Deep Root Canal Treatment: Causes of Pain and Complications

Issues with Over-Instrumentation in Root Canal Treatment

Hello Dr.
Tseng: I have a large cavity in my upper left canine tooth.
I have been seeing the same dentist for all my treatments.
On September 13, I had my first root canal, and the dentist placed a temporary filling afterward.
During my follow-up appointment on September 21, the dentist tapped on the tooth, and it still hurt, so I underwent a second root canal, and again, a temporary filling was placed.
On my third visit on September 28, I mentioned that pressing on the area near my left nostril was painful, but the canine tooth itself was no longer painful.
However, during the third root canal, when the dentist inserted the needle, I felt some soreness, so they administered another local anesthetic and continued with the procedure.
After completing the root canal, I had my first X-ray taken, and after reviewing the images, the dentist placed a filling.
Another X-ray was taken, and I was informed that I would need to return for a dental crown.
I would like to ask if the pain when pressing on the left side of my nostril could be due to the root canal being too deep, and why, after the third root canal, I experienced more pain four hours later compared to the first two times?

Mr. Hsieh, 20~29 year old female. Ask Date: 2022/09/28

Dr. Zeng Guanghui reply Dentistry

Pain upon pressing the nasal wing may indicate that there is still inflammation between the tooth roots.
The apical area of the root canal may require further debridement.
It is also possible that the root canal treatment was performed too deeply.
However, as long as the apical region is cleaned properly, the inflammation will gradually improve.
Dr.
Tseng Guang-Hui, Department of Dentistry, Nantou Hospital.

Reply Date: 2022/09/28

More Info

Understanding the complexities of root canal treatment, especially when complications arise, is crucial for both patients and dental professionals. Your experience with persistent pain following multiple root canal procedures raises several important considerations regarding the underlying causes of pain, potential complications, and the appropriate steps to take moving forward.

Firstly, it’s essential to understand that root canal treatment involves the removal of the dental pulp, which contains nerves and blood vessels. This procedure is typically performed to alleviate pain caused by infection or decay. However, even after the pulp is removed, patients may experience pain for various reasons. In your case, the pain you are experiencing, particularly in the area around your left nasal wing, could be attributed to several factors:
1. Residual Infection: If there is any remaining infection in the tooth or surrounding tissues, it can lead to ongoing pain. This is particularly relevant if the root canal treatment was not completely successful in removing all infected tissue.

2. Inflammation: After a root canal, inflammation can occur in the surrounding tissues, which may cause discomfort or pain. This inflammation can sometimes be exacerbated by the procedure itself, especially if multiple attempts are made to clean and fill the canal.

3. Pressure Changes: The process of cleaning and filling the root canal can create pressure changes within the tooth. If the pressure is not adequately relieved, it can lead to pain that may feel more intense after the procedure.

4. Nerve Sensitivity: Even after the nerve is removed, the surrounding tissues can remain sensitive. This sensitivity can sometimes be mistaken for pain originating from the tooth itself.

5. Referred Pain: The sensation of pain can sometimes be referred from other areas, such as the sinuses or jaw, especially if there is inflammation or pressure in those regions.

Regarding your specific question about whether the pain near your left nasal wing is due to "overly deep" nerve extraction, it’s important to clarify that during a root canal, the goal is to remove the entire pulp tissue without damaging surrounding structures. However, if the procedure inadvertently irritates nearby tissues or if there is an anatomical variation, it could lead to discomfort in adjacent areas.

Given that you have experienced increased pain after the third procedure, it is advisable to take the following steps:
1. Follow-Up with Your Dentist: It’s crucial to communicate your ongoing pain to your dentist. They may need to take additional X-rays to assess the situation further and determine if there are any complications that need to be addressed.

2. Consider a Specialist: If your current dentist is unable to resolve the issue, it may be beneficial to seek a consultation with an endodontist, a specialist in root canal treatments. They have advanced training and tools that may help in complicated cases.

3. Pain Management: In the interim, ensure you are managing your pain effectively. Over-the-counter pain relievers may help, but if the pain is severe, your dentist may prescribe stronger medication.

4. Monitor Symptoms: Keep track of any changes in your symptoms, including swelling, fever, or changes in the pain’s intensity or location. This information can be valuable for your healthcare provider.

5. Consider Further Treatment Options: If the pain persists despite treatment, your dentist may discuss other options, such as retreatment of the root canal, apicoectomy (surgical removal of the root tip), or even extraction if the tooth cannot be saved.

In conclusion, while root canal treatments are generally effective in alleviating pain caused by dental issues, complications can arise that lead to persistent discomfort. Understanding the potential causes of pain and maintaining open communication with your dental care provider are key to finding a resolution. Your health and comfort are paramount, and seeking timely intervention can help prevent further complications.

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