Question:
I recently had a root canal finished (it took 3 appointments.. isn't
that unusually long?). Now, after the 2nd appointment I had a good deal
of pain in the tooth for a few days, almost exclusively when biting down
on it (or poking it, if I was disposed to poke it, which I was not). I
hadn't been expecting any pain and was sort of alarmed. The dentist gave
me some pain meds and filed down the tooth a bit so I wasn't biting on it
involuntarily. All was well and the pain faded. Then last week he
finished the root canal (and incidentally pulled the widsom tooth
immediately behind the root-canalled tooth). I had the same sort of
pain-upon-biting in the root canal tooth after that, too. The root canal
tooth wasn't being hit by normal biting, but pressure caused by biting on
the tooth in front of it was painful. This pain also lessened over the
past week, and I went back today to get a crown put on now that the root
canal is done. I was a bit worried, though -- if he's all done with the
root canal, doesn't the tooth have no nerve left and thus it should have
no sensation? Why does it hurt? Sure, it's faded before, but he wasn't
*done* then. Anyway, putting the crown on REALLY REALLY HURT. I mean, I
alarmed people in the waiting room with my shriek and I nearly kicked the
dentist. The tooth doesn't hurt as long as I'm not biting down on it, and
the crown seems to fit well enough, but biting on that tooth is still
quite painful. It's not pain in the gums, it's not pain from the
extraction behind it, it's not pain in the tooth in front of it -- it's
very specifically pain caused by pressure on the tooth that has had the
root canal. The dentist seemed to think this would go away, and based on
past experience perhaps he's right, but.. *why* would the *tooth itself*
hurt after a completed root canal? Was it right to cement the crown on
despite the pain? The dentist said the x-rays after teh root canal looked
good. Is this sort of pain normal, or explicable, or what?
Answer:
In all seriousness I have had to deal with this question literally hundreds
of times as I perform close to 500 root canals each year. The newer
technologies have decreased the incidence of post operative discomfort.
I absolutely cannot diagnose this situation without seeing the post -endo
x-ray and knowing the actual "feel" of the procedure but I can address the
commonly placed question of why this still hurts when the "nerve is gone"
from the tooth.
There are nerves everywhere in the body. One type is inside teeth. Another
is in the thin lining around the root. Just having a root canal procedure
sometimes causes a lingering inflammation to the extremely sensitive nerve
endings that line the root.
This 'usually' subsides with time (if there is no root fracture or
perforation of the root and if the root canal was filled properly) Placing
the crown on the tooth in a 'timely' fashion was the best way to proceed.
The alternative might have been a fractured tooth in time. (especially if
the tooth was significalntly broken down from decay or previous restoration
failure)
I think that the combination of the multiple procedures, (protracted
endodontics and a 3rd molar extraction) have led to some truly uncomfortable
inflammatory reactions in the supporting tissues around the endodontically
treated tooth.
No further advice is pro-offered other than to know that this will either
subside with time or there is some other cause for the pain such as a root
fracture or perforation that happen in the best of circumstances, as simple
risks of a procedure.
Give it some time and then come back for follow-up with your dentist or the
group. There is always a perceived need to just "do something" when this
happens and that leads to further complications. There is no harm done by
just wait and see at this point. And wait and see means also good follow up
with some x-rays of the area later on even if it all seems just fine!
I know you can't diagnose over the net, I just wanted a ballpark
idea about whether pain after the procedure is within the realm of
normality. My dentist was pretty vague. I had to get the crown on fast
because I was moving out of town last week and we ran out of space for
further appointments. I plan to leave my teeth alone for a while and hope
that they get better. Followup would be difficult with the same dentist
as I'm quite far away from him now, but I'll be seeking out a new one in
the area soon enough.
