Why Does My Tooth Still Hurt After Microscopic Root Canal Treatment?

Q: Why Does My Tooth Still Hurt After Microscopic Root Canal Treatment?

Hello： It is recommended to return to the original clinic for treatment, including occlusal adjustment, replacement of the dental crown, redoing the root canal, or periodontal therapy, among others. <br>Besides the dental pulp nerves, the nerves surrounding the tooth can also res

Even after undergoing microscopic root canal treatment and having a crown placed, pain may still persist?

Hello doctor, my second to last lower left molar underwent root canal treatment at the end of June.
The dentist mentioned that the tooth was calcified and could not be thoroughly cleaned, so I was referred for microscopic root canal treatment.
I completed the microscopic root canal treatment and had a crown placed around September.
I do not experience pain when not eating, but when I bite into slightly hard foods, such as fried items or meat, I feel pain on the side of the tooth near the tongue at certain angles.
However, I have no issues with soft foods.
Due to the pain, I am hesitant to bite down, which has led to digestive problems, and it’s quite frustrating.
Could you help me understand why, even after completing the root canal treatment, I am still experiencing pain as of December? I have also visited another clinic for a check-up, but the doctors advised me to just observe and did not take any action.
However, biting still causes pain… What could be the reason for this? Should I go to a larger hospital for further examination? Thank you.

Ms. Wu, 30~39 year old female. Ask Date: 2023/12/11

Dr. Lin Jiayong reply Dentistry

Hello: It is recommended to return to the original clinic for treatment, including occlusal adjustment, replacement of the dental crown, redoing the root canal, or periodontal therapy, among others.
Besides the dental pulp nerves, the nerves surrounding the tooth can also respond to stimuli.
Therefore, if the tooth is subjected to excessive occlusal forces, even if the root canal treatment is successful, it may still cause pain during biting.
Whether this issue can be resolved depends on the specific situation.
If you wish to seek confirmation at a medical center, you can schedule an appointment with the Endodontics department.

Reply Date: 2023/12/11

More Info

Tooth pain after a microscopic root canal treatment can be frustrating and concerning, especially when it persists despite undergoing what is typically a definitive treatment. There are several potential reasons for your ongoing discomfort, and understanding these can help guide your next steps.

First, it’s important to recognize that root canal treatment aims to remove infected or inflamed pulp tissue from within the tooth and seal the space to prevent further infection. However, even after a successful procedure, some patients may experience pain due to a variety of factors.

1. Incomplete Cleaning or Treatment: In cases where the tooth has significant calcification or complex root canal anatomy, it is possible that not all infected tissue was removed. This can lead to persistent pain and discomfort. If your dentist mentioned that the tooth was calcified and difficult to clean, this could be a contributing factor.

2. Post-Operative Inflammation: After a root canal, it’s common for the surrounding tissues to be inflamed. This inflammation can cause discomfort, especially when pressure is applied, such as when biting down on harder foods. This pain may gradually subside over time as the inflammation resolves.

3. Cracks or Fractures: Sometimes, a tooth may have micro-cracks that are not visible on X-rays. These cracks can lead to pain when biting, especially if the tooth is subjected to pressure from harder foods. If your tooth was previously treated and then restored, it’s possible that the restoration itself could be contributing to the pain if it is not properly aligned or if it is too high.

4. Occlusal Issues: If the bite is not properly aligned after the crown placement, it can lead to discomfort when chewing. This misalignment can create excessive pressure on certain areas of the tooth, leading to pain. It’s important to have your bite evaluated by your dentist to ensure that the crown is not interfering with your normal chewing function.

5. Underlying Periodontal Issues: Sometimes, pain can be referred from the gums or the bone surrounding the tooth. If there is an underlying periodontal issue, such as gum disease or an abscess, this could manifest as pain in the tooth itself.

6. Nerve Sensitivity: After a root canal, some patients may experience nerve sensitivity as the tooth adjusts to the absence of the pulp. This sensitivity can sometimes be exacerbated by certain foods or temperatures.

Given that you have already sought a second opinion and were advised to observe the situation, it may be beneficial to keep a detailed record of when the pain occurs, what foods trigger it, and any other symptoms you may experience. This information can be valuable for your dentist or a specialist.

If the pain persists or worsens, it may be worth considering further evaluation by an endodontist (a specialist in root canal treatment) or a periodontist (a specialist in gum disease). They can perform more detailed imaging, such as a cone beam CT scan, to assess the tooth and surrounding structures for any issues that may not have been previously identified.

In summary, while it can be disheartening to experience ongoing pain after a root canal treatment, there are several potential explanations. It is crucial to communicate openly with your dental care providers about your symptoms and concerns, as they can help you navigate the next steps in your treatment plan.

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