Pain weeks after root canal.

[Phillyfish]

Had pain in lower crowned molar.  Went to regular dentist 3 times. Found nothing but suspected nerve problem in crowned tooth.  (Crown was at least 5 years old) Endodontist found abcess (abscess) in tooth and did root canal in May.  Put me on 1 week of antibiotic.  Tooth continued to hurt.  Called after 3 weeks, told it takes time - couldn't possibly be infection.  Called after 6 weeks and he saw me.  Put on another 1 week of same antibiotic.  Tooth/jaw still doesn't feel right.  It feels like the tooth is too big for the area.  I now have jaw pain when opening mouth and chewing.  Tooth is sensitive to touch.  Some days are worse than others but always is present.  Surrounding teeth have been checked.  Have had other root canals with no problems.

I am a breast cancer patient.  Had chemo and radiation 2 years ago.  Currently in remission.  No other health problems.  Endodontist has suggested I have "another non dental" health problem. Regular dentist says endodontist should be treating it.  Am reluctant to call primary care physician or oncologist for tooth problem.  Could it still be infected after 2 rounds of penicillin 500mg?  Could my immune system still be so low I need a longer course of antibiotics?  Have postponed permanent filling to tooth two times.  What kind of Dr./Dentist would you recommend for follow-up?

[Jerome Bogin, D.D.S.]

I don't like the fact that you are feeling the tooth when you bite. I am sure that the endodontist took the tooth out of occlusion. This is necessary after and during the RCT procedure. If you are hitting the tooth when you bite without anything in your mouth this should be corrected. The fact that you had chemo I believe you should be concerned about any possible infection. I am also getting the feeling that your GP and Endodontist are not communicating well. Maybe they should get on the same page.

[brcdmd]

Ditto.  Have the occlusion checked.  Bet you a nickel the tooth is high in occlusion.  Sometimes an infection below a tooth can cause it to erupt ever so slightly, causing you to strike it prematurely.  This can inflame tiny nerve fibers that SURROUND the root of the tooth, causing pain.  The root canal procedure removes the nerves from inside the tooth, but the fibers surrounding it remain (called the periodontal ligament) and can elicit pain, especially to pressure.  In the absence of thermal sensitivity, you can rest pretty well knowing the nerves inside the tooth are gone.  This narrows the focus for finding the source of your discomfort considerably.  Have your dentist check and adjust the bite.  If he or she does not, find one that will.

[hunter9]

I've got the same problem, however I DO have temperature sensitivity.  My Dentist has spent quite some time ensuring that the crown covering the tooth with the root canal (#14) was the proper height. The final crown was put on months after the initial infection was cleared up by "Z-pak" (sp?).   I even saw the x-ray he took after the root canal was complete showing the 2 root structures replaced by something bright white in the X-ray.   What does sensitivity to pressure, and primarily hot temperatures mean?

[brcdmd]

I don't like the sound of that.  Sensitivity to hot temp. usually is not a very good sign.  Typically, it indicates an infected tooth.  The gasses emitted by the affecting organisms expand on an increase in temp. (Boyle's Law??) causing pressure to be placed on neighboring nerves, resulting in discomfort.  9 out of 10 times I see pain to hot temperatures, the patient needs treatment, usually a root canal.  It could be you have another one in the same area, either adjacent to 14 or below it, that needs a root canal OR, possibly, there are still canals in 14 that were not filled.  Most upper first molars have three canals, some even have four.  Have it looked at if your symptoms do not get better in a day or so.

[Meddy2]

I agree with the hot/cold sensitivity issue.  Some molars even have five canals.  It's not common but it is possible.  There is also another thing that was left out and that is fracture.  Fractures of teeth do not show up on x-rays and are difficult to diagnose.  Usually they take a few visits before they are discovered.  Vertical fractures require that the tooth be pulled.  Also, if the roots are not filled to the tip, that will also cause problems with the root canal.  You may want to get a second opinion from another dentist/endodontist and have them look at the x-rays of the finished root canal. I had a root canal done and it did bother me somewhat afterwards.  However, the pain did go away completely before having the crown put on and then came back after the crown was placed.  It was not seated too high but it was somewhat tight.  I was told my tooth had to "mold" with the crown.  After a few months it did and I have no more pain.  As far as chemo goes, speak to your oncologist.  My daughter had leukemia and we were told that after one year her immune system was considered normal.  However, she did not have radiation.  Your oncologist is best to discuss that issue with.  And one more thing, a retreatment of a root canal does take longer to heal than a first time root canal.  Also, if there was  a perforation when doing the root canal, you will experience more pain simply for that reason.  It is your general dentist's job, however, to fix any crown issues.  The endodontist does not perform restorative work and it is the dentist's job to fix the crown if it is seated too high.  Sounds to me like the general is just bouncing you around.

[81artmonk]

A related discussion, Some pain after root canal was started.