Pain after root canal treatment got better then worse

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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.
Diagram of the phases of a dental implant for a comparison to a partial denture.

A dental implant can replace a tooth after root canal failure and extraction

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.

How many times can I get a root canal on the same tooth?

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Six years ago, my dentist did a root canal on a top right molar. The tooth is hurting again, and I am worried that I will need a dental implant. Is it possible to save a tooth that already had a root canal? Can a tooth remain stable after a second root canal? Thanks. Rachel

Rachel,

A dentist can repeat root canal treatment on a tooth two or more times. But successive root canal treatments don’t always make sense.

Can Root Canal Treatment Be Repeated?

Although a dentist can do a second or third root canal treatment—or more—on a tooth, the results are unpredictable. Even the most skilled dentists can perform root canal treatment that fails.

Studies show that root canal treatment has an 86 – 98% success rate. But cleaning out the canals of a tooth can be tricky. If a dentist doesn’t thoroughly remove infected tooth pulp, the infection will be sealed in the tooth only to flare up later.

A molar tooth has three canals, but sometimes a tooth has a “hidden” fourth canal. Sometimes a canal will branch out at a right angle. And although a dentist uses tiny, flexible instruments, it can be difficult—if not impossible—to get the device into angled canals to remove the infection.

Although highly angled canals are rare, when they exist, the probability of needing a repeat root canal increases. Retreatment has a 50 – 75% success rate. And if a highly skilled dentist performed the first root canal treatment, a second one might not work.

What About Root Canal Surgery?

Diagram of the phases of a dental implant for a comparison to a partial denture.

Get a root canal second opinion before agreeing to an extraction and dental implant

Root canal surgery is also known as an apicoectomy. During the procedure, a dentist makes an opening in the bone, cuts off the infected root tip, and fills the end of the tooth. But if tooth roots are not readily accessible, the surgery is risky and can damage the lower jaw and lip nerve.

An extraction and dental implant are the last options. If you’re uncomfortable with your dentist’s skill level, you can seek a second opinion with a dentist who is skilled in root canal treatment. Or you can ask your dentist to refer you to an endodontist, a root canal specialist. If you’re anxious about future procedures, ask your dentist or endodontist about sedation options.

 

Dr. Steven Brooksher of Baton Rouge sponsors this post. Dr. Brooksher has advanced training in restorative dentistry.