Root Canal Treatment
 

Is Root Canal Painful?

The phrase 'root canal' is generally enough to put fear in the minds of even the toughest individuals, but truthfully it's not a very painful procedure. I think it is largely a fear of the concept of 'taking the nerve out of the tooth- Aaarrrghh.' I see a patient's face when they sit up and I say,'OK all done!'They have this slightly confused look and reply 'That's it? That was a root canal? What's all the fuss about?'It just has a bad reputation because very occasionally a nerve decides it doesn't want to go numb.

When you have a tooth removed, the nerve of the tooth obviously has to be made numb to allow extraction, so simply removing the nerve from inside the tooth (a root canal) is generally less of a problem- it

What should I do if I have Pain?

The best thing to do initially is to take some over the counter analgesics (painkillers) preferably non-steroidal anti inflammatories (NSAIDS) of which the most common one is Ibuprofen- this is the ingredient in Neurofen but the generic brand will do just fine. Combine this with a soft diet and where possible try to avoid chewing on that side to give the tenderness a chance to settle down.

You may need to see the dentist; you may just need to give it a couple of days to settle. Have a read of some of the causes of pain below and book an appointment if you have any concerns.

Do I need Antibiotics?

Antibiotics are only required where the infection has spread to the surrounding tissues. Symptoms of systemic spread that indicate antibiotics are necessary may include feeling generally unwell and having a fever/ high temperature. If there is a large collection of pus, which presents often as an obvious facial swelling, antibiotics (in addition to draining the abscess) are mostly needed.

Draining the abscess will provide massive relief as the pressure dissipates; but this is not always possible and antibiotics may need to get into your system first before anything can be done such as numbing the tooth to extract it or drain it.

Pain during a Root Canal?

There are three main reasons you may get pain during a root canal:
  • Infection. On occasions, for whatever reason, it can be difficult to numb a tooth in order to extract it and the same goes for a root treatment. If the tooth is very inflamed or there is a large collection of pus- the acidic environment can neutralize the anesthetic so it isn't as effective. There are ways we try to solve this. A drop of anesthetic into the nerve chamber of the tooth is generally sufficient to do the trick, but if it doesn't, we may need to dress the tooth and let the infection/inflammation subside before trying again. This may require antibiotics or a dressing inside the canal to calm the nerve.
  • Living nerve. Sometimes when filing the canals, there may be a small amount of living nerve at the base of a particular canal that can be sensitive until removed. Normally washing the canals with dental bleach is sufficient to kill any nerve tissue that may be difficult to reach in the main or side canals.
  • Files through the end of the root. If files pass through the end of the tooth into the surrounding tissues, you may feel a little prick or be aware of the sensation. This is useful information for the dentist, who can gauge accurately from your response, where the end of the root is and adjust the file length so it doesn't happen again.

Pain In-between Root Canal Appointments?

Following your first appointment, you may experience some pain/discomfort as a result of the root canal procedure. This often occurs the day after- perhaps up to two or three days and then settles down.

Pain in-between appointments could be due to the following reasons:
  • Bacteria. Insufficient bacteria being removed during the emergency stage
  • Undiscovered canal. A canal that hasn't been found and is still giving some trouble
  • Living nerve. A nerve that has been incompletely removed; instruments or contents from the canal being pushed through the end of the canal during the preparation.
  • High filling. The temporary filling in the tooth left too high in the bite. Returning to your dentist and having the canal re-opened, cleaned and dressed again will generally solve the pain.
  • Phoenix abscess. It is possible that an acute flare up occurs with a temporary dressing in place before your appointment to place the root filling. This most often occurs where there has been a longstanding chronic infection around the end of the root and is likely to result from a disruption in the balance of the bacteria. It requires the tooth to be drained, dressed and antibiotics maybe needed

Pain After my Root Canal is Finished?

Following completion of your root canal some pain and discomfort is to be expected despite the most careful and thorough of procedures. Since the dentist is working very near the apex (end) of the root some inflammation and soreness may arise or persist for a few days, sometimes weeks.

It can often be confusing to the patient to feel pain since the nerve has been removed but it is the many nerves in the ligaments surrounding the roots of the tooth that are sending the pain messages. All this being said, a good proportion of patients do not report any problems following their finished root canal treatment, but expect some temporary discomfort and if it doesn't happen- great!

Pain after a root canal could be due to the following reasons:

  • Files through the tip. Files extending slightly beyond the root during the preparation aggravating the tissues around the end of your tooth. This is common and will settle in a few days.
  • Pre-existing inflammation. Inflammation around the apex from the toxins released by the bacteria hasn't yet settled down.
  • Sealant through the apex. A small amount of the sealant used to bind the root filling material together has been pushed through the end. This will resorb over time but may be sore for a while.
  • Missed canals. Sometimes extra canals are very hard to see and can go undetected. The dentist might find three when actually four exist and the one that wasn't found and disinfected can cause problems.
  • Perforation. A post or file that has perforated the sides of the root will give any bacteria the chance of remaining in the root canal system ;a potential source of food that will allow bacteria to grow causing persistant infection.
  • The root canal has been slightly over filled. Often this will only cause a mild discomfort. Painkillers as advised above may be necessary.
  • The root canal has been under filled. The important thing here is- has the canal been sufficiently disinfected? If the canal is cleaned properly and the filling is just short, then it is unlikely to be an issue. However, if some bacteria remain in the canal system because the dentist has incorrectly calculated the length of the canal, then a re-root treatment or extraction may be needed.
  • High filling. The filling or restoration in the tooth maybe slightly too high.
  • Undiagnosed root fracture. This may lead to the tooth being lost. This is most often found with lateral incisors, first premolars and molars. Your molar teeth should be protected against this occurring by having a crown placed. Root fracture is more likely if this is not done and if you grind your teeth at night.
If there is no sign of improvement after a few days or if things appear to be getting worse, it is advisable to see your dentist again for a review. The dentist will assess the options above and talk to you about your situation.