These days dentists prefer doing single sitting root canal treatment in which, after the diagnosis is made, in single visit the root canal treatment (RCT) is completed. After the root canal treatment, the patient can have few problems like pain after procedure, swelling after root canal treatment, Fracture of root canal treated tooth, discoloration of tooth after root canal. Incomplete filling, missing of a canal or breakage of instrument can also occur during root canal treatment and can cause complications later on. In case of failure of root canal treatment, root canal re-treatment, Apicoectomy or tooth extraction is done.

1. Pain after Root Canal Treatment: If root canal treatment is done when first indicated, then patient usually get immediate relief from symptoms after procedure. If there was severe infection in tooth before root canal treatment, then patient may experience some moderate pain after procedure. There can be pain after the affect of numbness is over. One can take a pain killer which is normally prescribed by the dentist. If pain is acute and there is swelling then one should consult the dentist. Mild soft tissue inflammation is there which causes irritation but it subsides within a week after the root canal treatment. Antibiotics may or may not be prescribed after root canal procedure. If patient experiences pain after few months of root canal treatment and there is difficulty in chewing then the dentist has to be consulted because some times the infection is left or the filling is not done properly and it causes the pain. In such cases some times root canal re-treatment is recommended. But the diagnosis has to be made after taking the proper history, clinical examination and with x-rays.


Medication after root canal therapy:

a. 600 mg dose of ibuprofen which is available OTC (Motrin, Advil) within 4 hours after root canal treatment is performed. Dose should not exceed 800mg. Dentist may also prescribe oxaprozin or ketorolac (Prescription only) after root canal treatment. Codeine is given in case of severe pain and has to be used for short term. Pain meds will provide relief and will reduce the swelling.

b. Amoxicillin or clindamycin antibiotic may also be given after root canal therapy.

When to consult a dentist or endodontist
If pain is acute or if pain persists for more than 2weeks, then patient should visit his dentist to get the root canal treated tooth evaluated. Pain persisting for long time can be because of root canal failure.

2. Swelling after root canal treatment: Swelling is one of the possible complications which can occur after root canal treatment. To reduce swelling after root canal treatment, anti-inflammatory meds are given. Swelling which doesn’t regress after some time can be because of faulty root canal therapy procedure, re-infection of root canals. To treat swelling after root canal treatment, cause of swelling is diagnosed and treatment is provided accordingly.If some teeth feel higher than other teeth, then patient can call his dentist or endodontist who can adjust the bite.

3. Fracture of the Tooth: It is advisable to go for crowning of the tooth after the root canal treatment as the tooth becomes brittle and is prone to fracture. The crown will save the tooth structure and gives natural feeling. Dental crown is given after root canal treatment to provide strength to the weak and brittle root canal treated tooth and to hide the discoloration which may occur at times after root canal treatment.

4. Discoloration of the Tooth: After the root canal treatment as the tooth looses its vitality, it becomes discolored. This discoloration can be taken care of either by bleaching or by giving dental crown on root canal treated tooth.

5. Breakage of instrument during cleaning and shaping of canals: The dental files or other instruments used in the cleaning and shaping of the pulp space might break down and cause complication. Broken file can be removed by an Endodontist who is specialist in root canal treatment. If the root canals are cleaned and sterilized before the endodontic file gets broken, then broken file doesn’t usually cause any symptoms. If canals are not sterilized before dental file is broken, then leaving broken file in the canal can cause problems like root canal failure and can even act as source of infection later on.

6. Incomplete filling or missing a canal: Incomplete filling or missing a canal while filling may act as a source of retained infection or new infection. All this leads to treatment failure and aggravates the complications.

Certain bacteria are not responsive to root canal treatment to a great extent enhancing the problems.

Care after Root Canal Treatment

1. Patient should avoid eating from side of root canal treated tooth.
2. To reduce swelling after root canal treatment, ice pack application over that area can be done. Ice pack application should be done for 10-15 minutes every hour.
3. Take the pain meds as directed and complete the course of antibiotics. Pain meds should be taken before the effect of local anesthesia wears off.
4. Patient should sleep with head at slightly elevated position.
5. Patient should take soft foods at least for 2 days after root canal treatment. Very hot or cold foods should be avoided after root canal treatment.
6. Avoid smoking, drinking or stressful exercises as it will affect the healing.

What to do if root canal treatment fails

In case of root canal failure, root canal re-treatment, Apicoectomy or tooth extraction is done. Root canal re-treatment and Apicoectomy is done to save the tooth and to remove the infection from the tooth. Procedure for root canal re-treatment is similar to root canal treatment and is mainly performed by endodontist. Apicoectomy is surgical removal of root apex to remove infection. If prognosis of root canal re-treatment or Apicoectomy is poor, then tooth extraction may also be required. After tooth extraction, patient can get the missing tooth replaced with either dental implants or dental bridge.

Whether all the teeth which have pain can be saved by the root canal treatment?

The answer is No, for the success of root canal treatment the careful selection of the case is very important. All the teeth can not be treated by root canal treatment. There are few conditions in which the teeth can not be treated with root canal treatment:

1. When the tooth in question does not have adequate bone support and the bone supporting the tooth shows resorption and tooth is mobile, then that tooth cannot be saved by root canal treatment.
2. When the tooth which has to be treated by root canal treatment has inadequate tooth structure and can not be restored after wards
3. When the general resistance of the patient is poor in that case root canal treatment is not indicated.
4. If the root is fractured then also the tooth cannot be saved by root canal treatment.

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Comments

  • dr ashfaq shaikh

    dr ashfaq shaikh 22 - April - 2015, at 11:23 AM

  • last week my wife had root canal treatment done for her left upper and lower pre-molar teeth after she started experiencing sever pain in her left TM joint with inability to open her mouth not more than an inch. kindly advice what should be done. do we need to visit the dentist again or hot fomentation is sufficient. thanks.

  • Jaya Samuel

    Jaya Samuel 07 - May - 2014, at 15:16 PM

  • On 3-5-2014 I went to a dentist for dental check up. He said that 2 of my teeth need RCT. I agreed to it. No Antibiotics were given to me before or immediately after the RCT. On Monday, 5-5-2014, I felt severe pain and swelling of the left side of my face. When contacted, the Dentist prescribed antibiotics (Amoxycillin and Potassium Clavulanate Tabs 650) and Combiflam tab. The swelling increased and pain also increased. On 7-5-2014, the Dentist prescribed the same tablets of 1000g. Still the pain and swelling did not come down. Kindly advice.

  • Maria Hendon

    Maria Hendon 04 - May - 2014, at 18:20 PM

  • After a apicoectomy in December, a RCT in December and another apicoectomy in April- I am still having some numbness and pain but most of all- there is a really foul taste, somewhat metallic in my mouth. Had 3-4 rounds of antibiotics throughout the procedures. Can handle everything except for the bad taste- what is it and why wont it go away?

  • Dr.Ritz

    Dr.Ritz 30 - October - 2013, at 20:26 PM

  • Dr. Mark Mancin The post operative sensitivity is either because of over instrumentation or it can be due to pulpal remants either in the main canal or some accessory canal. For this you can put the medicament in the canal and wait for few days before going for obturation.

  • Dr. Mark Mancin

    Dr. Mark Mancin 24 - October - 2013, at 11:58 AM

  • Dear Doctor! I had a patient who requited RCT on #2. She had a previous large area of buccal decay and a filling was done in this area ~ 1 year ago. The tooth became symptomatic and painful requiring RCT to relieve her pain. The RCT was straight forward; pulpal contents were removed, irrigated thoroughly and medicament placed with pellet and temp filling. Approximately 24 hours later the patient experienced a strong throbbing sensation in the tooth that woke her at night. She received minor relief with NSAI's and/or Vicoprofen. She presented today with the throbbing sensation in the UR area. Before anesthesia I reverified that the discomfort was coming from this tooth. I then gave her a PSA injection only to once again verify that #2 was the cause. She got relief but not 100% relief. She still felt a dull ache in the tooth with most of it coming from the palatal area upon testing. A palatal injection was given and she experienced immediate relief. We placed the rubber dam, removed the temp filling and pellet. The pellet showed on signs of blood and/or infection. The medicament was flushed and paper points were placed down the 3 canals and once again no sign of infection or blood was noted. I reverifed the working length both with apex locator and x-ray. Please note the canals are located within the sinus cavity. She had been experiencing some right sided sinus problems prior to the RCT and after. Upon filing the canals the MB and DB were WNL. The palatal canal hurt upon placement of the file at the apex and upon withdrawal of the file (hand file)from the apex towards the coronal portion of the tooth. She described it as being electrical in nature. She is so uncomfortable she wants the tooth out! I relieved the occlusion so she in not touching the opposing teeth. She said it hurts to place her tongue up against the tooth. I am at loss as to why this is happening. Additionally a root fracture has been ruled out. What could be causing this post operative hypersensitivity??? Any help would be greatly appreciated...Dr. Mark S. Mancin

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