Cosmetic Dentistry Blog Cosmetic and General Dentistry Questions Answered

July 20, 2016

The use of steroids to treat root canal pain


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Dr. Hall,
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

Patty,
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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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.

6 Comments »

  1. Hi Dr. Hall,
    What are some key indicators to look for in a root canal specialist? I am sure many dentists will claim to be one, but how can I weed those dentists out?
    Megan

    Response by Dr. Hall
    Unlike cosmetic dentistry, endodontics (root canal treatment) is a specialty that is recognized by the American Dental Association, and legitimate root canal specialists will have gone to school an additional two years and their practice will be limited to only doing root canals. For any dentist to call himself or herself an endodontist, they have to have had this extra training.

    Comment by Megan — July 20, 2016 @ 3:34 pm

  2. I had no idea steriods blocked the symptoms of infection. I have a doc that prescribes them liberally. I’ll be more educated next time. Thank you. – Annmarie

    Response by Dr. Hall:
    Annmarie,
    It’s not that they block the SYMPTOMS of infection, they block the body’s RESPONSE to infection. So the things your body does to fight the infection, steroids block those things.

    Comment by Annmarie — August 8, 2016 @ 7:34 pm

  3. Hi there, last month my sister had a root canal treatment from Cal Dental Group in Southern California, which was suggested by one of her friends. A few days after treatment she had some pain while chewing, but slowly she had relief and they don’t suggest to use steroids.

    Comment by Enrique Lyon — November 30, 2016 @ 11:29 pm

  4. I think your response to this question 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.’

    Response by Dr. Hall,
    Nan Anne, I think your comment deserves a separate post. Here’s a link to read it: Is this a failed root canal?.

    Comment by Nan Anne — March 8, 2017 @ 7:10 am

  5. Great post about the use of steroids. I’m a general dentist in Los Angeles who does a lot of root canal treatments, and I find your information very useful. Thank you.

    Comment by General Dentist — July 7, 2017 @ 12:06 am

  6. Hi, I had 2 root canal 2 days ago. After the root canal I started to experience severe pain. I thought I was going to die. I called my dentist and he give me a steroid’s prescription. I took the 1st day dosage last night and after 1 hours I had no pain, slept well and woke up feeling happy because I can live again :-). Now doing some researching about Methylprednisolone I found Dr. Hall’s post. Not sure what to think, if I should stop taking it but I’m scared of the pain again. I’m still taking 200mg ibuprofen every 6 hours plus 500mg Amoxicillin every 8 hours. – Serli

    Serli,
    I’m a little confused by what you are telling me. Yes, if you have simple inflammation, steroids are an excellent treatment. Since your pain responded to steroids, that tends to indicate that you were having simple inflammation, even though it was severe. I would see no reason not to continue with your dentist’s prescription. But then why the antibiotic? This is where I think that some dentists are not using proper diagnosis. If the cause of the pain is inflammation, then steroids. If the cause is infection, then antibiotics. But one or the other, not both. – Dr. Hall

    Comment by Serli Maciel Greene — July 26, 2018 @ 6:53 am

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