Post Root Canal Issue

[KayakMacGyver]

Long story short, I cracked a molar back in June trying to bring some nostalgia around my kids with a box of Cracker Jacks. Went to the Dentist, who referred me to an endodontist and had my first root canal. Now, I have pain in the tooth WORSE than when I had the crack. It's been 2.5 months since the root canal and the discomfort (sharpness) has been this way since the work was done. I only feel it when I start to chew on it and the discomfort actually starts to dissipate once I've chewed for a little while.

I was warned that there are ligaments around the tooth that could continue to cause pain, even after they killed the nerve via root canal. Went back to the endo and they suggested I try one of these, Gum Massager, but otherwise it's something I have to deal with OR have the tooth pulled and replaced with an implant.

Anyone out there had a root canal and still experienced pain in the tooth? Did it go away over time? It's not debilitating, but incredibly annoying. Maybe I'm just being a whiner, but you don't know what you miss until it's gone and I'm looking for hope.

 

[OntarioHunter]

Did the dentist crown the tooth after root canal? You are having pressure issues so it sounds like a structural problem, not nerve issue which would be hot/cold sensitivity. Perhaps the crack is not properly mended if they only did a filling instead of crown. It could be hard to see that on x-ray if filling is in the way. Talk to your dentist not the root canal guy.

 

[Bob-WY]

It can't be the tooth, the nerve is gone. It must be in the jaw/gums. I'd agree: see the dentist not the endo

 

[Deleted member 16014]

I believe @kansasdad on here is a well-tenured dentist.

 

[OntarioHunter]

Have your dentist check the bite on that tooth, especially if it was crowned. I had a similar issue a couple years back and new dentist discovered the bite on the crowned molar was not right, probably because the tooth moved after implant next to it reoriented alignment of everything in the jaw. She trimmed down the crown to correct the bite and that ended the problem though it took a while for that tooth, which had been pushed loose, to reseat itself solidly. Good luck.

 

[kansasdad]

Teeth are funny things sometimes.....

Studies show the failure rate of root canals run around 5% over 5 years. Failure reasons include uncleaned or under sealed canal spaces, continued bacterial introductions into the canal spaces (no crown or leaking crown) and cracks in teeth that go beyond the encirclement of the crown.

In general, molars are trickier to clean, shape and fill than front teeth due to the number and shape of the multiple canals. They also take more PSI during chewing due to being closer to the hinge axis of the jaws.

For our OP, it seems like a return visit to the endodontist has already happened, and they seem well pleased with the clean/shape/seal, so a visit to the family dentist to have the bite checked out is in order. When I do root canals on my patients, I make certain that the tooth isn't in direct function with the opposing tooth. Right after endodontic therapy there can be inflammation of the attachment mechanism of the tooth to the jaw that can cause some swelling, causing the tooth to "rise up" in the socket. Then, under function, you hit the tooth harder than you should, which in turn creates even more inflammation in a positive feedback cycle.

If you haven't yet had the access hole in the top of the tooth filled with "permanent" filling and/or the crown done, it is possible that bacteria are re-entering the canal spaces, so that should be evaluated.

Also, the original problem seems to be a vertical root crack/fracture. I check for continued presence of this crack by carefully placing my gum probe into the sulcus (the ditch that goes around the tooth) and see if there is a discrete spot where the probe finds a deeper probing zone, which could be where the bacteria are able to breach the protective seal provided by the gums around the tooth.

I might suggest to one of my patients that are having pain after a root canal that they give the tooth rest (eat on the other side) and regularly take a NSAID (ibuprofen, naprosyn, etc) for pain relief and anti-inflammatory effects, and allow for time to have the body heal.

Trend monitoring is important. Ask the question: is it better today than last week? If yes, you can probably relax a bit. If no, or increasing symptoms, don't delay getting professional evaluation/follow up.

The above advice is worth exactly what you paid for it...... Hoping for a complete healing for you @KayakMacGyver


PS: you might have cracked more than one tooth on that candy. Ask me how I know.....front porch of my cousins Wyoming cabin having a little dessert, bit down on a Big Hunk candy bar, which jerked a molar crown off my tooth, and then when I bit down not realizing the crown was off, I cracked the adjacent tooth. A new crown and a new filling had to be done, but not before enjoying the hunt, but only eating on one side of my mouth.

 

[KayakMacGyver]

Thank you for the perspective and input. Especially you, @kansasdad, for taking so much time to provide a great explanation.

Getting my bite checked was the first thing we did. No contact. The pain is such that I can tap on the side of the molar and replicate the problem.

One thing that's throwing me that I didn't mention before is the fact that between the temporary crown and permanent crown period, I had no pain in the tooth. It was only after the permanent was put on my dentist put the permanent on that I began feeling this discomfort. I swore it was a bad fit or something, but he held firm that it was an endo issue related to the root canal.

Perhaps coincidence, but I'm frustrated that I had 2 weeks of no discomfort in the Tooth and literally the day after my permanent was put on I've had issues.

Anyway, I'm going to take it up with my dentist and talk about options for remedy. I may even pay to have the permanent taken off for a period and see if there is any actual pain in the Tooth without it..

Thanks again for all the input and if anyone has any other opinion on the matter, I'm all ears. I never knew how much tooth pain could impact every day living.

 

[kansasdad]

@KayakMacGyver
Glad to have been able to reply to your questions.

Searching YouTube, I ran across an American Endodontics Assoc video that has a pretty cool explanation of cracked cusp syndrome.

I find that teeth with cracks that lead to pulpal disease (needing root canals) are the least predictable procedure I do in dentistry.

I grabbed a still image from the above video. If your tooth has the crack style in the fourth one over, the long term prognosis is way less than the other ones.




I had a cracked tooth root caneled and then crowned this summer on my lower right first molar. Fingers crossed as the endodontist said he could see the crack, and was able to remove tooth structure down to the terminus of the visible crack line, and once the temporary crown went on, my chewing symptoms stopped. Had they not stopped, or should the sharp jolting discomfort to pressure returns, it will be time to head over to the oral surgeon for extraction and implant placement.

Once again, the advice is worth twice what you’ve paid for, and I truly hope that your return to full function is swift and permanent.

 

[KayakMacGyver]

Thanks again @kansasdad. Very kind of you to take the time to point me in the right direction.

Unfortunately, the crack shown fourth one over is my situatuon. Reckon I'll be in for some more chair time in the near future.

Adulting sucks sometimes.

 

[LopeHunter]

It can't be the tooth, the nerve is gone. It must be in the jaw/gums. I'd agree: see the dentist not the endo

I had a root canal and about 18 months later developed sensitivity as brushed teeth near that tooth but only on the outside gum zone near cheek. Told the dentist and he put cold qtip on top of the crown but just a bit of sensation. Said to keep an eye on it. Next cleaning is still annoying as brush teeth and seems worse. Watch another 6 months is the guidance. Two weeks later my gum ruptured below the tooth from build up of infection around a fragment of root missed. Dentist was apologetic. I went to a different periodontist for the repeat root canal and treatment.

 

[Sytes]

Best to ya, Kayak. Wouldn't want to be in your dentist seat... This is the valuable aspect of Hunt Talk, typically select people stand out for their skill set. Great to have Kanasasdad here to share some specific insight.

Wishing the best for ya!

 

[Seeleylakehunter]

Good luck man. I've had a few teeth pulled in my day . Wish you the best.

 

[OntarioHunter]

Something doesn't sound right. My mouth is probably worth fifty grand. I've had a lot of experience with crowns and implants. Sometimes the root canal can be sensitive for a while but downright painful I've never experienced. My bite problem was not acknowledged by my regular dentist but instead his daughter who had only recently started up her practice in his office. She is an absolute wizard with crowns. Did one of cuspids last year and I couldn't tell it from the real thing next to it. Fit was perfect right out of the chute. She uses digital imaging to scan my mouth rather than the old style taking a mold. I'm wondering if a second opinion from another dentist might be in order?

 

[nwihunter]

I had an issue some years back after my first root canal and crown. It was a couple of years later when my pain began. Turns out I developed an infection in that root and they never got all of the nerve out when they originally did the root canal. The pain got to be absolutely unbearable. The oral surgeon had to drill a hole through my crown and it was instant pain relief when that thing drained. Left there feeling great but I did have to have the root canal done over again.