Tooth Pain After Root Canal Treatment and Dental Crowns - Dentistry

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Pain in a dental crown following root canal treatment and bleeding gums?


Hello Doctor, I have been suffering from tooth pain recently.
The main issue started with pain in my lower right first molar, which was followed by pain in the corresponding upper tooth (both of these teeth have undergone root canal treatment and have crowns).
The dentist took X-rays of the upper tooth and stated that there were no cavities, but they did find bleeding gums.
I then went to another clinic for a second opinion, and they also confirmed that the upper tooth had no cavities but recommended extracting the first molar.
They suggested that the pain in the upper tooth might be referred pain, so the first molar was extracted, and I was scheduled for an implant afterward.
I have been on antibiotics for four days (three days before the extraction and one day after).
Last night, the upper tooth started bleeding again and was painful, especially in the spaces between that tooth and its neighbors.
The pain relief medication is not effective, and it is even more painful than the extraction site, which has not yet healed, making it difficult for me to sleep.
I would like to ask the doctor what other possible causes there could be for the pain in this tooth? What treatment should I pursue? Should I consult a specific dental specialty at the hospital? Could it be that a secondary cavity in the upper tooth is difficult to detect on X-rays? Or does the crown need to be redone? I noticed a black line on the inner side of the crown near the gums, and I have many questions.
Thank you in advance for your response.

li, 30~39 year old female. Ask Date: 2023/08/24

Dr. Zeng Guanghui reply Dentistry


Hello Ms.
Li: It is recommended to return for a follow-up appointment with a dentist to take X-rays and conduct a detailed examination to determine whether there are cracks in the teeth or inflammation of the dental nerve, and then decide on the appropriate treatment.
Dr.
Tseng Guang-Hui, Department of Dentistry, Nantou Hospital.

Reply Date: 2023/08/24

More Info


Tooth pain after root canal treatment and the placement of dental crowns can be a complex issue, often leading to confusion and distress for patients. Based on your description, it seems you are experiencing significant discomfort in your upper molar area, which has been exacerbated by the extraction of the lower molar and subsequent dental procedures. Let's break down the potential causes and solutions for your situation.


Understanding the Pain
1. Referred Pain: The pain you are experiencing in the upper molar could be referred pain from the lower molar that was extracted. This phenomenon occurs when pain is perceived in an area different from its source. The nerves in the jaw are interconnected, and issues in one area can manifest as pain in another.

2. Gum Issues: You mentioned bleeding gums, which can indicate periodontal disease or inflammation. If the gums around your upper molar are inflamed, this could lead to pain, especially when chewing or applying pressure. It's crucial to address any gum disease, as it can affect the health of the surrounding teeth.

3. Dental Crown Complications: If your upper molar has a dental crown, there could be several issues at play:
- Crown Fit: If the crown does not fit properly, it can cause discomfort or pain when biting down. An ill-fitting crown can lead to pressure on the underlying tooth or surrounding gums.

- Underlying Tooth Issues: Even if X-rays show no visible decay, there could be issues such as a cracked tooth or residual infection that are not easily detectable. A root canal may not have fully resolved the underlying problem, leading to persistent pain.

4. Infection: After an extraction, it’s possible for an infection to develop in the surrounding area, especially if there was pre-existing gum disease. This could explain the bleeding and pain you are experiencing.
5. Sinus Issues: Given the location of your upper molars, sinus problems can also cause discomfort that mimics tooth pain. If you have sinusitis or other sinus issues, this could contribute to the pain in your upper teeth.


Recommended Actions
1. Consult a Specialist: Given the complexity of your symptoms, it would be advisable to consult with an endodontist (a specialist in root canal treatments) or a periodontist (a specialist in gum disease). They can provide a more thorough examination and may use advanced imaging techniques, such as a cone beam CT scan, to identify issues that standard X-rays might miss.

2. Further Evaluation of the Crown: If the crown is suspected to be the source of pain, it may need to be evaluated for fit and integrity. If there is a black line near the gum line, this could indicate a problem with the crown material or an issue with the underlying tooth.

3. Gum Treatment: Addressing any gum disease is critical. This may involve professional cleaning, scaling, or even surgical intervention if the disease is advanced.

4. Pain Management: Continue to manage your pain with over-the-counter pain relievers, but consult your dentist if the pain persists or worsens. They may prescribe stronger medications or recommend alternative treatments.

5. Follow-Up Care: After any dental procedure, follow-up care is essential. Ensure you attend all scheduled appointments and communicate any ongoing issues to your dental care provider.


Conclusion
Tooth pain following root canal treatment and crown placement can stem from various sources, including referred pain, gum disease, crown complications, or infections. It is crucial to seek specialized dental care to accurately diagnose and treat the underlying issues. By addressing these concerns with the appropriate dental specialists, you can work towards alleviating your pain and ensuring the long-term health of your teeth and gums. Remember, effective communication with your dental team is key to finding the right solution for your discomfort.

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