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Broken File during Root Canal Treatment
FAQs for Root Canal Treatment
Root Canal Treatment Vs Tooth Extraction
Pain after Root Canal
Is Root Canal Treatment Painful
Falsehoods and Truths about Root Canal Treatment
Root Canal Re-Treatment
What if Root Canal Treatment Fails
Alternatives to A Root Canal Treatment
Cost of Root Canal Treatment
Restoration of Root Canal Treated Tooth
Why is Root Canal Treatment RCT required
How Root Canal Treatment Is Done
Diagnosis of Root Canal Treatment
Complications if Root Canal Is Not Done
Understanding Root Canal Therapy RCT
When is Root Canal Treatment Required
Complications and Care After Root Canal Therapy
Procedure For Root Canal Therapy
Signs And Symptoms Of Root Canal Therapy
What Is Root Canal Therapy RCT

Complications and Care After Root Canal Therapy

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.

 User Comments on  Complications and Care After Root Canal Therapy
Posted By : Dr Ritz on 2/5/2012 6:08:28 AM
Cindy, the pain should not be there after two weeks of root canal treatment. After RCT pain is there but it is for 3-4 days and max for a week. You should visit your dentist who has done RCT and find out the cause. Donot go for crowns tills the pain subsides.
Posted By : Dr Ritz on 2/5/2012 6:01:00 AM
Sandra, After 4 months of Root Canal treatment,there should not be any pain. The pain can be either because of infection in the tooth and that can be due to faulty root canal treatment or it can be because of high crown which causes the repeated trauma and hence the pain. Pocket formation cannot cause so much pain. The pocket formation can be there because of improper crown fitting which causes the food lodgement. so you can take a second opinion from an Endodontist.
Posted By : Cindy Schertz on 2/4/2012 1:09:39 PM
I have had 2 root canals in the past few months due to old fillings being filled with new ones. I was in so much pain after the new filling were put in that I had to get root canals. Now Im in alot of of pain and its been about 2 weeks. The gums around my tooth hurt like I have a cold sore or scraps. I take Ibuprofen like crazy to take care of the pain. Im scared to death to get crowns put on these 2 teeth. How long should I live with this pain?Thank you so much, Cindy Schertz
Posted By : Sandra on 2/3/2012 9:43:49 PM
I had a root canal done on a molar 4 months ago. It was painless at first and I return to have the crown filed down. It was fine again for some time and then it became painful again. Xrays were taken and I was told it looked fine. I returned again as the pain increased. I finally had a full exam and it would found that there is a "pocket" under the tooth, but first I need to have a deep cleaning before the dentist can continue. I'm in increasing pain, my gum is swollen and it bled when the exam was done. Now what? As many here have said, I've paid in full and seeing an endodontist doesn't seem to be in the plan.
Posted By : Dr Carl on 1/2/2012 4:50:39 AM
Lucy, If there is extensive bone loss present along with chronic infection in the tooth, then it is endo-perio lesion and prognosis of such tooth is not very good. In such cases, tooth extraction is done. After tooth extraction, missing tooth can be replaced with bone grafting, dental implants or dental bridge. Without examination and without seeing your radiographs, it is difficult to comment as to which procedure will be more suitable for you. Your dentist can best advise you about outcome of root canal treatment if done.
Posted By : Lucy on 12/31/2011 9:04:06 AM
Regarding your reply of 12/31/2011 1:43:21 AM to my post of the 30th.: First, thanks! for your prompt reply. Can you please clarify how much (1) bone loss and (2) infection is too much in millimeters (mm) or percentage in regard to a hopeless outcome--that is, compared to a fair, poor, good or excellent prognosis? My dentist indicated that bone loss as revealed by my xray is extensive, suggesting the infection has been around for quite awhile, and seemingly is leaving the treatment decision up to me. To make that decision, I need to know how to determine how much bone loss is too much bone loss--that is, when is endodontic treatment not a doable option, regarding amount of bone loss/infection. So is bone loss calculated in millimeters or percentage? Also, how is the degree of infection calculated? Apparently, I am the decision maker in this case. Help...
Posted By : Dr Carl on 12/31/2011 1:43:21 AM
Lucy, Prognosis of tooth depends on extent of infection which is present and amount of bone loss which is there. If there is small amount of bone loss, then you can save the tooth by root canal procedure. If much of bone loss has taken place and prognosis of tooth is poor, then extraction is required followed by replacement of missing tooth with dental implants or dental bridge. Without clinical examination and without seeing the x-rays, it would be difficult for us to comment as to which option would be better for you. Your dentist can best advise you whether to get root canal treatment done or opt for tooth extraction after taking into account extent of bone loss and infection present. If tooth can be saved, then better save it than getting it pulled out. It is always better to save a natural biologic tooth instead of tooth extraction.
Posted By : Lucy on 12/30/2011 8:22:31 PM
Hello. I'm considering root canal therapy (RCT) or tooth extraction for a root abscess on a upper back tooth which is crowned. Noticed abscess (without pain or swelling) & was seen by dentist same day who determined that tooth is dead & abscess is draining. Xray shows considerable bone loss & infection. Yet tooth is not loose. My question is whether or not RCT is pointless in cases with significant infection & bone loss? Dentist said to wait to see if endodontist wants me to start antibiotic with RCT if I decide to go that route--or else, go to oral surgeon to get tooth extraction followed by (1) either bone graft plus tooth implant or (2) bridge. Anyway, wondering when RCT treatment is futile, considering infection and bone loss. Need to make decision shortly after the first of the new year to get tooth extraction or start RCT. Thanks in advance for your insight. Lucy
Posted By : Dr Carl on 12/24/2011 1:34:06 AM
Nina, Calcified canals are difficult to locate and can’t be treated. Calcified canals in tooth may or may not cause problem later on. Occasional pain can be because of untreated canal. Dental crown should not be given until the pain regress completely. Your dentist can evaluate root canal before giving dental crown. Your endodontist will be able to give you better idea of chance of successful long term result.
Posted By : nina on 12/23/2011 11:04:10 AM
I had a root canal for major decay under a crowned tooth. The endodontist had me come for 4 visits and could not get to 2 canals because he said there was calcification. I paid him in full for 4 canals with no insurance. He said to wait and if it didn't hurt to get a crown. It has been 3 months now and my dentist does not want to put on a crown if it hurts. I get occasional pain in the tooth and don't think the endodontist should be paid for the complete job. has anyone had this experience? what procedure did you have and should he be paid the entire amount.
Posted By : Dr Ritz on 12/8/2011 10:49:37 PM
Bel, Pain can be because of infection still left in root canal treated tooth. Root canal treatment failure takes place when a canal is missed by a dentist or if the shape of canals is such that it is difficult to detect the canals. Cracked root or resistant bacteria in root canal can also lead to failure of root canal. Accessory root canals if missed can lead to root canal failure. Prognosis of root canal re-treatment is not a good as root canal treatment done for the first time. If your dentist thinks that the prognosis of tooth is poor, then tooth extraction will be required. If tooth extraction is done, then you can get the missing tooth replaced with dental implant or dental bridge.
Posted By : Bel on 12/8/2011 12:59:20 PM
I am currently on a root canal procedure and it is my 5th visit already. everytime my dentist will cover my molar with temporary filling, it always get's infected again. So my Dentist said that we need to observe more and if not, a tooth extraction will be done. What is wrong with my molar? this is my 3rd root canal and this has been the very tedious one. The molar was covered last August by a permanent filling and then it still hurts after it was covered, then my dentist said to take in antibiotic due to infection. after 2 weeks, the pain stops, and then on October, it hurts again. then I got another dentist (the one doing my root canal) and was told that this molar should have been treated with a root canal procedure way back in august. and now, I am still in pain. what should I do.?
Posted By : Dr Ritz on 12/6/2011 11:35:05 PM
Cindy,When teeth are not in normal occlusion and the filled tooth or dental crown or bridge are not meeting the teeth on other side of dental arch properly and is high, then it is known as high point on restoration. High point if present will strain the periodontal tissues and will cause pain and soreness on biting. In case of high point present on filling or dental crown or bridge, selective grinding is done for relief. After dental filling or after giving dental crown or bridge, dentist will check the bite of the patient with articulating paper.
Posted By : Cindy on 12/6/2011 7:14:53 PM
Doctor Ritz, Can you please tell us what "high point" is? I looked online, but there is no such term except for high point dentistry (cosmetic. Thanks.
Posted By : Dr Ritz on 11/29/2011 10:57:04 PM
Rosemary, Root canal treatment is mostly done in 2 sittings. In first sitting, the infected portion of the tooth is removed and cleaning and shaping of the canals is done and in second sitting, filling of the canals is done. Interval between fist and second dental appointment should not be more than 1-2 weeks. Swelling, sore jaw, fever, headache can be because of infection in the tooth. You need to get your root canal procedure completed from an endodontist. Pain and swelling will regress after treatment. Only antibiotics are not going to treat the infection. By the time you get root canal traetment completed, avoid eating from side of infected tooth and maintain good oral hygiene.
Posted By : rosemary on 11/29/2011 1:10:23 PM
I had an incomplete root canal done one month ago. The dentist said that it was too complex and that I need to see a specialist. i have been on amoxicillin for a month and now my face is swollen on the right side, stiff neck, sore jaw, slight fever and headaches. could i possibly have a blood infection. Also, my BP was 145/119 most of the day today
Posted By : Dr Ritz on 10/17/2011 1:31:00 AM
Pain in the root canal treated tooth can be because of infection still left in the tooth or can be because of gum infection in relation to the tooth or can be because of some high point on the tooth which can cause pain. You can get the tooth checked from the dentist to know as in what is causing pain in the tooth. If there is infection still left in the tooth, then re-root canal treatment can be done to save the tooth. If there is gum infection in relation to root canal treated tooth, then you can do warm saline rinses for some relief and if some high point is present on the tooth, then it can be removed by the dentist. Without clinical examination, it is difficult to give definite diagnosis. you have to refer to your dentist to get the tooth examined. You can take opinion of second dentist if you want.
Posted By : Carolyn on 10/16/2011 1:39:40 PM
I had a root canal done on the #7 tooth two months ago. After a couple of weeks it hurt to the touch. I went back and the endodontist went back in to the tooth. It has never been any better, still hurts to the touch. I left the office with okay I'll give it two weeks to see if it stops. Two weeks is this coming Thursday and there is no change, the tooth still hurts to the touch and if I over exert as in walking or leaning over to remove weeds. Is there any hope for this tooth? Being a front tooth I don't want to lose it. The tooth is not sensitive to hot or cold and the xrays showed no infection. Thank you for any suggestions. Carolyn

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