Toothache After a Root Canal

One of the most dreadful scenarios that most people would agree with is sitting in a dentist's chair. However, something that supersedes even that scene in cruelty is after having undergone root canal treatment, thinking with relief that now you can sleep peacefully at night, only to stay awake all night clutching your jaw with both your hands. Root canal pain is something that spells doom for both - the dentist and the patient. Ideally, there should not be any pain after root canal treatment; in fact there shouldn't be any pain after the first sitting of the treatment, that is, after complete pulp extirpation. However, sometimes the patient does return complaining of root canal pain after treatment.

Ghost Pain
Although sometimes pain is said to be an undesirable root canal complication, some patients, after a root canal procedure, may complain of pain which may actually not be there. Often, after a root canal procedure, a patient may mistake sensitivity for pain. Sensitivity may occur due to either the material used, or the tooth involved, but there shouldn't be any pain. Thus, it is firstly important to distinguish whether the person is experiencing sensitivity and tingling in the tooth, or actual pain after root a canal.

Crown Impingement
In most cases after root canal treatment, if the tooth was significantly decayed, with less than two walls intact, then a crown is given. The crown on the tooth maybe either loose fitting, in which case it presents a leeway for the entry of food particles, which subsequently becomes a breeding ground for bacteria, or the crown maybe too tight, in which case, it may impinge on the gums, causing gum irritation, inflammation, swelling and pain.

Faulty Diagnosis
Root canal treatment is often the last resort that most dentists take to while trying to save the tooth, because the fact is that even the best artificial tooth in the world will never come close to a natural decayed tooth. However, there are certain cases that are sometimes misdiagnosed, or treated with root canal treatment as a last ditch effort to save the tooth, which may lead to complications. These include cases that have a combined periodontic-endodontic lesions, cases where the tooth pain may actually be due to a periodontal disease, which obviously does not stop pain from occurring.

Pre-existing Infection
In some cases, initially the tooth infection may have spread to the bone, but may not be visible in the X-ray, because of which the dentist may not suspect that you have an infection that has spread to the bone. Also, if there is a periapical abscess that is present, then after the first step of root canal procedure, the dentist should wait till the entire abscess is drained, before proceeding. This is necessary because the infection in the abscess, if left behind, may aggravate and cause pain due to progressive bacterial multiplication. Also, in some cases, the person maybe immunocompromised, like if the person is suffering from diabetes, or any other disease, then he is at a higher risk of suffering from root canal pain post treatment.

Hyperocclusion
Sometimes, the patient may experience pain only on biting or occluding his root canal treated tooth. This may occur if the dentist does not grind the occlusal surface of the tooth, due to which the tooth will still be in occlusion. This can not only lead to pain during and after the root canal treatment, but the prognosis for such a tooth is also very poor. Furthermore, this problem may eventually lead to temporomandibular joint disorders.

Faulty Root Canal Treatment
Well, as much as every dentist will blame you for the root canal pain after treatment, citing your inability to follow the required post root canal treatment protocol, the truth is, that there is a possibility that the dentist may be at fault as well. Now before you run to sue your dentist, you need to know that there are certain factors that are not very easily avoided. For example, sometimes, teeth that are very curved at the root, so it may be difficult to access the root completely. Due to this, at times, that side of the root gets perforated by the instrument, which becomes an entry portal for bacteria. Furthermore, the dentist may at times miss out on an extra canal in an abnormal tooth, or incompletely fill the canal causing gas pressure and pain, or fracture the root, or use material that causes a hypersensitivity reaction. All this may lead to problems like pain and swelling post treatment. Sometimes, when the instrument enters the canal, it may inadvertently push the infection further deeper into the apex, causing pain. The biggest nightmare though, for both dentist and patient, is when an instrument breaks in the canal. The tip of the instrument, especially if it is a curved canal, sometimes breaks off, which makes its retrieval, well, let's just say, not so easy. In such cases, the instrument is removed either via the opening of the canal, or by taking an apical root by a procedure known as apicoectomy.

Prevention of Root Canal Pain

• After the root canal procedure, give the tooth some time to recuperate, because after all the drilling that it has gone through, it will take some time to recover from it. Furthermore, try and identify if the pain is indeed pain and not merely sensitivity.
• For patients who are susceptible to infections or already have a pre-existing infection, do the root canal procedure under an antibiotic cover, just to be on the safe side and to provide the patient with some pain relief.
• Ensure that the crown is of proper fit when it is placed. If it impinges or causes even a little bit of discomfort, inform the dentist then and there.
• Follow all the post root canal treatment instructions and other dental care instructions diligently, because remember, they're for your own good (your dentist is not going to win a lottery if you take your medicine on time).

After a root canal procedure, the patient may feel some kind of slight tingling and sensitivity, but should definitely not return to the dentist complaining of pain and impaired dental health. To prevent these complications and more, all dentists should chalk out a detailed treatment plan, keeping the possible risks of the procedure in mind. So always remember - diagnose thrice and treat once, don't diagnose once and treat thrice!