date: 2020/10/14

Dr. Huang Tingfang reply Dentistry

Dear Anonymous,
Hello! This doctor is quite excellent and very patient!
1.
If the outside is sealed properly, there will be no infection!
2.
There may be temporary discomfort after root canal treatment, but it will gradually subside!
3.
It will not decay! Just avoid keeping it too long!
Take care! Wishing you all the best!
Sincerely, Dr.
Huang Ting-Fang, Dentistry

Reply Date: 2020/10/14

More Info

Dear Patient,
Thank you for your detailed inquiry regarding your ongoing dental issues following root canal therapy. It’s understandable to feel concerned about persistent pain and the potential implications for your oral health. Let’s address your questions one by one, while also providing some context about root canal treatment and its complications.

1. Infection Risk Without Medication: After root canal treatment, the tooth is often filled with a medicated material to help prevent infection. If the filling material is removed and left unfilled for an extended period (like three weeks), there is indeed a risk of reinfection. The tooth's pulp chamber, which is the innermost part of the tooth containing nerves and blood vessels, can become a breeding ground for bacteria if not properly sealed. This could lead to a condition known as apical periodontitis, where the infection spreads to the surrounding bone, causing further complications. It’s crucial to maintain communication with your dentist about any changes in symptoms during this waiting period.

2. Pain When Chewing or Brushing: Experiencing pain when biting down or brushing your teeth after root canal therapy is not uncommon, especially if the tooth has not yet been fully restored or if there is an underlying issue that has not been addressed. The pain could be due to several factors, including inflammation of the surrounding tissues, residual infection, or even the presence of a cracked tooth. It’s important to note that while some discomfort can be expected after a root canal, persistent or severe pain should be evaluated further. Since you mentioned that you did not experience discomfort after the first root canal, this ongoing pain may indicate that the current treatment is not fully resolving the issue.

3. Impact of Temporary Crown and Repeated Procedures: Using a temporary crown is a common practice when waiting for a permanent restoration, especially after root canal treatment. However, frequent removal and reapplication of the crown can potentially weaken it, especially if it is not designed for multiple uses. Temporary crowns are generally made from less durable materials than permanent crowns, so they may not withstand repeated adjustments well. If the crown is damaged or compromised, it could lead to further complications, including misalignment or additional pain. It’s advisable to discuss with your dentist the best approach to minimize the risk of damaging the crown while ensuring that your tooth receives the necessary treatment.

In summary, it’s essential to keep your dentist informed about any persistent pain or discomfort you experience. They may recommend further diagnostic imaging, such as X-rays or a CT scan, to assess the health of the tooth and surrounding structures. If the pain continues despite treatment, it may be necessary to consider retreatment options or even extraction, depending on the severity of the infection and the condition of the tooth.

Your dental health is important, and addressing these issues promptly can help prevent more serious complications down the line. Please continue to follow up with your dentist and advocate for your health to ensure the best possible outcome.

Best wishes for your recovery and dental health.

Sincerely,
Doctor Q&A Teams

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