Root Canal Treatment Issues: Common Concerns and Solutions

Issues related to root canal treatment?

Hello, doctor.
I had a dental bridge placed on my upper right central incisor, lateral incisor, and premolar two years ago after having the lateral incisor extracted.
The central incisor and premolar were reduced in size to accommodate the bridge (healthy teeth).
About a month ago, I experienced discomfort in the central incisor and returned to the clinic that placed the bridge, where I was diagnosed with the need for root canal treatment.
The procedure involved drilling a small hole behind the bridge on the central incisor for the root canal.
After the first root canal treatment, I returned a week later because I still felt some discomfort.
The dentist changed the medication and suggested monitoring it.
After a few subsequent visits, the pain would subside for the first couple of days after changing the medication, but by the fourth day, I would start to feel discomfort again (a feeling of pressure and pain at the apex).
Recently, I even experienced pain radiating to the side of my nose.
Due to the lack of improvement, the dentist suggested continuing to change the medication and monitoring for another week until there is no pain or symptoms before sealing it.
The dentist indicated that this situation might require several more cleanings to resolve, and if pain persists, they would consider enlarging the root canal and trying different medications.
A CT scan was performed, and the doctor noted no obvious root fractures or dark shadows.
Since March 15, I have returned to the clinic about six times, with the pattern being severe pain → return for root canal medication change → symptoms disappear → pain returns after about four days → return for another visit.
My questions are:
1.
Why does the pain significantly decrease after changing the medication, but then return after a couple of days?
2.
Could the medication used in the root canal cause an allergic reaction in my body? (I heard the dentist mention calcium hydroxide.)
3.
Since my occlusal force is currently concentrated on the right side (the upper left molar is undergoing implant placement), could this be related to the root canal pain?
4.
I always feel a sense of pressure inside the root canal of the central incisor.
Could it be that the internal pressure decreases after changing the medication, but builds up again over a few days, leading to pain? Would sealing it help reduce the pressure on the tooth?
5.
Should I continue changing the medication and monitoring until there is no pain, or should I undergo additional examinations? Thank you.

A-Kang, 10~19 year old female. Ask Date: 2022/04/13

Dr. Zeng Guanghui reply Dentistry

If pain persists after several sessions of root canal treatment, it is possible that the apex of the tooth root is still in an inflamed state.
However, if the root canal has been thoroughly cleaned and pain continues, there may be tiny cracks in the tooth root that are causing recurrent infections and inflammation.
It is advisable to return for a follow-up appointment for a detailed examination by a dentist.
Dr.
Tseng Guang-Hui, Department of Dentistry, Nantou Hospital.

Reply Date: 2022/04/13

More Info

Understanding root canal treatment issues can be quite complex, especially when patients experience persistent pain or discomfort after the procedure. Based on your detailed description, it seems you are facing several challenges following your root canal treatment on your upper right front tooth. Let’s address your concerns one by one.

1. Recurring Pain After Treatment: It’s common for patients to experience pain after a root canal, especially if the tooth was already compromised before the procedure. The pain you feel may be due to inflammation in the surrounding tissues or an incomplete cleaning of the root canal system. The fact that you feel relief after medication but then experience pain again suggests that there may be residual infection or inflammation that hasn't been fully resolved. This could be due to complex root canal anatomy that may not have been fully cleaned or treated.

2. Allergic Reactions to Medications: The medication used in root canal treatments, such as calcium hydroxide, is generally well-tolerated. However, in rare cases, patients can have allergic reactions to dental materials or medications. If you suspect an allergy, it’s important to discuss this with your dentist, who may consider alternative medications or treatments.

3. Bite and Occlusion Issues: You mentioned that your bite is currently unbalanced due to ongoing dental work on the left side. An uneven bite can indeed contribute to discomfort and pain in the teeth that are bearing the load. If your right side is compensating for the left side, it could lead to increased pressure and pain in the treated tooth. It’s essential to have your bite evaluated and adjusted if necessary, as this can significantly affect your overall dental health and comfort.

4. Pressure Sensation in the Tooth: The sensation of pressure you describe could be related to the inflammation in the area or the buildup of fluids within the tooth or surrounding tissues. After each treatment, if the pressure decreases, it may indicate that the inflammation is temporarily relieved. However, if the underlying issue is not resolved, the pressure can build up again. Sealing the tooth may help reduce the pressure, but it’s crucial to ensure that the infection or inflammation is adequately addressed first.

5. Continuing Medication vs. Further Evaluation: Your dentist’s recommendation to continue with medication and observation is a common approach, especially if there are signs of improvement. However, if the pain persists despite multiple treatments, it may be time to consider further diagnostic evaluations, such as advanced imaging (like a 3D cone beam CT scan) or referral to an endodontist (a specialist in root canal treatments). They can provide a more detailed assessment of the root canal system and determine if additional treatment, such as retreatment or surgery, is necessary.

In summary, your situation highlights the complexities of root canal treatments and the importance of thorough evaluation and management. Persistent pain can arise from various factors, including incomplete cleaning of the root canals, bite issues, or even allergic reactions to materials used. It’s crucial to maintain open communication with your dental care provider, express your concerns, and consider seeking a second opinion if you feel your issues are not being adequately addressed. Your comfort and health should always be the priority in any dental treatment plan.

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