Diagnosing post-root canal pain
Photo: Caroline LM, Unsplash
Frustration and disappointment can ensue for people when a root canal does not solve the dental pain from a tooth. Up to 5% of people can have lingering pain up to six months in some cases. The key is to diagnose the reason why pain lingers after root canal treatment, which is most often due to other non-root canal areas.
Some of those problems are:
Occlusion
This is “the bite,” or the way a person closes their teeth. A misaligned or high bite can increase the stress on a tooth crown leading to excessive pounding on the tooth. Then the tooth’s shock absorber, the periodontal ligament gets inflamed and painful. This periodontal ligament is alive and well and is not affected when the pulp of a tooth is removed by a root canal treatment. The “PDL” fibres transmit forces to the bone that mimics tooth pain. A simple adjustment is all that may be needed.
Multiple Canals
Mother nature has made teeth beautifully and especially molars. Multi-rooted teeth can have a complicated root canal system. Canals can be microscopic and very hard to find or can be calcified, leading to live/necrotic pulp tissue that is not fully removed. There are also multiple “side canals” called accessory canals that can be impossible to reach as well. Things like perforations, irrigant irritation, filling material extrusion and broken instruments are rare but possible as well.
Fracture
Root fracture is a common source of pain, possibly years after root canal treatment and is difficult to diagnose; with 3D technology and microscopes, this can be easier, but not guaranteed. Isolated pockets, a history of sharp pain that progresses to a dull throbbing pain upon chewing are common signs of fracture. Risk factors include: the lower second molar (tooth most likely to fracture), clenching/bruxism, large silver restorations. A fractured root is impossible to save.
Periodontal
The surroundings of the root can also be a source of pain, especially if there is a communicating perio and endo lesion. The tooth should be clinically examined and x-rays taken following root canal treatment to evaluate both the surrounding bone and gum tissues.
Non-odontogenic (non-dental)
Many things can mask themselves as dental pain and have nothing to do with the tooth. Research suggests that 3% to 5% of tooth pain can be non-dental: TMD, maxillary sinusitis, cancers and cystic lesions can all mimic tooth pain. Pain syndromes from shingles, trigeminal neuralgia, idiopathic periodontalgia/odontalgia and phantom tooth pain have also been reported to be psychogenic aspects of tooth pain that could persist after root canal treatment. As such, appropriate referral to a medical provider is suggested.
Make sure you visit your health-care provider. If dental pain is not dealt with, it can be intense and painful.
Dr. Preety Desai is a laster implant periodontal specialist at Kamloops Periodontist who has called Kamloops home for 24 years. She graduated dentistry from McGill University and completed residency at the Hospital for Sick Children in Toronto, treating medically compromised children. She was in private practice for 3 years in Toronto and in public health, treating new immigrants, the aged and disabled. She also spent many months in Northern Ontario providing dentistry on First Nations reserves. Dr Desai then moved to BC to specialize in Periodontics at UBC. Dr. Desai and her husband loved BC so much that they settled in Kamloops to raise their family and enjoy the best quality of life. She can be reached at 778.471.6001 or by visiting www.kamloopsperiodontist.com.
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