Persistent Swelling and Pain After Root Canal Treatment: What to Do?

Q: Persistent Swelling and Pain After Root Canal Treatment: What to Do?

Hello： Your teeth may still have symptoms of periapical inflammation, which can cause swelling and tenderness upon percussion. <br>After root canal treatment, inflammation outside the apex may sometimes take time to resolve. <br>It is important to maintain close communication wit

After root canal treatment (nerve extraction), there is still a feeling of swelling, and tapping on the area causes pain?

During root canal treatment, the doctor mentioned that there was calcification.
While using the instruments, I felt a lot of force being applied while working inside the nerve canal.
One of the canals (there are a total of three) was very painful.
The doctor said the pain would naturally subside.
After three days, I had a core build-up, and then five days later, I received a crown.
However, after 15 days, I still feel swelling, and tapping on the occlusal surface is still painful.
What should I do? Thank you.

Ya tong you gou fan, 30~39 year old female. Ask Date: 2014/12/08

Dr. Huang Zhicheng reply Dentistry

Hello: Your teeth may still have symptoms of periapical inflammation, which can cause swelling and tenderness upon percussion.
After root canal treatment, inflammation outside the apex may sometimes take time to resolve.
It is important to maintain close communication with your dentist and return for follow-up visits every month.
If symptoms persist after three months, it may be necessary to remove the crown and post, and re-disinfect the root canal.
Only after the symptoms have resolved should the crown be placed.
Wishing you safety and good health.
Sincerely, Dr.
Huang Chih-Cheng, Director of Dentistry, Taoyuan Hospital, Ministry of Health and Welfare.

Reply Date: 2014/12/08

More Info

Persistent swelling and pain after root canal treatment can be concerning and may indicate several underlying issues. It's essential to understand that root canal therapy is designed to remove infected or damaged pulp tissue from within the tooth, and while it can alleviate pain, some discomfort may persist for a variety of reasons.

Firstly, the presence of calcification in the canals, as mentioned by your dentist, can complicate the procedure. Calcified canals can be difficult to clean and shape properly, which may leave residual bacteria or infected tissue behind. This can lead to ongoing inflammation and pain. If the pain persists beyond a few days, it may indicate that the cleaning and disinfection process was not entirely successful.

Swelling and pain after root canal treatment can also be a sign of a few other conditions:
1. Incomplete Cleaning: If all the canals were not adequately treated, or if there are accessory canals that were missed, this could lead to persistent symptoms. In your case, with three canals, if one was not fully cleaned, it could harbor bacteria.

2. Post-Operative Inflammation: After a root canal, it is normal to experience some inflammation as the body responds to the procedure. However, if the swelling does not subside after a few days, it may be a sign of an ongoing infection or other complications.

3. Periapical Abscess: Sometimes, an abscess can form at the root of the tooth if infection persists. This can cause significant pain and swelling and may require further treatment, such as retreatment of the root canal or even surgical intervention.

4. Bite Issues: If the tooth is not properly aligned after the procedure, it can lead to discomfort when biting down. This can be due to the temporary filling or crown being too high, causing pressure on the tooth.

5. Allergic Reaction or Sensitivity: Some patients may have a reaction to the materials used during the root canal, which can cause prolonged discomfort.

Given that you are experiencing swelling and pain even after several days, it is crucial to follow up with your dentist. Here are some steps you can take:
- Contact Your Dentist: Inform them about your persistent symptoms. They may want to examine the tooth again, possibly taking new X-rays to assess the situation.

- Pain Management: Over-the-counter pain relievers such as ibuprofen or acetaminophen can help manage discomfort. However, if the pain is severe or worsening, prescription medication may be necessary.

- Avoid Hard Foods: Stick to soft foods to avoid putting pressure on the affected tooth until you can see your dentist.

- Follow-Up Treatment: Depending on the findings, your dentist may recommend retreatment of the root canal, additional imaging (like a cone beam CT scan), or possibly a referral to an endodontist (a specialist in root canal treatments).

In conclusion, while some discomfort can be expected after a root canal, persistent swelling and pain warrant further investigation. It is essential to communicate openly with your dental care provider to ensure that any underlying issues are addressed promptly. Early intervention can often prevent more severe complications and help preserve your tooth.

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