Post-Root Canal Gum Pain: Causes and Solutions Explained

Gum pain after root canal treatment?

Hello Dr.
Huang: I had root canal treatment on my upper left third molar a while ago, and I have already had a crown placed on it.
However, when I press on the upper outer gum area, I feel pain (it doesn't hurt when I don't press).
Sometimes, I also feel a "throbbing" sensation in that tooth (similar to a pulse, but it doesn't hurt).
Since I've already had root canal treatment, why is this happening? What further treatment is needed? Additionally, I have dentures on my lower left three teeth.
Initially, I felt a lack of strength when biting, but it has improved slightly as I'm getting used to them.
However, I noticed that when brushing my teeth, I feel a slight sharp pain where the denture meets the gum.
I'm not sure why this is happening.
Thank you for your response.

Lili, 40~49 year old female. Ask Date: 2007/06/27

Dr. Huang Zhicheng reply Dentistry

Dear Miss Lili,
(1) The third tooth from the left on the lower jaw may still have periapical inflammation, which could explain the pain when pressure is applied to the outer side near the root tip.
It is advisable to consider redoing the root canal treatment.
(2) The three lower left teeth appear to have some root exposure, similar to sensitive teeth.
It is recommended to use fluoride toothpaste or have a dentist apply fluoride.
However, if the pain is due to an ill-fitting crown, then it should be redone.
Sincerely,
Dr.
Huang Chih-Cheng
Director of Dentistry, Taoyuan Hospital, Department of Health

Reply Date: 2007/06/27

More Info

Post-root canal pain, especially in the gums, can be a perplexing issue for many patients. After undergoing root canal therapy, it is not uncommon to experience some discomfort or pain, particularly in the days or weeks following the procedure. This can be attributed to several factors, which I will outline below, along with potential solutions.

Causes of Post-Root Canal Gum Pain
1. Inflammation and Healing: After a root canal, the tissues around the tooth may become inflamed as they heal. This inflammation can lead to tenderness and pain when pressure is applied to the gums. Typically, this discomfort should subside within a few days to a couple of weeks. If the pain persists beyond this timeframe, it may indicate an underlying issue.

2. Residual Infection: Sometimes, bacteria can remain in the root canal system despite treatment. This can lead to an ongoing infection, which may cause pain and discomfort in the gums. If there is an abscess or a pocket of infection, it may require further treatment, such as retreatment of the root canal or even surgical intervention.

3. Incomplete Treatment: If all the canals of the tooth were not adequately treated or if there are additional canals that were missed, this could lead to persistent pain. In some cases, teeth with complex root canal systems may require advanced techniques, such as the use of a microscope, to ensure complete cleaning and sealing.

4. Pressure from Bite: If the tooth has been restored with a crown, improper occlusion (bite alignment) can lead to discomfort. If the crown is too high, it can cause excessive pressure on the tooth when biting down, leading to pain in the gums and surrounding tissues.

5. Nerve Sensitivity: After a root canal, the nerves in the area may still be sensitive as they heal. This can sometimes manifest as a "pulsing" sensation, which may feel like the tooth is throbbing or "pulsing" in rhythm with your heartbeat.

Solutions and Recommendations
1. Follow-Up Appointment: It is crucial to return to your dentist for a follow-up appointment. They may recommend taking X-rays to assess the status of the tooth and surrounding bone. This can help identify any issues such as residual infection or incomplete treatment.

2. Pain Management: Over-the-counter pain relievers, such as ibuprofen or acetaminophen, can help manage discomfort. However, if the pain is severe or persistent, your dentist may prescribe stronger medication.

3. Adjustments: If the issue is related to bite alignment, your dentist may need to adjust the crown or any other restorations to ensure proper occlusion. This can alleviate pressure on the tooth and surrounding gums.

4. Further Treatment: If an infection is suspected, your dentist may recommend retreatment of the root canal or possibly an apicoectomy (surgical removal of the tip of the root) to address the issue.

5. Oral Hygiene: Maintaining good oral hygiene is essential, especially after dental procedures. Be gentle when brushing around the treated area to avoid aggravating the gums. If you experience pain while brushing, consider using a softer toothbrush or adjusting your technique.

Regarding Your Lower Teeth
As for the discomfort you are experiencing with your lower false teeth, it is not uncommon to feel some sensitivity or discomfort as you adjust to new dental prosthetics. The connection between the false teeth and the gums can be sensitive initially. Here are some tips:
- Adjustment Period: Give yourself time to adjust to the new false teeth. It can take a few weeks for your mouth to adapt fully.

- Soft Diet: Consider a soft diet during the initial adjustment period to minimize discomfort while eating.

- Consultation: If the pain persists, consult your dentist. They may need to make adjustments to the false teeth to ensure a better fit and reduce irritation.

In conclusion, while post-root canal pain can be concerning, it is essential to communicate with your dentist about your symptoms. They can provide a thorough evaluation and recommend appropriate treatment to alleviate your discomfort.

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