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Nerve pain following root canal treatment
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Nerve pain following root canal treatment

My wife had root canal treatment on a lower molar over two months ago.  Since then her incisors 2-3 teeth along have been in considerable pain, and now into the gum in that area.  

She has been back to the dentist many times, had the root canal opened up and cleaned, and had lots of antibiotics and X-rays.  Her incisors look healthy.  She has been referred to a specialist who suspects nerve pain rather than infection.

Questions - is it likely this nerve pain is due entirely to the root canal treatment; if so is it surprising (i.e., is it likely to have been faulty)?  What treatments are there; and how long is it likely to last?  It's really getting her down!

Thanks, Nick B
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540545_tn?1377626518
When did the nerve pain in the incisor start compared to when the root canal was done on the lower molar?  Just to clarify, these are the lower incisors?

If its nerve pain, is there a follow up with a neurologist?
10 Comments
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Avatar_m_tn
Hello the pain started 3 days later. Yes, it is in the lower incisors and is often excruciating (it's now 02.30am and we're wide awake!).  

The follow up is with an endodontist, not a neurologist
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540545_tn?1377626518
If the endodontist thinks its a nerve pain, whats the recommended course of treatment at this point from his/her perspective?  Is it a nerve pain from the actual nerve inside the tooth or is it a nerve pain from the root canal and is "referred pain" (kind of like jumping from one tooth to another)?

I would imagine the specialist should be have told you what he suspects what it may be.  
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540545_tn?1377626518
Sorry.  I misread your post.  You haven't seen the root canal specialist yet it sounds like.  In that case, the endodontist should be running some tests to isolate the tooth in question (the front incisors) and try to figure out if there's nerve problems inside that tooth.  Is it just a constant throbbing pain?  

There's a possibility that the pain is coming from the back molar.  If the tip of the root is near the inferior alveolar nerve (a large nerve that runs down along the bottom jaw) it may have been injured possibly from the root canal procedure. This could cause problems with the nerve and results in pain in another area.  It may take some time for it to heal.  

I think you'll find out a more solid and specific answer when you see the specialist though.  I can only speculate.
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Avatar_m_tn
Hello thank you for your prompt and useful responses.

My wife has so far seen the endodontist once.  He ran some tests and believes that it is damage to the the inferior alveolar nerve you mention, rather than anything wrong with the incisors themselves.

It's a constant tingling and aching pain with irregular attacks (every few days) of far more severe pain lasting anything from a few hours to 24 hourrs.  

I came online to gain some other views and advice.  In your view how long do these things take to heal, or at least stop hurting so much?  She's been in pain since early March (two and a half months).  And also what are the best ways of treating?  The endodontist is minded to recommend Amitriptyline.

Regards,
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Avatar_m_tn
Hello, update on the above.  Today the endodontiist is now scratching his head and wants to refer to an oral medicine consultant - over in the UK this could take some time unless you go private, which would be tough financially.  The pain in my wife's front teeth has spread across to the incisors on the other side of the mid-point, i.e.,both left and right-hand side of her mouth.  

He recommends no further action until then, for fear of upsetting the nerve more.  He doesn't want to finish the root canal filling unitl it's all settled down.

Our regular dentist meanwhile doesn't propose to do anything until the specialists have done their work.  A bt rih, as we're certain his work has triggered the pain.  I've told him we shall probably oomplaiin unless he makes some redress.

We've also seen our GP today who has prescribed Amitriptyline.

Yours, Nick B
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540545_tn?1377626518
Sorry.  I don't treat any injuries to the inferior alveolar nerve and I would probably refer to a specialist too.  You can try to see a neurologist if it would get you to see the doctor faster than if you waited for the oral medicine specialist.  

I would guess that it would have a window of about 6 months to heal.  If it doesn't heal in 6 months, that means the nerve wasn't able to regenerate itself after the possibly injury.  When wisdom teeth are removed, this type of injury can occur as well.  Sometimes patients will experience constant numbness or tingling.  If it doesn't heal in 6 months, usually there's no chance for it to recover.

You could also try posting this question in the neurology section to see what they may think.  Unfortunately we don't have an oral medicine specialist here on medhelp.org.

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Avatar_m_tn
Thank you for your comments, very helpful even if not what we wanted to hear...let's hope it all clears up within 6 months!  We saw  the GP this morning and she is hopeful of recovery.

She could have the nerve removed?

Nick B
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540545_tn?1377626518
Probably not.  The nerve may have been injured when the endodontic file (the small file that we use to go down the canals) extended past the end of the root and into the nerve bundle.  Hopefully its not too injured and it'll recover soon.  Has it gotten gradually better the last two months?
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Avatar_m_tn
Sorry - my last comment went before I typed anything!

Anyway, the nerve pain has not got any better in the last 2.5 months, in fact it seems to be getting worse, hence my deperate note the other night to see if anyone online had any ideas!

We're thinking about making an appointment with a consultant in oral medicine, as the endodontist isn't 100% sure it's nerve pain

My wife has started taking Amitriptyline - hopefully it will help with ythe symptons.

Nick
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Avatar_m_tn
The diagnosis will depend on the type of pain she is having.  Is it sharp, excruciating, electric shock like stabbing pain lasting just a second or two. But brought on by talking, touching brushing teeth or while eating even when facing cold wind blowing across face.  If this is so she needs to see a neurologist and not the dentist.  
I feel the dentist has injured one of the branches of the 5th cranial nerve which is called the trigeminal nerve.   I only hope that I m wrong.  But if that is so I m afraid she may be suffering from trigeminal neuralgia.
Please see the neurologist immediately even private if u can afford it.
I was in similar circumstances, but b4 I reached neurologist the dentist had removed 3 teeth unnecessarily thinking that my tooth may be causing it.
Trigeminal neuralgia is a rare disease, even the GPs hardly come across any patients during their practice for years.
By the way, my pain is under total control with tegretol & neurontin 1 of each twice a day.
Hope ur wife is feeling better.
Yakub karim




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