I had a root canal in May in a front tooth and serious pain following it, I was treated with antibiotics and steroids. This did not help so the dentist redid the root canal. I felt OK for 2-3 days then the pain came back. I feel a lot of pressure on this front tooth and the gum is inflamed and the root area is tender.
– Patty from Kansas
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There are some experts in root canal treatment who recently have been advocating treating postoperative root canal pain with steroids, but I disagree with that. Yes, if there is simple inflammation, steroids are an effective treatment. But the problem is that you have some dentists who don’t understand pharmacology well enough or aren’t good enough at diagnosis, and you have the treatment being misapplied, as I believe it was in your case.
Steroids block inflammation. That’s why some of these dental school professors recommend it for post-operative pain. There is irritation of the tissue around the end of the root of the tooth because the instruments used to clean out the teeth irritated it. When that happens, that tissue tends to swell, raising the tooth and causing traumatic occlusion, which only irritates that tissue more. It’s a nasty vicious cycle and Decadron, a steroid, is an effective treatment.
But the problem is that steroids also block the body’s response to infection. So when you have a post-operative infection, as you apparently did, steroids do more harm than good. And then the dentists feel that, to cover the possibility that there is infection involved, they need to prescribe antibiotics. This leads to an overuse of antibiotics and contributes to the serious public health problem of cultivating antibiotic-resistant bacteria in the population.
What I did for post-operative root canal pain in my practice, that was very effective, was that I would give a strong dose of ibuprofen at the beginning of the root canal appointment, so that it was fully absorbed by the time I was done with the appointment. This would help head off that inflammatory response. (Ibuprofen is a non-steroidal anti-inflammatory drug.) Then I would reduce the occlusion of the root canal tooth so that it didn’t touch the opposing tooth when the patient clenched together. Since the tooth would later need a crown anyway, it wouldn’t hurt to reduce it a little. That pretty much took care of any post-operative pain.
So what do you do now? 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 in your case appears to be a failed root canal. In your case, this would be the second failure on this tooth. It seems that the infection here has never completely gone away, and thus the tenderness around the root comes from that persistent infection. If this wasn’t done by a root canal specialist, I would ask for referral to a specialist. The specialist may feel that he or she could solve the problem by re-doing the treatment one more time. Or, root canal surgery is fairly simple on an upper front tooth, if that’s what tooth we’re talking about. That may be required. Or you could end up losing the tooth.
– Dr. Hall
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