Post-Root Canal Pain: Possible Nerve Issues

New deep pain begins after root canal treatment?

Hello Doctor, I just completed a microscopic root canal treatment on my lower left second molar last week.
During the procedure, I felt a spot (under the root) that repeatedly became inflamed and painful, but it would alleviate whenever the dentist opened it up for cleaning during the next appointment.
This continued until the treatment was completed.
In the week leading up to the filling, I occasionally experienced discomfort, but the doctor said the inflammation had significantly improved, so they proceeded with the filling.
Everything felt normal for five days, but on the sixth day, I started to feel a bit of discomfort, which worsened day by day.
By the eighth day, I began to feel pain; opening my mouth slightly or lying on my side sometimes made me feel pressure on a specific spot, which could cause discomfort or a momentary sharp pain.
Strangely, if I maintained a position (e.g., lying on my side) without moving, the sharp pain would disappear.
When I returned to the dentist, they reviewed the X-rays and said everything looked normal, suggesting it might not be an issue with the tooth itself.
However, I am still experiencing this sharp pain, which is quite bothersome.
The clinic doctor advised me to see a hospital's oral surgery or neurology department for further examination.
Currently, I have visited a general clinic and received medication for neurology, which has alleviated the pain, but I still feel something unusual around the root canal tooth.
1.
Is it possible to develop trigeminal neuralgia just a few days after completing a root canal treatment? Could it be that coincidental?
2.
I feel pressure on a specific spot or something; could it be that I am compressing a newly grown nerve? If so, would the only solution be to extract the tooth to completely eliminate this sharp pain?

Zhang, 20~29 year old female. Ask Date: 2022/09/09

Dr. Jiang Junyi reply Neurology

Hello Mr.
Zhang,
From an epidemiological perspective, the annual incidence of trigeminal neuralgia is approximately 4 to 13 per 100,000 people.
It is more common in females than in males and occurs more frequently in adults than in children.
The incidence increases with age, commonly affecting adults around the age of 50.
You do not belong to a high-risk group.
The course of trigeminal neuralgia varies from person to person.
Episodes can last from a few days to several weeks or months, followed by periods of remission.
Symptoms tend to recur, but effective treatment can usually control them.

I recommend that you ask your dentist for a referral to a regional hospital's oral and maxillofacial surgery department for a second opinion.
(Patients with a referral will be prioritized for appointments at the referral desk.) If the oral surgeon rules out any structural abnormalities, they will typically refer you to the neurology department of that hospital.
Thank you for your inquiry.
If you have any related questions, feel free to discuss further! Wishing you good health and peace.
Dr.
Jiang Junyi, Taoyuan Medical Center, cares about you.

Reply Date: 2022/09/09

More Info

Post-root canal pain can be a frustrating and concerning experience, especially when it seems to be linked to nerve issues. Let's break down your questions and concerns regarding the pain you're experiencing after your root canal treatment.

1. Can post-root canal pain develop into trigeminal neuralgia?
While it is uncommon, it is possible for post-root canal pain to mimic symptoms of trigeminal neuralgia, especially if the pain is sharp, sudden, and triggered by certain movements or stimuli. Trigeminal neuralgia is characterized by intense, stabbing pain along the distribution of the trigeminal nerve, which innervates the face, including the teeth. However, the onset of trigeminal neuralgia shortly after a dental procedure is rare. More commonly, pain following a root canal can be attributed to inflammation, infection, or irritation of the surrounding tissues, including the nerves.

2. Could the pain be due to pressure on a newly grown nerve?
It is plausible that the discomfort you are feeling is related to inflammation or irritation of the nerves in the area surrounding the treated tooth. After a root canal, the body goes through a healing process, and sometimes the surrounding tissues can become inflamed, leading to discomfort. This inflammation can put pressure on nearby nerves, causing sensations of pain or discomfort. However, it is unlikely that this would necessitate tooth extraction unless there is a significant underlying issue, such as an infection that has not been resolved.

Additional Considerations:
- Healing Process: After a root canal, it is normal for some discomfort to persist as the area heals. The pain you are experiencing could be due to residual inflammation or irritation from the procedure itself. It is essential to give your body some time to heal, but if the pain worsens or does not improve, further evaluation is warranted.

- Follow-Up Care: Since your dentist has suggested seeing an oral surgeon or neurologist, it is a good idea to follow through with that recommendation. They can perform a thorough examination and possibly imaging studies to rule out any complications, such as an abscess or nerve entrapment.

- Pain Management: It is encouraging that you have received some relief from the medication prescribed by the neurologist. Pain management is crucial in the recovery process, and if the current medications are not providing adequate relief, discussing alternative options with your healthcare provider is essential.

- Potential Complications: In some cases, if there is a persistent infection or if the root canal treatment was not entirely successful, it may lead to ongoing pain. If this is the case, your dentist may recommend retreatment or other interventions.

In conclusion, while it is possible for post-root canal pain to mimic nerve-related issues, it is essential to have a thorough evaluation to determine the exact cause of your discomfort. Follow-up appointments with your dentist and possibly a specialist will help ensure that any underlying issues are addressed, allowing for a more comfortable recovery. If the pain persists or worsens, do not hesitate to seek further medical advice.

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