Pain after root canal treatment got better then worse

After getting a second root canal on my tooth, the pain came back a few days later. I called my dentist, and she said my tooth should be fine. I read online that after root canal treatment, peak inflammation and pain can occur for 48 to 72 hours but should improve. The hygienist at my dentist’s office is a good friend of mine, so I called her yesterday, and she said that the pain returning can mean that the second root canal failed. I hate to take a hygienist’s word over my dentists, so I decided to write for a tiebreaker. I know that I will need to see my dentist again, but which prognosis seems correct? I am concerned about losing the tooth and needing a dental implant – Sareda from Knoxville, TN

Sareda,

Peak inflammation after root canal treatment occurs in the following 48-72 hours if a dentist does not treat the pain by reducing the occlusion (the way your upper and lower teeth fit together). Inflammation can cause post-operative pain that hurts right away, peaks, then improves. When the local anesthetic wears off, an untreated tooth feels worse the second and perhaps third day before improving.

When root canal post-operative pain improves, then returns

If you experience peak pain on day two or three, but it improves and begins to hurt again, it can be a sign of post-operative infection. But not every case of post-operative pain is a sign of root canal failure.

• The risk of root canal failure increases in a tooth with two or more root canal treatments.
• If a tooth had a repeat root canal treatment and you have passed the peak pain period (48-72 hours), but the pain returns, it is often a sign of root canal failure.
• The American Association of Endodontics advises that if severe pain or pressure lasts for more than a few days, you should contact your endodontist.

Please schedule a follow-up appointment with your dentist. If your dentist’s response is unsatisfactory, we recommend that you get an exam from an endodontist (root canal specialist). When root canal treatment fails, an endodontist might recommend root canal surgery by making an incision in the root tip to treat the tooth. If you want to avoid tooth extraction and a dental implant and your dentist cannot resolve the issue, an endodontist or a dentist with advanced implantology training will give you the best chance at saving a problem tooth.

For information about how to avoid implant failure, read our post: My painful dental implant and bone graft failed

Steven Brooksher, DDS, of Baton Rouge, sponsors this post.