Root canal therapy is often the only way to calm the pain of an inflamed tooth without removing it. Sometimes the pain does not go away after a root canal treatment, or it returns after a while. Find out here why pain can come back after a root canal treatment and what you can do about it.
What is a root canal treatment?
An inflamed tooth causes severe toothache. If you suffer from these aches, there are only two options: Either to remove the affected tooth, or we must remove the inflamed nerve from the tooth. Root canal treatment is always an attempt to preserve a diseased tooth. Sometimes, the canal system within the tooth is so complex that the attempt to preserve it fails.
Post root canal pain: how can it happen?
Since the dentist removes the nerve from the tooth during a root canal treatment, many patients assume that there will be no more toothache on the root-treated tooth afterwards. This assumption is obvious, but we cannot rule pain after the root canal treatment.
There can be various reasons for this pain: On the one hand, the canal system is so complex that it sometimes cannot be completely cleaned and tissue residues and bacteria remain in the tooth which can lead to renewed inflammation. Another reason for renewed pain can be a fracture of the treated tooth. Depending on the cause, your pain can start right after the root canal treatment, come back a few weeks later, or last for a longer period.
Option 1: Your pain occurs right after the root canal treatment
Pain is not uncommon right after the root canal treatment. By removing the nerve, the dentist made a minor wound at the bottom of the tooth. This wound can and should be painful shortly after the treatment.
If your dentist has given pain killers to the root-treated tooth, the symptoms usually go away the next day. Alternatively, there are drugs that do not relieve pain. Here, the pain can last for a few days. If there is no swelling, however, bearable pain is nothing to worry about.
However, this pain should subside after a few days. If the symptoms do not improve a few days after the root canal treatment, visit the dentist again.
Option 2: The toothache persists days after the root canal treatment
If the pain does not go away shortly after the root canal treatment, further treatment is necessary. If a dentist does not complete the root canal treatment, we can easily treat the pain. If it has already placed a root filling in the tooth, treating the pain becomes more complicated.
The cause of toothache on a root-treated tooth that does not subside is almost always insufficient cleaning of the canal system, because of which bacteria migrate to the tip of the root and cause inflammation there. Taking an antibiotic and properly disinfecting the root canals will initially ensure freedom from pain. However, sometimes it is not possible to clean the root canals clean completely because it is overly complex.
Another cause of discomfort that does not go away is a crack in the tooth. The teeth that have undergone root canal treatment sometimes become unstable and crack. Bacteria can also penetrate the tooth interior through this crack and cause pain. Unfortunately, in this case, the tooth cannot be preserved because a crack cannot be closed in such a way that bacteria can no longer penetrate.
In both cases, bacteria cause pain after root canal treatment. The body fights the microorganisms by sending defense cells into the jawbone. There these cells form a protective wall to prevent the bacteria from spreading in the body. Affected patients feel this inflammatory reaction as pain. If the inflammation is very severe, the gums can swell. The severe pain produces this swelling.
Attention: If swelling develops on the root-treated tooth after a root canal treatment, please consult a dentist immediately. Here, too many microorganisms have entered the jaw from the dead tooth. There pus has formed, which is now causing the swelling. The spread of the inflammation can have life-threatening consequences in individual cases.
Option 3: The pain returns after a root canal treatment
If pain occurs again after some time in a tooth that has undergone root canal treatment, bacteria are almost always responsible. The question here is how the microorganisms got into the tooth.
There are several ways to do this:
1. The microorganisms remained in the tooth during the root canal treatment.
2. The filling of the tooth is no longer in order so that germs can penetrate.
3. The tooth has new cavities that have brought bacteria into the tooth.
4. The tooth has a crack through which germs can penetrate.
If one of the first three cases occurs, a new root canal treatment, the so-called revision, can achieve the desired success. The alternative to this is surgical intervention: extraction or apical resection. In the fourth case, the only therapy is the removal of the tooth.
Option 4: Bacteria does not cause the pain
There are also toothaches that bacteria do not cause. For patients, however, they feel the same pain as the one caused by microorganisms. Often the affected teeth hurt when biting and the pain disappears for a brief time when taking a pain reliever, but then occurs again. Often the pain radiates, but we find nothing unusual on an X-ray.
Here, teeth grinding may be responsible for your discomfort. Since the tooth is missing some nerves after a root canal treatment, the brain can no longer assess the stress on the tooth as precisely as that on the other teeth. If the patient grinds or presses heavily on the root-treated tooth, the tooth holding apparatus and the surrounding muscles are overloaded and an occlusal splint can help.
What helps in the short term against the pain after a root canal treatment?
For short-term pain after a root canal treatment, you can take a pain reliever. However, if you regularly take other medication, you must make sure that the pain reliever is compatible with the other active ingredients. You should also refrain from consuming alcohol while taking pain medication.
Tip: If the root canal treatment is still to come, ask your dentist for a prescription for pain medication. Please also tell him about any other supplements you are taking. In this way, the dentist can check whether the active ingredients interact and prescribe the remedy for you. If you have no symptoms after the root canal treatment, you can save the pain medication for a later date.
Treatment options for recurrent pain after a root canal
1. The root canal revision/
Unfortunately, during canal treatment, it is not possible to clean it completely, so that germs remain. It is so hard to remove microorganisms from a tooth if it fills the roots, all that remains is to disinfect the root canals again, also known as a root canal revision.
Since it already fills the canals, the dentist must first remove the existing filling. As soon as we have removed the old filling, the sewer system can be disinfected again with rinsing. Inserting medication also helps to clean the canals. The inflammation under the affected tooth can now subside because new bacteria are not always coming from the tooth. The cleaned root canals can fill again at a further treatment appointment.
This renewed root canal treatment is only rarely a service provided by statutory health insurance companies. It is promising. According to the German Society for Endodontics, the probability of success is 65 – 90%. Additional services such as the use of an operating microscope and the distribution of different irrigation with ultrasound in the canals must be paid for privately.
By the way: There are dental supplement tariffs that reimburse 100% of all services. Dentolo’s supplementary dental insurance will even insure you retrospectively for acute dental problems.
2. The root tip resection
Not every tooth is the same, some teeth have a strong curvature at the root tip thus all instruments cannot grasp and clean that.
Often, however, this area is so small that it is not a problem. If inflammation develops around the root tip, there is the option of performing a root tip resection after the root treatment. This treatment is a minor surgical procedure, as the untreated tip of the root and the surrounding inflammation are completely removed. The dentist can then clean the root canals from below and seal them tightly.
3. Tooth extraction
The tooth broke, if the inflammation is too big, or you have had the affected tooth removed, the last option is to perform a tooth extraction. Once the tooth is gone, the inflammation heals too. You can then have the gap filled with a bridge, an implant, or a prosthesis.
Are you wondering which solution is right for you? Your dentist will help you figure out which solution is best for you. In hopeless cases, tooth extraction may be the only sensible way to go. With an inadequate root filling, the revision is often sufficient, and with a complex canal system, a sequence of revision and apical resection may be necessary to save the tooth.
If in doubt, contact a specialist
If your tooth hurts after a root canal treatment, please contact your dentist. He can tell you if the pain is normal or if treatment is needed.
In complicated cases, it can also be useful to consult a specialist. This usually makes his work pay dearly. However, a specialized dentist will only treat you if he is certain that he can save your tooth.