PAIN is the first thing that comes in most people’s mind when someone starts to talk about root canals.
Pain, actually the fear of pain, is the main reason why some people delay their visit to the dentist for root canal treatment, although they already have tooth pain and other symptoms of tooth infection.
Finally they end up suffering much more pain than those visiting their dentist early for proper treatment. The majority of root canal procedures are not painful, both during and after treatment.
The bad reputation that root canals are painful is due to the fact that most people associate root canal pain with the strong pain
they feel prior to the treatment caused by the infection in the tooth and not with the root canal treatment procedure itself.
The truth is that some decades ago, root canal treatments were indeed painful. Today, with modern technology and anesthetics, a root canal treatment is not more uncomfortable or painful than having a dental filling.
Root canal pain may be a sign of complications which may increase the cost of the overall treatment.
A good dental insurance may prove very useful in this case.
Most endodontic procedures need only minimal anesthesia. If the nerve of the tooth is already dead, the patient may need no anesthesia at all.
Local anesthesia is provided before beginning the root canal procedure, to numb the tooth and the surrounding area and ensure that the root canal procedure will be painless.
A single shot of anesthetic is generally sufficient to totally anesthetize a tooth in order to complete a root canal procedure comfortably.
But under certain conditions, a root canal may prove to be more painful than expected:
- Badly inflamed teeth. Regular anesthesia may be inadequate in case of severe tissue inflammation.
The acidic environment caused by the inflammation decreases the effectiveness of anesthesia that is pH sensitive.
In these cases a higher dose of anesthesia is required, especially if the tooth nerve is still alive.
In general, the chance of experiencing pain during or after root canal increases as stronger was the pain that somebody had before going to the dentist.
A root canal treatment may need more than one dental visit. Some patients experience root canal pain between the dental visits that could be caused by the following conditions:
- Gas pressure build-up. This condition happens between visits after the nerve has been removed from the tooth, but before the canals and pulp chamber are filled.
The dentist uses a temporary filling to isolate the tooth interior until the next visit.
The volume of air trapped inside the tooth may increase if the environment’s pressure decreases (bad weather / air flights) or the temperature rises.
The only way for the air to expand is through the root tips, pressuring the surrounding tissues and causing pain.
A mild analgesic is enough for temporary pain relief. Removing the temporary filling will provide a more drastic solution if analgesics have no result.
- Bruxism. Habits such as grinding and clenching teeth can cause severe pain problems during (and after) a root canal treatment, especially in case of hyper occlusion of the treated tooth.
During clenching the pressure is transferred to the already irritated periodontal ligaments and bone around the tooth tips, causing discomfort and root canal pain.
Stopping the bruxism habit and treating the malocclusion (if any) is necessary to relieve the pain.
It is normal to experience some discomfort for a few days after root canal treatment. A post root canal pain should be expected if the tooth was seriously painful before the procedure.
The tooth might feel tender when biting or chewing and may even appear to feel loose. Many people wonder why does a tooth hurts after root canal since the nerve is removed.
But actually it is not the tooth itself that hurts but the surrounding tissues.
Tooth pain after root canals may be caused by the following conditions:
- Periapical abscess (concentration of fluid at the tip of the root). This fluid may be a result of the initial infection due to bacteria that were forced beyond the tip of the root during the endodontic procedure.
In some cases, the periapical abscess is caused by small amounts of the fluid that is used to clean and sterilize the canals pressed beyond the tip of the root during the root canals cleaning.
In both cases the pressure on the tissues surrounding the tooth roots is increasing, causing pain and sometimes swelling. The dentist must ensure that there is no fluid around the roots before permanently filling the tooth.
Failure to drain and properly disinfect the periapical area may result in severe post root canal pain.
- Irritation of periodontal ligament. A tooth abscess will usually cause an inflammation of the periodontal ligament around the root tips of the infected tooth.
The periodontal ligament may be further irritated by overextension of the file beyond the tip of the root during the procedure, as well as by the forcing of debris and fluids beyond the tip of the root during the cleaning of the root canals.
This irritation may cause a mild pain after the root canal procedure.
- Inflammation of adjacent tissues. Discomfort may not be related directly with the treated area but with the inflammation of nearby tissues due to the increased blood flow during the healing process of the infected tissues.
- Bruxism and Hyper occlusion is another cause of post root canal pain.
The dentist must correct the occlusion of the tooth, so that it does not make contact with the opposing teeth, not only to stop the related pain but also to protect the treated tooth from fracturing.
- Failed root canal. If a tooth that has had endodontic treatment continues to cause significant pain and/or the tooth is sensitive to cold, it could be a sign of a failed root canal.
A return visit to the dentist is necessary to re-evaluate the tooth’s condition if you feel persistent pain after a root canal.
The post root canal pain is usually managed with over the counter pain medications.
If the pain is intense the dentist may prescribe anti-inflammatory medication or a stronger analgesic to provide pain relief.
- Eat a soft diet for at least two days and do not to chew on the treated side until the tenderness is gone.
- Avoid very hot or cold foods between dental visits until the tooth is filled.
- Warm salt-water rinses can help relieve the pain.
The pain normally subsides within a few days. A post root canal pain that continues for more than a week or two may be an indication of a failed treatment or of a post root canal therapy infection.
If you have an insisting post root canal pain, contact your dentist to ensure that your condition seems to be within the normal limits and exclude the possibility of a severe complication.
The cost involved with root canal treatment is significant and many patients may not afford it if they are not covered by their dental insurance.
Learn how to choose a dental insurance that will help you provide the best dental treatment to yourself and your family.