Persistent Pain After Root Canal: Seeking Solutions and Expert Recommendations

Q: Persistent Pain After Root Canal: Seeking Solutions and Expert Recommendations

Hello： Root canal treatment is a highly intricate medical procedure. <br>For successful root canal therapy, it is essential to remove all necrotic pulp tissue from the root canal system, achieve complete sterilization, and eliminate any endotoxins. <br>After carefully shaping the

Unresolvable root canal treatment

Hello Dr.
Liu,
I would like to ask you a question that has been troubling me for a long time.
I had a root canal treatment on my front tooth nearly a year ago, but I still experience occasional pain.
Two months ago, I underwent the procedure again, but the pain persists, accompanied by sensitivity.
I have consulted many dentists, and their opinions vary:
1.
Some dentists say that the pulp chamber was not cleaned properly.
2.
Others claim it is clean, but the X-ray shows a dark shadow at the apex, suggesting surgical treatment may be necessary.
3.
There are also dentists who believe the issue is caused by the adjacent tooth (which also has problems), so a week ago, I had a root canal done on that tooth.
However, the dentist only used MTA to fill it and applied a paste at the apex.
When I asked if there might be residual pulp in the affected tooth, the dentist said it wouldn't matter if there was residual pulp.
Currently, the tooth that underwent the second root canal is very painful in the area near my nose (just below the nostril).
It feels hard to the touch, and pressing on it causes significant pain.
Even biting into food, sometimes even bread, is painful.
Is this normal? How can I determine if the pulp chamber is truly clean to prevent recurrence? If a dentist claims it is clean and then places a crown, but later it is found not to be clean, will the crown still be viable? Would I need to redo the procedure?
Additionally, since I live in Taichung, could you recommend a good endodontist in the area? I have seen many doctors, but the problem remains unresolved, and I am at a loss about what to do next.
Sincerely,
Leonard

Leonard, 30~39 year old female. Ask Date: 2004/05/10

Dr. Liu Tiancai reply Dentistry

Hello: Root canal treatment is a highly intricate medical procedure.
For successful root canal therapy, it is essential to remove all necrotic pulp tissue from the root canal system, achieve complete sterilization, and eliminate any endotoxins.
After carefully shaping the root canal, it should be filled with materials that meet the standards for root canal filling to ensure a tight seal.
Successful root canal treatment should be asymptomatic, with no tenderness, and X-rays should show no radiolucency in the periapical area.
1.
The presence of radiolucency outside the apex indicates bacterial infection within the root canal, which can be retreated without the need for surgery.
2.
Incomplete removal of pulp tissue is often associated with future inflammation.
3.
After root canal treatment, symptoms should diminish to minimal or completely absent within 2-3 weeks; if there is a hard sensation, it indicates inflammation, and a specialist should be consulted.
4.
The root canal has a three-dimensional shape, making it difficult to accurately assess cleanliness through X-rays.
5.
If symptoms arise after a crown has been placed, it is best to remove the crown and redo the root canal if possible; if the crown needs to be preserved, surgical intervention may be necessary to address the root canal issue.
6.
In the Taichung area, there are several endodontic specialists, such as Dr.
Chen Jin at Taichung Veterans General Hospital and Dr.
Zheng Kun-Yuan at China Medical University Hospital, who are highly skilled and can address your concerns.

Respectfully, Dr.
Liu Tian-Cai, Director of Dentistry, Taoyuan Hospital, Ministry of Health and Welfare.

Reply Date: 2004/05/10

More Info

Dear Leonard,
I understand your frustration and discomfort regarding the persistent pain after your root canal treatment. It can be incredibly challenging to deal with ongoing dental issues, especially when the solutions seem elusive. Let's break down your concerns and explore potential solutions based on the information you've provided.

Understanding Persistent Pain After Root Canal Treatment
1. Incomplete Cleaning of the Root Canal: One of the most common reasons for persistent pain after a root canal is that the root canal system was not completely cleaned or sealed. The root canal system can be complex, with multiple canals that may not be visible on X-rays. If any infected tissue or bacteria remain, it can lead to ongoing pain and discomfort.

2. Periapical Radiolucency: The "black shadow" you mentioned at the root tip on X-rays could indicate an infection or inflammation in the bone surrounding the tooth. This condition, known as periapical periodontitis, often requires additional treatment, such as retreatment of the root canal or even surgical intervention (apicoectomy) to remove the infected tissue.

3. Adjacent Teeth Issues: Sometimes, pain can be referred from adjacent teeth that also require treatment. If the neighboring tooth has decay or an infection, it could contribute to the discomfort you're experiencing.

4. Residual Pulp Tissue: If there is residual pulp tissue left in the canal, it can cause ongoing pain. This is why thorough cleaning and shaping of the canal are crucial during the initial treatment.

Recommendations for Management
1. Seek a Specialist: Given your ongoing issues, it may be beneficial to consult an endodontist, a specialist in root canal treatments. They have advanced training and tools to diagnose and treat complex cases. If you are in Taichung, I recommend looking for an endodontist with good reviews and experience in handling difficult cases.

2. Diagnostic Imaging: A 3D imaging technique, such as Cone Beam Computed Tomography (CBCT), can provide a more detailed view of the root canal system and surrounding structures. This imaging can help identify any missed canals or other issues that may not be visible on standard X-rays.

3. Consider Retreatment: If your current dentist or endodontist believes that the root canal was not adequately cleaned, retreatment may be necessary. This involves reopening the tooth, cleaning out the canals again, and resealing them.

4. Pain Management: While waiting for your next appointment, over-the-counter pain relievers like ibuprofen or acetaminophen can help manage discomfort. However, it’s essential to follow the recommended dosages and consult with your healthcare provider if you have any concerns.

5. Follow-Up Care: After any retreatment, it’s crucial to have regular follow-ups to ensure that the infection has resolved and that the tooth is healing properly. If a crown is placed, it should be monitored for any signs of discomfort or infection.

Conclusion
Persistent pain after a root canal can be due to various factors, including incomplete cleaning, adjacent tooth issues, or residual pulp tissue. Seeking the expertise of an endodontist and considering advanced imaging can provide clarity on the underlying issues. Remember, it’s essential to communicate openly with your dental care providers about your symptoms and concerns to find the most effective treatment plan.

If you need recommendations for specific endodontists in Taichung, I suggest checking local dental associations or online reviews to find a reputable specialist. Your comfort and health are paramount, and I hope you find relief soon.

Best wishes for your dental health,
Doctor Q&A Teams

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