Post-Endodontic Pain: Causes and Solutions

Q: Post-Endodontic Pain: Causes and Solutions

Hello： During the root canal treatment process, the body also requires healing and recovery, which necessitates patience and time. <br>It is recommended that you first return to Shuanghe Hospital for further management and communicate in more detail with your treating physician.

Pain Issues After Emergency Root Canal Treatment

On December 20, 2016, I went to Shuanghe Hospital for a dental filling on my left central incisor.
On December 28, I experienced pain in the same tooth and returned for a check-up.
The dentist said it was just discomfort from the filling being too close to the nerve due to the deep excavation, and advised me to go home.
On January 5, 2021, I had severe pain in my central incisor, which radiated to both upper and lower teeth on the same side.
After testing, the doctor informed me that I needed an emergency root canal treatment.
He administered anesthesia and began the procedure.
Afterward, he mentioned that I might experience slight discomfort for three days and asked me to return the following Thursday (the 14th) for a more thorough treatment, prescribing CataFLAM for pain relief.
On January 6, my tooth felt fine with no discomfort.
However, on January 7, the pain in my central incisor returned, resembling the condition before the emergency root canal treatment, except that the adjacent teeth were no longer painful.
The central incisor was so sensitive that even light touch caused pain, and it felt loose, making it difficult to close my mouth due to pain in the lower teeth.
On January 8, I returned to the hospital to discuss my symptoms with the doctor.
He opened the tooth again and stated that he would perform additional treatment.
After finishing, he mentioned that he placed medication inside, which should help alleviate the pain.
He explained that since the treatment was not yet complete, the nerve at the bottom had not been fully cleaned, which was causing the pain.
He indicated that the root canal length needed to be measured before further cleaning could be done and advised me to go home.
He said if the pain persisted, I should return.
However, after returning home, the pain remained severe, regardless of whether the root had been cleaned or not.
Additionally, my left lateral incisor, which had been decayed for years and only had a small portion of tooth remaining, was previously fine.
Since the root canal treatment on my central incisor, that lateral incisor began to hurt and felt loose, causing pain when touched.

I am wondering, Dr.
Lin Chia-Yung, what could be causing this level of pain that makes me want to extract the tooth? It has made it difficult for me to concentrate on work.
The painkillers provide only slight relief, lasting about an hour, and I can't sleep; I wake up due to the pain.
Should I consider going to another larger hospital?

Qiuqiu, 20~29 year old female. Ask Date: 2021/01/09

Dr. Lin Jiayong reply Dentistry

Hello: During the root canal treatment process, the body also requires healing and recovery, which necessitates patience and time.
It is recommended that you first return to Shuanghe Hospital for further management and communicate in more detail with your treating physician.
Thank you! Sincerely, Lin Chia-Yung, Department of Dentistry, Taichung Hospital, Ministry of Health and Welfare.

Reply Date: 2021/01/09

More Info

Understanding post-endodontic pain can be quite complex, as it often stems from various factors related to the dental procedure itself, the condition of the tooth, and individual patient responses. Based on your detailed account, it seems you have been experiencing significant discomfort following a root canal procedure on your front tooth, which has not only affected that tooth but also caused pain in adjacent teeth.

Causes of Post-Endodontic Pain
1. Inflammation and Infection: After a root canal treatment, inflammation can occur in the surrounding tissues. If the infection was not completely resolved during the procedure, it can lead to persistent pain. This inflammation may also affect the adjacent teeth, causing them to become sensitive or painful.

2. Incomplete Cleaning: As your dentist mentioned, if the root canal was not fully cleaned, remnants of the pulp or bacteria may remain, leading to ongoing pain. The root canal system can be complex, and sometimes additional canals may not be identified or treated during the initial procedure.

3. Post-Operative Sensitivity: It is common for teeth to be sensitive after a root canal, especially if the procedure was extensive. This sensitivity can last for several days to weeks, but if it persists or worsens, it may indicate a problem.

4. Occlusal Trauma: If the tooth is not properly adjusted after the root canal, it may be hitting harder than the surrounding teeth when you bite down, leading to pain. This is often referred to as occlusal trauma and can cause discomfort in the treated tooth and adjacent teeth.

5. Adjacent Tooth Issues: The pain in your adjacent tooth could be due to referred pain from the treated tooth or an independent issue with that tooth, especially if it had previous decay or structural problems.

Solutions and Recommendations
1. Follow-Up with Your Dentist: It is crucial to maintain open communication with your dentist. Given the ongoing pain, you should return for a follow-up appointment. Your dentist may need to reassess the tooth, possibly taking new X-rays to evaluate the root canal's success and check for any signs of infection or complications.

2. Consider a Second Opinion: If you feel that your concerns are not being adequately addressed, seeking a second opinion from another dental professional, particularly an endodontist (a specialist in root canal treatment), may provide more insight into your situation.

3. Pain Management: While you are currently taking CataFLAM, it may be beneficial to discuss alternative pain management strategies with your dentist. They may prescribe stronger analgesics or recommend adjunct therapies, such as anti-inflammatory medications or even a short course of steroids to reduce inflammation.

4. Evaluate Adjacent Teeth: Since you mentioned pain in the adjacent tooth, it may be worthwhile to have that tooth evaluated as well. If it has structural issues, it may require treatment to alleviate the pain.

5. Restorative Treatment: If the root canal is confirmed to be successful but you still experience pain, your dentist may recommend placing a crown on the tooth to provide additional support and protection, which can also help with sensitivity.

6. Consider Referral to a Pain Specialist: If the pain persists despite dental interventions, a referral to a pain management specialist may be warranted. They can provide additional strategies for managing chronic pain, which may include physical therapy or other modalities.

Conclusion
Post-endodontic pain can be frustrating and debilitating, especially when it interferes with daily activities and work. It is essential to address these concerns with your dental care provider and explore all avenues for relief. Persistent pain is not typical after a root canal, and further investigation is warranted to ensure that all underlying issues are addressed. Don't hesitate to advocate for your health and seek the care you need to alleviate your discomfort.

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