Persistent Sensitivity After Root Canal Treatment: What to Do Next?

Q: Persistent Sensitivity After Root Canal Treatment: What to Do Next?

Hello： If you are concerned about a possible crack in the tooth root, it is recommended to take a CBCT scan for confirmation. <br>If there is no fracture, you can continue to have the endodontist monitor and treat the tooth. <br>However, if a fracture is confirmed, extraction is

Six months after root canal treatment, there is still sensitivity when touching the tooth?

Hello, Doctor.
I had a traditional root canal treatment on my upper right third molar at the end of July this year.
During the treatment, medication was placed and observed, then medication was placed again and observed until the end of September (with weekly follow-ups).
However, I still experienced slight pain when touching the tooth.
The treating dentist mentioned that the root canal was cleaned thoroughly and suggested monitoring it until there was no sensation before returning for a crown placement.
However, during this period, I continued to feel some discomfort when touching the tooth (a few touches would elicit a sensation, but then it would go numb).
Although the discomfort was tolerable, the crown placement was delayed.
In November, I returned for a follow-up and asked the dentist about it.
He again placed medication and suggested monitoring, stating, "There might be a crack in the tooth! If the pain does not improve, I recommend extraction." Consequently, in mid-December, I visited another dental clinic for a self-paid microscopic root canal treatment.
The dentist indicated that one of the root canals had not been cleaned properly and addressed that issue.
Following this, I underwent medication placement and observation again, with weekly follow-ups.
However, I still felt sensations when touching the tooth.
I also asked the dentist to use a microscope to check for any cracks, and the result was normal.
On January 6, when the dentist placed medication, I experienced significant pain, which he explained was due to the medication being placed deep into the root apex.
The next day (January 7), the tooth was swollen and uncomfortable all day (likely due to the medication taking effect).
On days 2 and 3 (January 8-9), I felt no sensation when touching the tooth, and I initially thought the sterilization had been successful.
However, afterward, the tooth returned to its previous state, and I still felt sensations when touching it.
Although the pain was slightly improved and less frequent, it was still present.
I would like to ask the doctor:
1.
Are there any other recommended approaches?
2.
Should I continue with "medication placement and observation"?
3.
If extraction is not considered for now, will it affect the tooth, surrounding tissues, or other teeth?
Thank you, Doctor.

A Mei, 30~39 year old female. Ask Date: 2022/01/12

Dr. Lin Jiayong reply Dentistry

Hello: If you are concerned about a possible crack in the tooth root, it is recommended to take a CBCT scan for confirmation.
If there is no fracture, you can continue to have the endodontist monitor and treat the tooth.
However, if a fracture is confirmed, extraction is indeed a treatment option to prevent further damage to the surrounding healthy structures.
Sincerely, Lin Chia-Yung, Department of Dentistry, Taichung Hospital, Ministry of Health and Welfare.

Reply Date: 2022/01/12

More Info

After undergoing a root canal treatment, it's not uncommon for patients to experience persistent sensitivity or discomfort in the treated tooth. Your situation, where you have experienced ongoing pain and sensitivity despite multiple treatments, raises several important considerations.

1. Understanding the Pain: The pain you are experiencing could be due to several factors. After a root canal, it's possible for the tooth to remain sensitive for a period of time as the surrounding tissues heal. However, if the pain persists or worsens, it may indicate that the root canal treatment was not entirely successful. This could be due to an incomplete cleaning of the canals, the presence of additional canals that were not treated, or even the development of a crack in the tooth that may not have been detected during the examination.

2. Next Steps: Given that you have already sought a second opinion and undergone a more thorough treatment with a microscope, it may be beneficial to continue monitoring the situation closely. If the sensitivity is tolerable and does not significantly interfere with your daily life, your dentist may recommend a wait-and-see approach. However, if the pain becomes more pronounced or if you notice swelling or other symptoms, it may be necessary to consider further intervention.

3. Further Treatment Options: If the sensitivity continues, you might want to discuss additional treatment options with your dentist. This could include:
- Retreatment: Sometimes, a second root canal treatment may be necessary if the first one did not adequately address the issue.

- Apicoectomy: This surgical procedure involves removing the tip of the tooth root and any infected tissue, which can help resolve persistent issues.

- Consultation with a Specialist: If you haven't already, consider consulting an endodontist, a specialist in root canal treatments. They may have more advanced techniques or insights into your specific situation.

4. Impact of Delaying Treatment: If you choose to delay further treatment and the tooth continues to be symptomatic, there is a risk of developing more serious complications, such as an abscess or further infection. This could potentially affect the surrounding teeth and overall oral health. Therefore, while it is understandable to want to avoid extraction, it is crucial to keep an eye on the tooth's condition.

5. Monitoring and Follow-Up: Regular follow-ups with your dentist are essential. They can monitor the healing process and determine if any changes occur that might necessitate a different approach. If you notice any new symptoms, such as increased pain, swelling, or fever, you should seek immediate dental care.

In summary, while it is not uncommon to experience some sensitivity after a root canal, persistent pain warrants further investigation. Continuing to communicate openly with your dental care provider about your symptoms and concerns is crucial. They can guide you through the best course of action based on your specific situation, ensuring that you receive the appropriate care to resolve your discomfort.

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