Cosmetic Dentistry Blog Cosmetic and General Dentistry Questions Answered

March 8, 2017

Delayed pain after a root canal treatment


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Dr. Hall,
I think your response to Patty from Kansas about increased post-root canal pain a few days following the procedure was somewhat misleading. It’s my understanding (and several resources suggest) that it is not uncommon to experience peak inflammation/pain 48-72 following a root canal, yet you advised: ‘The tooth being fine right after the second time doing the root canal but then the pain coming back a few days later, that is a particularly bad sign. This isn’t ordinary post-operative pain but a failed root canal.’
– Nan Anne from Chicago

Nan Anne,
I didn’t write what I wrote from reading research about it, but from actual extensive clinical experience and an understanding of the physiology involved. And I’m not sure that your reading is disagreeing with me. You didn’t say who these “several resources” were, but you did say they are suggesting that peak inflammation occurs 48-72 hours following the root canal. I think that may be true, if the pain is not treated by reducing the occlusion. The tooth hurts right after the novocain wears off but then, untreated, it feels worse the second day, maybe a little worse the third day, and then starts getting better. So the pain has peaked on the third day. That sounds about right. When there is postoperative pain after a root canal treatment that comes from simple inflammation, it will hurt right away and then get worse, and then get better.

But that is different from what Patty from Kansas reported to me. She said her tooth felt fine for 2-3 days after the procedure and then started to hurt again after that. That’s a typical pattern for post-operative infection. And then, to add further weight to this being an infection, she indicated that the pain continued after that and the root area is still tender.

Prodded by your comment, I did revise the blog post to make it more clear that when I said she had a failed root canal, I was talking about her particular case, and I don’t mean to imply that whenever a root canal tooth begins hurting a few days later it is a failed root canal. This was her second time around, so the root canal had already failed once. I’m confident that her renewed pain was not just a simple inflammatory reaction to the instrumentation of her tooth.

– Dr. Hall

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About David A. Hall

Dr. David Hall was one of the first 40 accredited cosmetic dentists in the world. He practiced cosmetic dentistry in Iowa, and in 1990 earned his accreditation with the American Academy of Cosmetic Dentistry. He is now president of Infinity Dental Web, a company in Mesa, Arizona that does complete Internet marketing for dentists.

May 25, 2011

This dentist isn’t handling this infection correctly.

Hi Dr. Hall,
So I had my root canal done a few years ago (3 or so) and just started hurting hard a week and a half ago. I saw a dentist on Tuesday last week, who saw infection on an x-ray and did root canal re-treatment and sent me home with Penicillin 500mg and Vicodin. Pain wasn’t going away after these meds so I was using 400mg ibuprofen too to get a minor relief until Saturday when I did get an hour or two no pain but everything still highly sensitive. And pain keeps coming back hard! Sleepless nights all this time!

Sunday to Tuesday it kept hurting. I feel pressure in my jaw and my tooth is kinda hurting, numb pain, constant feeling that I am trying to ignore most of the day. Not to mention headaches during the whole week and also earache Saturday thru Monday!

I saw the same dentist again to consult, and he said that some people have a longer recovery and since pain is less – it is going to be better. And if still hurts after two weeks, we can do another dose of antibiotics. I am still up at night (it’s the 9th night since he did re-treatment!!!) and taking 400mg ibuprofen and waiting for pain to stop!

I want to know is it really that my course of recovery is so long or is something else? Thanks much!!!
– Kate from New York

Kate,
I think you should see a root canal specialist. This infection should be resolving by now if the penicillin were working. I have a couple of points for you.

When you have a root canal that fails, generally a root canal re-treatment will be successful somewhere between half the time and three quarters of the time. So there is a reasonable chance that this root canal re-treatment won’t be successful.

Also, penicillin would not generally be the first choice of antibiotic for a root canal infection, especially for a situation of root canal failure, so I question your dentist’s judgment on that. And I question his judgment further if he hasn’t offered to change the antibiotic when this has been going on for a week. Penicillin resistance of infections is very common. He should have switched you to clindamycin or another strong antibiotic when you had gone a few days and weren’t seeing any significant improvement.

Also, if I am understanding what you are saying, the pain did get better but then got worse again. That’s a particularly bad sign. Clearly this isn’t working.

Ask him for a referral to a root canal specialist (endodontist), and if you get any delays, find one on your own.
– Dr. Hall

Response from Kate:
Thanks so much! I didn’t have anyone to tell me that this is not normal or that meds he gave don’t work. I really knew that something is wrong and all he said was to wait for 14 days! horrible.

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About David A. Hall

Dr. David Hall was one of the first 40 accredited cosmetic dentists in the world. He practiced cosmetic dentistry in Iowa, and in 1990 earned his accreditation with the American Academy of Cosmetic Dentistry. He is now president of Infinity Dental Web, a company in Mesa, Arizona that does complete Internet marketing for dentists.

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